AHIP AHM-510 - Governance and Regulation Exam

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Total 76 questions

Antitrust laws can affect the formation, merger activities, or acquisition initiatives of a health plan. In the United States, the two federal agencies that have the primary responsibility for enforcing antitrust laws are the

  • A. Internal Revenue Service (IRS) and the Department of Justice (DOJ)
  • B. Office of Inspector General (OIG) and the Department of Defense (DOD)
  • C. Federal Trade Commission (FTC) and the Department of Labor (DOL)
  • D. Federal Trade Commission (FTC) and the Department of Justice (DOJ)


Answer : D

The following statements are about the Federal Employees Health Benefits Program
(FEHBP), which is administered by the Office of Personnel Management (OPM). Three of the statements are true and one statement is false. Select the answer choice that contains the FALSE statement.

  • A. For every plan in the FEHBP, OPM annually determines the lowest premium that is actuarially sound and then negotiates with each plan to establish that premium rate.
  • B. Once a health plan has submitted its rate proposals for a contract year to the OPM, it cannot adjust its premium rate for any reason.
  • C. To cover its administrative costs, OPM sets aside 1% of all FEHBP premiums.
  • D. Each spring, OPM sends all plan providers its call letter, a document that specifies the kinds of benefits that must be available to plan participants and cost goals and procedural changes that the plans need to adopt.


Answer : A

One federal law amended the Social Security Act to allow states to set their own qualification standards for HMOs that contracted with state Medicaid programs and revised the requirement that participating HMOs have an enrollment mix of no more than 50% combined Medicare and Medicaid members.
This act, which was the true stimulus for increasing participation by health plans in

Medicaid, is called the -

  • A. Omnibus Budget Reconciliation Act of 1981 (OBRA-81)
  • B. Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)
  • C. Employee Retirement Income Security Act of 1974 (ERISA)
  • D. Federal Employees Health Benefits Act of 1958 (FEHB Act)


Answer : A

The following situations illustrate per se violations of federal antitrust laws:
Situation A - Two groups of providers agreed among themselves that each provider will do business with health plans only on a fee-for-service basis.
Situation B - In order to avoid competing with each other, two independent, competing physician-hospital organizations (PHOs) divide the geographic areas in which they will market their services.
From the following answer choices, select the response that correctly identifies the types of per se violations illustrated by these situations.

  • A. Situation A: price fixing; Situation B: horizontal division of markets
  • B. Situation A: price fixing; Situation B: tying arrangement
  • C. Situation A: horizontal group boycott; Situation B: horizontal division of markets
  • D. Situation A: horizontal group boycott; Situation B: tying arrangement


Answer : A

Some health plans qualify as tax-exempt organizations under Sections 501(c)(3) and
501(c)(4) of the Internal Revenue Code. One true statement regarding a health plan that qualifies as a 501(c)(4) social welfare organization, in comparison to a health plan that qualifies as a 501(c)(3) charitable organization, is that a

  • A. 501(c)(4) social welfare organization is allowed to distribute profits for the benefit of individuals, whereas a 501(c)(3) charitable organization can use surplus only for the benefit of the organization, the community, or a charity
  • B. 501(c)(4) social welfare organization can raise operating funds through the sale of tax- exempt bonds, whereas a 501(c)(3) charitable organization does not have this advantage
  • C. 501(c)(4) social welfare organization has less flexibility in determining use of funds for social or political activities than does a 501(c)(3) charitable organization
  • D. 501(c)(4) exemption is easier to obtain than a 501(c)(3) exemption, because 501(c)(4) social welfare organizations are allowed to benefit a comparatively smaller group of individuals


Answer : D

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Total 76 questions