AHIP AHM-510 - Governance and Regulation Exam
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Total 76 questions
Question #11 (Topic: )
The Nonprofit Institutions Act allows the Neighbor Hospital, a not-for-profit hospital, to
purchase at a discount drugs for its 'own use'. Consider whether the following sales of
drugs were not for Neighbor's own use and therefore were subject to antitrust enforcement:
Elijah Jamison, a former patient of Neighbor, renewed a prescription that was originally
dispensed when he was discharged from Neighbor.
Neighbor filled a prescription for Camille Raynaud, who has no connection to Neighbor
other than that her prescribing physician is located in a nearby physician's office building.
Neighbor filled a prescription for Nigel Dixon, who is a friend of a Neighbor medical staff
member.
With respect to the United States Supreme Court's definition of 'own use,' the drug sales
that were not for Neighbor's own use were the sales that Neighbor made to
purchase at a discount drugs for its 'own use'. Consider whether the following sales of
drugs were not for Neighbor's own use and therefore were subject to antitrust enforcement:
Elijah Jamison, a former patient of Neighbor, renewed a prescription that was originally
dispensed when he was discharged from Neighbor.
Neighbor filled a prescription for Camille Raynaud, who has no connection to Neighbor
other than that her prescribing physician is located in a nearby physician's office building.
Neighbor filled a prescription for Nigel Dixon, who is a friend of a Neighbor medical staff
member.
With respect to the United States Supreme Court's definition of 'own use,' the drug sales
that were not for Neighbor's own use were the sales that Neighbor made to
A. Mr. Jamison, Ms. Raynaud, and Mr. Dixon
B. Mr. Jamison and Ms. Raynaud only
C. Mr. Dixon only
D. None of these individuals
Answer: A
Question #12 (Topic: )
One provision of the Mental Health Parity Act of 1996 (MHPA) is that the MHPA prohibits
group health plans from
group health plans from
A. Setting a cap for a group member's lifetime medical health benefits that is higher than the cap for the member's lifetime mental health benefits
B. Imposing limits on the number of days or visits for mental health treatment
C. Charging deductibles for mental health benefits that are higher than the deductibles for medical benefits
D. Imposing annual limits on the number of outpatient visits and inpatient hospital stays for mental health services
Answer: A
Question #13 (Topic: )
One typical difference between a for-profit health plan's board of directors and a not-for-
profit health plan's board of directors is that the directors in a for-profit health plan
profit health plan's board of directors is that the directors in a for-profit health plan
A. Can serve on the board for a period of no more than ten years, whereas the terms of service for a not-for-profit board's directors are usually unlimited by the director's age or by a preset maximum number of years of service
B. Must participate in raising capital for the health plan, whereas a not-for-profit board's directors are prohibited from participating directly in raising capital for the health plan
C. Are directly accountable to shareholders, whereas a not-for-profit board's directors are accountable to plan members and the community
D. Are not compensated for board participation, whereas a not-for-profit board's directors are compensated for board participation
Answer: C
Question #14 (Topic: )
There are several exceptions to the Ethics in Patient Referrals Act and its amendments
(the Stark laws), which prohibit a physician from referring Medicare or Medicaid patients for
certain designated services or supplies provided by entities in which the physician has a
financial interest. Consider whether the situations described below qualify as exceptions to
the Stark laws:
Situation A: Dr. Wong is a physician in the Marvel Health Plan's provider network and has a
financial relationship with Marvel arising from the health plan's compensation for his
services. Marvel is not a prepaid health plan.
Situation B: Dr. Ryder is a physician in the provider network of the Glen Health Plan, which
is not a prepaid health plan. In situations of medical necessity, Dr. Ryder refers Glen
patients to a physical therapy clinic that leases office space from him.
Situation C: Dr. Yost has a compensation arrangement with a health plan for providing
health services under the Medicare+Choice program.
An arrangement that is exempt from the Stark laws is described in
(the Stark laws), which prohibit a physician from referring Medicare or Medicaid patients for
certain designated services or supplies provided by entities in which the physician has a
financial interest. Consider whether the situations described below qualify as exceptions to
the Stark laws:
Situation A: Dr. Wong is a physician in the Marvel Health Plan's provider network and has a
financial relationship with Marvel arising from the health plan's compensation for his
services. Marvel is not a prepaid health plan.
Situation B: Dr. Ryder is a physician in the provider network of the Glen Health Plan, which
is not a prepaid health plan. In situations of medical necessity, Dr. Ryder refers Glen
patients to a physical therapy clinic that leases office space from him.
Situation C: Dr. Yost has a compensation arrangement with a health plan for providing
health services under the Medicare+Choice program.
An arrangement that is exempt from the Stark laws is described in
A. All of these situations
B. Situations A and C only
C. Situation B only
D. Situation C only
Answer: D
Question #15 (Topic: )
There are several approaches to the interagency division of responsibility for managed
care entity (MCE) oversight. In State M, the state Medicaid agency, the state department of
health, and the state insurance department are all responsible for ensuring that quality
improvement programs are in place among the same group of MCEs and that these
programs meet each agency's rules and regulations for such programs. This information
indicates that State M uses the approach known as the
care entity (MCE) oversight. In State M, the state Medicaid agency, the state department of
health, and the state insurance department are all responsible for ensuring that quality
improvement programs are in place among the same group of MCEs and that these
programs meet each agency's rules and regulations for such programs. This information
indicates that State M uses the approach known as the
A. Parallel model
B. Shared model
C. Concurrent model
D. PACE model
Answer: C
