Question 1

The government uses various tools within the realm of two broad categories of public policyallocative policies and regulatory policies. In the context of public policy, laws that fall into the category of allocative policy include

AThe Balanced Budget Act (BBA) of 1997

BThe Health Insurance Portability and Accountability Act (HIPAA) of 1996

CLaws affecting health plan quality oversight

DLaws specifying procedures for health plan handling of consumer appeals and grievances

Answer : A

Question 2

Health plans are allowed to appeal rules or regulations that affect them. Generally, the grounds for such appeals are limited either to procedural grounds or jurisdictional grounds. The Kabyle Health Plan appealed the following new regulations:

Appeal 1 - Kabyle objected to this regulation on the ground that this regulation is inconsistent with the law.

Appeal 2 - Kabyle objected to this regulation because it believed that the subject matter was outside the realm of issues that are legal for inclusion in the regulatory agency's regulations.

Appeal 3 - Kabyle objected to the process by which this regulation was adopted.

Of these appeals, the ones that Kabyle appealed on jurisdictional grounds were

AAppeals 1, 2, and 3

BAppeals 1 and 2 only

CAppeals 1 and 3 only

DAppeals 2 and 3 only

Answer : B

Question 3

The following answer choices describe various approaches that a health plan can take to voice its opinions on legislation. Select the answer choice that best describes a health plan's use of grassroots lobbying.

AThe Delancey Health Plan is launching a media campaign in an effort to persuade the public that proposed health care legislation will increase the cost of healthcare.

BThe Stellar Health Plan is using direct mail and telephone calls to encourage people who support a patient rights bill to contact key legislators and voice their support for the bill.

CThe Bestway Health Plan is encouraging its employees to contribute to a political action committee (PAC) that is funding the political campaign of a pro-health plan candidate.

DA representative of the Palmer Health Plan is attending a one-on-one meeting with a legislator to present Palmer's position on pending managed care legislation.

Answer : B

Question 4

Health plans should monitor changes in the environment and emerging trends, because changes in society will affect the managed care industry. One true statement regarding recent changes in the environment in which health plans operate is that

AWomen as a group receive more healthcare and interact more often with health plans than do men over the course of a lifetime

BThe focus of healthcare during the past decade has shifted away from outpatient care to inpatient hospital treatment

CThe uninsured population in the United States has been decreasing in recent years

DThe decline in overall inflation in the 1990s failed to slow the growth in healthcare inflation

Answer : A

Question 5

One example of health plan's influence on the practice of medicine is that, during the past decade, the focus of healthcare has moved toward _________________, which is designed to reduce the overall need for healthcare services by providing patients with decision-making information.

ADemand management

BManaged competition

CComprehensive coverage

DPrivate inurement

Answer : A

Free AHIP Governance, Legal Issues, Medicare and Medicaid (AHM-510) Practice Questions

AHIP AHM-510 Sample Exam Questions

Question 1

Question 2

Question 3

Question 4

Question 5