AHIP AHM-510 問題集

質問 1：
One provision of the Mental Health Parity Act of 1996 (MHPA) is that the MHPA prohibits group health plans from
A. Imposing limits on the number of days or visits for mental health treatment
B. Charging deductibles for mental health benefits that are higher than the deductibles for medical benefits
C. 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
D. Imposing annual limits on the number of outpatient visits and inpatient hospital stays for mental health services
正解：C

質問 2：
Directors on a health plan's board must demonstrate their compliance with three duties in all their decisions. Directors who exercise their duties in good faith and with the same degree of diligence and skill that an ordinary, reasonable person would be expected to display in the same situation are meeting the duty known as the
A. Trustee duty
B. Duty to supervise
C. Duty of loyalty
D. Duty of care
正解：D

質問 3：
Several states have adopted clinical practice guidelines for treating workers' compensation injuries. Clinical practice guidelines can best be described as
A. Detailed plans of medical treatment designed to facilitate a patient's return to the workplace
B. Fee schedules that specify the maximum amount providers may charge for treating workers' compensation patients
C. A utilization management and quality management mechanism designed to aid providers in making decisions about the most appropriate course of treatment for a specific case
D. Payment practices that might technically violate the provisions of the anti-kickback statute but that will not be considered illegal and for which providers and health plans will not be subject to penalties
正解：C

質問 4：
The Surrey Medical Supply Company was formed as a limited partnership. In this partnership, Victoria Lewin is one of the limited partners and Oscar Gould is a general partner. This information indicates that, with respect to the typical characteristics of limited partnerships,
A. the partnership will continue upon the death of Mr. Gould, whereas it will end with the death of Ms. Lewin
B. both Ms. Lewin and Mr. Gould participate in the day-to-day management of Surrey
C. Ms. Lewin has more liability for the debts of Surrey than does Mr. Gould
D. Ms. Lewin has more freedom to opt out of the partnership than does Mr. Gould
正解：D

質問 5：
The government uses various tools within the realm of two broad categories of public policy-allocative policies and regulatory policies. In the context of public policy, laws that fall into the category of allocative policy include
A. The Health Insurance Portability and Accountability Act (HIPAA) of 1996
B. Laws specifying procedures for health plan handling of consumer appeals and grievances
C. The Balanced Budget Act (BBA) of 1997
D. Laws affecting health plan quality oversight
正解：C

質問 6：
The following statements are about various provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Three of the statements are true and one statement is false. Select the answer choice that contains the FALSE statement.
A. HIPAA permits group health plans that offer coverage through an HMO to impose affiliation periods during which no benefits or services are provided to a plan member.
B. HIPAA provides that any fines and penalties recovered through regulatory proceedings to enforce the federal fraud and abuse statutes will be turned over to enforcement agencies to conduct additional investigations.
C. HIPAA created a new category of federal healthcare crimes, called federal healthcare offenses that apply to private healthcare plans as well as to federally funded healthcare programs.
D. One effect of Section 231(h) of HIPAA, which amended the Social Security Act, has been to permit health plans with Medicare contracts to provide enrollees with value-added services such as discounted memberships to health clubs.
正解：D