AHIP AHM-510 問題集

質問 1：
Greenpath Health Services, Inc., an HMO, recently terminated some providers from its network in response to the changing enrollment and geographic needs of the plan. A provision in Greenpath's contracts with its healthcare providers states that Greenpath can terminate the contract at any time, without providing any reason for the termination, by giving the other party a specified period of notice.
The state in which Greenpath operates has an HMO statute that is patterned on the NAIC HMO Model Act, which requires Greenpath to notify enrollees of any material change in its providernetwork. As required by the HMO Model Act, the state insurance department is conducting an examination of Greenpath's operations. The scope of the on-site examination covers all aspects of Greenpath's market conduct operations, including its compliance with regulatory requirements.
From the following answer choices, select the response that identifies the type of market conduct examination that is being performed on Greenpath and the frequency with which the HMO Model Act requires state insurance departments to conduct an examination of an HMO's operations.
A. Type of examination: target; Required frequency: at least every three years
B. Type of examination: comprehensive; Required frequency: at least every three years
C. Type of examination: target; Required frequency: annually
D. Type of examination: comprehensive; Required frequency: annually
正解：B

質問 2：
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. Federal Trade Commission (FTC) and the Department of Justice (DOJ)
B. Internal Revenue Service (IRS) and the Department of Justice (DOJ)
C. Federal Trade Commission (FTC) and the Department of Labor (DOL)
D. Office of Inspector General (OIG) and the Department of Defense (DOD)
正解：A

質問 3：
After conducting a business portfolio analysis, the Acorn Health Plan decided to pursue a harvest strategy with one of its strategic business units (SBUs)-Guest Behavioral Healthcare. By following a harvest strategy with Guest, Acorn most likely is seeking to
A. Maintain Guest's market position
B. Sacrifice immediate earnings in order to fund Guest's growth
C. Increase Guest's market share
D. Maximize Guest's short-term earnings and cash flow
正解：D

質問 4：
SoundCare Health Services, a health plan, recently conducted a situation analysis. One step in this analysis required SoundCare to examine its current activities, its strengths and weaknesses, and its ability to respond to potential threats and opportunities in the environment. This activity provided SoundCare with a realistic appraisal of its capabilities. One weakness that SoundCare identified during this process was that it lacked an effective program for preventing and detectingviolations of law. SoundCare decided to remedy this weakness by using the 1991 Federal Sentencing Guidelines for Organizations as a model for its compliance program.
With respect to the Federal Sentencing Guidelines, actions that SoundCare should take in developing its compliance program include
A. Holding management accountable for the misconduct of their subordinates
B. Assigning a high-level member of management to the position of compliance coordinator or administrator
C. Creating a system through which employees and other agents can report suspected misconduct without fear of retribution
D. All of the above
正解：D

質問 5：
Health plans typically divide their costs into medical and administrative expenses. Examples of medical expenses are.
A. Salaries and benefits for executives and for all functional areas
B. Sales and marketing costs
C. Equipment costs
D. Payments to providers for the delivery of healthcare
正解：D

質問 6：
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.
A. The 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.
B. A 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.
C. The 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.
D. The 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.
正解：D