AHM-510試験無料問題集（76題）「AHIP Governance and Regulation 認定」

出題：1

Regulators of health plans have set standards in a number of areas of plan operations.
Requirements with which health plans must comply typically include

A. maintaining quality assurance programs that reflect the plan's activities in monitoring quality

B. all of the above

C. maintaining internal grievance and appeals processes to resolve enrollee complaints against the organization

D. providing enrollees and prospective enrollees with detailed information about various aspects of health plan policies and operations

正解：B 解答を投票する

出題：2

The Tidewater Life and Health Insurance Company is owned by its policy owners, who are entitled to certain rights as owners of the company, and it issues both participating and nonparticipating insurance policies. Tidewater is considering converting to the type of company that is owned by individuals who purchase shares of the company's stock. Tidewater is incorporated under the laws of Illinois, but it conducts business in the Canadian provinces of Ontario and Manitoba.
Tidewater established the Diversified Corporation, which then acquired various subsidiary firms that produce unrelated products and services. Tidewater remains an independent corporation and continues to own Diversified and the subsidiaries. In order to create and maintain a common vision and goals among the subsidiaries, the management of Diversified makes decisions about strategic planning and budgeting for each of the businesses.
By combining under Diversified a group of businesses that produce unrelated products and by consolidating the management of the businesses, Tidewater has achieved the type(s) of integration known as

A. Conglomerate integration only

B. Horizontal integration and operational integration

C. Horizontal integration and virtual integration

D. Conglomerate integration and operational integration

正解：D 解答を投票する

出題：3

The following statements are about market conduct examinations of health plans. Select the answer choice that contains the correct statement.

A. Multistate examinations are not appropriate for financial examinations, because regulatory requirements concerning a health plan's financial condition tend to vary from state to state.

B. Market conduct examinations of a health plan's advertising and sales materials include comparing the advertising materials to the policies they advertise.

C. In imposing sanctions on health plans, state insurance departments are required to follow federal sentencing guidelines.

D. Once an examination report is provided to the state insurance department, a health plan is not given an opportunity to present a formal objection to the report.

正解：B 解答を投票する

出題：4

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. Federal Trade Commission (FTC) and the Department of Justice (DOJ)

C. Office of Inspector General (OIG) and the Department of Defense (DOD)

D. Federal Trade Commission (FTC) and the Department of Labor (DOL)

正解：B 解答を投票する

出題：5

Any willing provider laws have their share of proponents and opponents. Arguments commonly made in opposition to any willing provider laws include

A. That such laws reduce the number of providers in a health plan's network

B. That such laws limit consumer choice to coverage options that are more costly than network-based plans

C. That such laws encourage providers to offer discounts in exchange for patient volume

D. All of the above

正解：B 解答を投票する

出題：6

The Opal Health Plan complies with all of the provisions of the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA). Samantha Hill and Debra Chao are Opal enrollees. Ms. Hill was hospitalized for a cesarean birth, and Ms. Chao was hospitalized for a normal delivery. From the following answer choices, select the response that indicates the minimum hospital stay for which Opal, under NMHPA, must provide benefits for Ms. Hill and Ms. Chao.

A. Ms. Hill: 72 hours; Ms. Chao: 24 hours

B. Ms. Hill: 72 hours; Ms. Chao: 48 hours

C. Ms. Hill: 96 hours; Ms. Chao: 48 hours

D. Ms. Hill: 96 hours; Ms. Chao: 24 hours

正解：C 解答を投票する

出題：7

The Good & Well Pharmacy, a Medicaid provider of outpatient drugs, is subject to the prospective drug utilization review (DUR) mandates of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90). One component of prospective DUR is screening. In this context, when Good & Well is involved in the process of screening, the pharmacy is

A. Consulting directly with prescribers and patients in the planning of drug therapy

B. Denying coverage for the off-label use of approved drugs

C. Updating a formulary to represent the current clinical judgment of providers and experts in the diagnosis and treatment of disease

D. Reviewing patient profiles for the purpose of identifying potential problems

正解：D 解答を投票する

出題：8

In developing its corporate strategies, the Haven Health Plan decided to implement a growth strategy that is focused on increasing the percentage of preventive health office visits from its current plan members. To accomplish this objective, Haven will send a direct mail kit to existing plan members to remind them of the variety of preventive health services that Haven currently offers, including physical exams, cholesterol tests, and mammograms. This information illustrates Haven's use of

A. An integrated growth strategy known as product development

B. A diversified growth strategy known as market penetration

C. An integrated growth strategy known as market development

D. An intensive growth strategy known as market penetration

正解：D 解答を投票する

AHM-510試験無料問題集「AHIP Governance and Regulation 認定」