AHIP AHM-540 AHM Medical Management Exam Practice Test

The following statement(s) can correctly be made about medical management considerations for the Federal Employee Health Benefits Program (FEHBP):

FEHBP plan members who have exhausted the health plan's usual appeals process for a disputed decision can request an independent review by the Office of Personnel Management (OPM)

All health plans that cover federal employees are required to develop and implement patient safety initiatives

Access to services is an important issue for both fee-for-service (FFS) Medicaid and managed Medicaid programs. Access to services under managed Medicaid is affected by the

The BBA of 1997 allows states to provide Medicaid benefits to children through the State Children's Health Insurance Program (SCHIP). Under the terms of the BBA, states can implement SCHIP as

Part of their existing Medicaid programs

Separate commercial insurance programs

CMS has developed two prototype programs---Programs of All-inclusive Care for the Elderly (PACE) and the Social Health Maintenance Organization (SHMO) demonstration project---to deliver healthcare services to Medicare beneficiaries. From the answer choices below, select the response that correctly identifies the features of these programs.

The Shoreside Health Plan recently added coverage for behavioral healthcare services to its benefit package. In order to support the quality of its behavioral healthcare services, Shoreside plans to seek accreditation for its behavioral healthcare program. Accreditation specifically designed for behavioral healthcare programs is available through

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

The National Committee for Quality Assurance (NCQA)

The American Accreditation HealthCare Commission/URAC (URAC)

In recent years, the demand for prescription drugs has increased dramatically. Factors that have contributed to this increase include

Maxwell Midler's health plan operates a drug formulary that includes a typical three-tier copayment structure with required copayments of $5, $10, and $25. Mr. Midler recently filled a prescription for a $75 drug that was not included in the formulary. According to the plan's formulary copayment structure, the amount that Mr. Midler was required to pay for his prescription was