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Course 1C_L1 - Quiz 1

 

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1)
One of the main themes of a managed system of care is 'containing costs' while also improving the quality of care.
 
True False
 
2)
One example of 'redesign of the delivery system' that is mentioned in this lesson, is the need for . . .
 
reduction of the pre-managed care Provider Fee Structure by 50%.
the Federal government to assume responsibility for all health care.
three or more HMOs doing business in the region at the same time.
new services which can serve as a 'step-down' or as a diversion from the most intensive levels of care.
disqualification of current providers from participation.
 
3)
One change that is often needed in a new managed care system is to re-design the delivery system so that there will be a full array of services which are cost effective.
 
True False
 
4)
The National Alliance For The Mentally Ill (NAMI) recently expressed confidence that the Managed Care industry is effectively balancing COST CONTROLS and CARE for patients.
 
True False
 
5)
CAPITATION or CAPITATED contracts are defined in this Module. Please choose the correct answer below, based upon information presented in this course.
 
Under a capitation contract, the 'AT RISK' entity (usually an HMO or similar) must provide or arrange medically necessary treatment for all ENROLLED, ELIGIBLE members who present for services.
The Capitation Contract arrangement pays the contractor XX amount of dollars (such as $6.25 or $11.30) per member per month (p.m.p.m.), for each member enrolled in the plan, usually thousands of individuals.
The assumption is that only a small percent of the total enrolled population will actually seek healthcare services, and that only a small percent of those who seek services will require intensive services
All of the above
None of the above
 
6)
Managed Care Companies are NOT allowed to SHIFT where and how the money is spent for treatment services, which is one of the problems with managed care.
 
True False
 
7)
This lesson makes the comment that CAPITATION CONTRACTS _________________
 
are workable for large private practices and CMHCs, as the primary RISK HOLDER, if carefully managed.
are NOT necessarily 'high risk' ventures
require that the managed care company provide MEDICALLY NECESSARY treatment for all enrolled, eligible consumers who present for services.
 
8)
This lesson tells us that the movement into Managed Care brings providers into the era of
 
larger Block Grant contracts for all categories of providers.
dependable annual State Contracts for Community MHMR Centers and Substance Abuse treatment providers.
Fee-For-Service contracts.
 

 

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