AHM-540 Exam Questions & Answers

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.

For this question, if answer choices (A) through (C) are all correct, select answer choice (D). Otherwise, select the one correct answer choice.

In most commercial health plans, the case management process is directed by a case manager whose responsibilities typically include

When analyzing and applying HRA results, the Multistate Health Plan noted sampling bias. This information indicates that the HRA results

Administrative action plans are used when performance problems or opportunities are related to the way the organization itself operates. The following statement(s) can correctly be made about administrative action plans:

Administrative action plans allow health plans to coordinate management activities

One function of administrative action plans is to integrate service across all levels of the organization

Administrative action plans are designed to improve outcomes by helping plan members assume responsibility for their own health

The Harbor Health Plan's formulary policy encourages network pharmacists who are asked to fill a prescription for a costly, brand-name drug to dispense a different chemical entity within the same drug class in order to reduce costs. This type of drug substitution is referred to as