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AHM-510 Exam Dumps : Governance and Regulation

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Governance and Regulation Questions and Answers

Question 1

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

Options:

A.

Internal Revenue Service (IRS) and the Department of Justice (DOJ)

B.

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

C.

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

D.

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

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Question 2

One federal law amended the Social Security Act to allow states to set their own qualification standards for HMOs that contracted with state Medicaid programs and revised the requirement that participating HMOs have an enrollment mix of no more than 50% combined Medicare and Medicaid members.

This act, which was the true stimulus for increasing participation by health plans in Medicaid, is called the

Options:

A.

Omnibus Budget Reconciliation Act of 1981 (OBRA-81)

B.

Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)

C.

Employee Retirement Income Security Act of 1974 (ERISA)

D.

Federal Employees Health Benefits Act of 1958 (FEHB Act)

Question 3

TRICARE, a military healthcare program, offers eligible beneficiaries three options for healthcare services: TRICARE Prime, TRICARE Extra, and TRICARE Standard. With respect to plan features, both an annual deductible and claims filing requirements must be met, regardless of whether care is delivered by network providers, under

Options:

A.

TRICARE Prime and TRICARE Extra only

B.

TRICARE Extra and TRICARE Standard only

C.

TRICARE Standard only

D.

None of these healthcare options