ACA Quality Assurance & Compliance 3 — Questions and Answers
Question 1: Which ACA provision established the National Strategy for Quality Improvement in Health Care?
- Section 3011 (Correct answer)
- Section 1332
- Section 2718
- Section 4002
Correct answer: Section 3011
ACA Section 3011 required HHS to develop and publish a National Quality Strategy to guide quality improvement across the health care system.
Question 2: A health plan's Medical Loss Ratio (MLR) report must be submitted to CMS by what deadline each year?
- June 1 following the end of the calendar year (Correct answer)
- March 31 following the end of the calendar year
- December 31 of the reporting year
- September 30 of the following year
Correct answer: June 1 following the end of the calendar year
Issuers must submit annual MLR reports to CMS by June 1 following the end of the MLR reporting year.
Question 3: Under the ACA's quality reporting framework, what is a 'Consumer Assessment of Healthcare Providers and Systems' (CAHPS) survey used to measure?
- Patient experience with their health plan and care (Correct answer)
- Clinical outcomes of specific surgical procedures
- Physician board certification rates
- Hospital infection rates
Correct answer: Patient experience with their health plan and care
CAHPS surveys measure patients' perceptions of their experiences with health plans, providers, and facilities as part of ACA quality reporting.
Question 4: Which ACA program financially penalizes hospitals with excess readmissions within 30 days of discharge?
- Hospital Readmissions Reduction Program (HRRP) (Correct answer)
- Value-Based Purchasing Program
- Hospital-Acquired Condition Reduction Program
- Meaningful Use Incentive Program
Correct answer: Hospital Readmissions Reduction Program (HRRP)
The HRRP reduces Medicare payments to hospitals with higher-than-expected 30-day readmission rates for specified conditions.
Question 5: Under ACA quality compliance standards, what is the primary purpose of HEDIS (Healthcare Effectiveness Data and Information Set)?
- To measure health plan performance on dimensions of care and service (Correct answer)
- To certify individual physicians for participation in QHPs
- To set minimum staffing ratios for hospitals
- To standardize prescription drug formularies across plans
Correct answer: To measure health plan performance on dimensions of care and service
HEDIS is a widely used tool that allows consumers to compare health plan performance across standardized quality and service measures.
Question 6: When a QHP issuer fails to meet ACA MLR requirements, what must they do?
- Provide rebates to enrollees, employers, or both (Correct answer)
- Reduce premiums by the shortfall percentage
- Suspend enrollment until the ratio is corrected
- Pay a federal excise tax equal to the shortfall
Correct answer: Provide rebates to enrollees, employers, or both
Issuers who fail to meet MLR thresholds must issue rebates to policyholders or employers based on the excess amount spent on administrative costs.
Question 7: Which document must QHP issuers provide to enrollees that summarizes the key features of their health plan in plain language?
- Summary of Benefits and Coverage (SBC) (Correct answer)
- Evidence of Coverage (EOC)
- Certificate of Insurance (COI)
- Explanation of Benefits (EOB)
Correct answer: Summary of Benefits and Coverage (SBC)
The ACA requires issuers to provide a standardized SBC that clearly explains coverage, cost-sharing, and coverage limitations in plain language.
ACA Quality Assurance & Compliance 3
Which ACA provision established the National Strategy for Quality Improvement in Health Care?