CCMC - Commission for Case Manager Healthcare Laws and Regulations Questions and Answers

Question 1

A case manager in an emergency department is evaluating an uninsured patient who presented with severe abdominal pain.
After a medical screening exam determines an emergency medical condition exists, the patient is stabilized.
The patient then requests a transfer to a public hospital 20 miles away to reduce potential costs.
According to the Emergency Medical Treatment and Active Labor Act (EMTALA), which of the following is the hospital's primary obligation?

Accepted Answer

Ensure the receiving hospital has the capacity and has accepted the transfer, and the transfer is conducted with appropriate medical personnel.

Answer

Discharge the patient with a referral to a GI clinic since they are now stable.

Answer

Inform the patient that a transfer is not possible due to their insurance status.

Answer

Obtain pre-authorization from the public hospital's financial services before arranging transport.

Question 2

A case manager is coordinating a complex discharge planning meeting for a patient who is deaf and communicates using American Sign Language (ASL). To comply with the Americans with Disabilities Act (ADA), which of the following represents the most appropriate action to ensure effective communication?

Accepted Answer

Arranging for a qualified and impartial ASL interpreter to be present for the meeting.

Answer

Providing a written summary of the meeting for the patient to read afterwards.

Answer

Asking the patient's adult child, who knows some sign language, to interpret.

Answer

Using a text-to-speech mobile application on a tablet.

Question 3

A client is considering genetic testing for a hereditary condition and expresses fear to their case manager that a positive result could cause their employer to fire them or their health insurer to raise their premiums. The case manager can provide reassurance by explaining the protections of which federal law?

Accepted Answer

Genetic Information Nondiscrimination Act (GINA)

Answer

Patient Protection and Affordable Care Act (ACA)

Answer

Health Insurance Portability and Accountability Act (HIPAA)

Answer

Americans with Disabilities Act (ADA)

Question 4

A case manager at a federally-assisted substance use disorder (SUD) clinic receives a request from a client's insurance company for treatment records to process a claim. The client has signed a standard, general HIPAA release form. What is the case manager's responsibility under 42 CFR Part 2?

Accepted Answer

Obtain a specific, written consent from the client that names the insurance company and the purpose of the disclosure before releasing the records.

Answer

Release the records, as the general HIPAA consent is sufficient for payment purposes.

Answer

Contact the insurance company and provide the information verbally to avoid a paper trail.

Answer

Deny the request, as SUD records can never be shared with insurance companies.

Question 5

A hospital-based case manager is arranging post-discharge care for a Medicare patient. The patient's physician insists on referring the patient to a home health agency where the physician has a significant financial investment. This situation raises a concern primarily related to which law?

Accepted Answer

The Stark Law (Physician Self-Referral Law)

Answer

The Anti-Kickback Statute

Answer

The Health Insurance Portability and Accountability Act (HIPAA)

Answer

The Emergency Medical Treatment and Active Labor Act (EMTALA)

Question 6

A case manager is assisting a client with a history of cancer in finding a new health insurance plan on the state marketplace. The client is worried they will be denied coverage. The case manager can assure the client that insurance companies are prohibited from denying coverage based on their medical history due to which key provision of the Patient Protection and Affordable Care Act (ACA)?

Accepted Answer

The prohibition of discrimination based on pre-existing conditions.

Answer

The expansion of Medicaid eligibility.

Answer

The creation of Essential Health Benefits.

Answer

The individual mandate requiring most Americans to have health insurance.