CMC Medicare & Medicaid Funding 3

Question 1

Which federal agency administers the Medicaid program at the national level and sets minimum coverage standards?

Accepted Answer

The Centers for Medicare & Medicaid Services (CMS)

Answer

The Centers for Medicare & Medicaid Services (CMS) administers Medicaid at the federal level and sets minimum coverage and eligibility requirements that states must follow.

Question 2

A Medicaid waiver program that allows states to provide home and community-based services (HCBS) instead of institutional care is authorized under which section of the Social Security Act?

Accepted Answer

Section 1915(c)

Answer

Section 1915(c) of the Social Security Act authorizes states to operate Home and Community-Based Services waiver programs as an alternative to institutional care.

Question 3

For a beneficiary who qualifies for both Medicare and Medicaid (dual eligible), which program is billed FIRST for a covered mobility device?

Accepted Answer

Medicare, as the primary payer

Answer

For dual-eligible beneficiaries, Medicare is always the primary payer and Medicaid is billed second to cover remaining cost-sharing or items Medicare does not cover.

Question 4

A state Medicaid program wants to cover power wheelchairs but imposes a prior authorization requirement. This is:

Accepted Answer

Permissible as states may add utilization management requirements within federal guidelines

Answer

States have broad flexibility to impose prior authorization and other utilization management requirements for Medicaid-covered services, including mobility equipment.

Question 5

Under Medicaid, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children under age 21 requires that:

Accepted Answer

Any medically necessary service must be covered even if not in the state plan

Answer

EPSDT mandates that all medically necessary services be covered for Medicaid-eligible children under 21, even if the service is not included in the state's standard Medicaid plan.

(CMC) Certified Mobility Consultant Practice Test

(CMC) Certified Mobility Consultant Practice Test

CMC Medicare & Medicaid Funding 3