Healthcare System and Policy Flashcards
7 cards from real CPE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Healthcare System and Policy flashcards as text
Under the ACA's Medicaid expansion, states that opted in extended eligibility to adults with incomes up to what percentage of the federal poverty level?
Answer: 133%
The ACA expanded Medicaid to non-elderly adults with incomes up to 133% FPL (effectively 138% with the 5% income disregard).
Which federal program provides health insurance primarily to individuals with disabilities and end-stage renal disease, regardless of age?
Answer: Medicare
Medicare covers people with qualifying disabilities and end-stage renal disease in addition to those aged 65 and older.
The concept of 'never events' in healthcare policy refers to which of the following?
Answer: Serious preventable adverse events that should never occur
Never events are serious, largely preventable patient safety incidents (e.g., wrong-site surgery) that CMS will not reimburse.
A hospital's case mix index (CMI) reflects which of the following?
Answer: The average acuity and resource intensity of its patient population
CMI measures the relative weight of Medicare DRGs for a hospital's inpatient cases, indicating acuity and expected resource use.
Which legislation established the Hospital Readmissions Reduction Program (HRRP) that penalizes hospitals for excess readmissions?
Answer: The Affordable Care Act
The ACA created the HRRP, which reduces Medicare payments to hospitals with higher-than-expected 30-day readmission rates for targeted conditions.
In the context of U.S. health policy, 'cherry-picking' by insurers refers to:
Answer: Preferentially enrolling healthier, lower-risk individuals
Cherry-picking (favorable selection) occurs when insurers target healthier populations to reduce claims costs.
The Stark Law (physician self-referral law) primarily prohibits physicians from referring Medicare/Medicaid patients to entities in which they have a financial relationship UNLESS:
Answer: A specific statutory exception applies
The Stark Law is a strict liability statute; referrals are only permissible if they fall within one of the law's enumerated exceptions.