CPE Healthcare Policy & Advocacy 2 — Questions and Answers
Question 1: Under the ACA's employer mandate, organizations with how many full-time equivalent employees must offer minimum essential coverage or face a penalty?
- 25 or more
- 50 or more (Correct answer)
- 100 or more
- 250 or more
Correct answer: 50 or more
The ACA employer shared responsibility provision applies to applicable large employers (ALEs) with 50 or more full-time equivalent employees.
Question 2: A physician executive advocates for bundled payment models. Which characteristic best defines a bundled payment?
- Per-member per-month capitation for primary care only
- A single payment covering all services for an episode of care (Correct answer)
- Fee-for-service with a shared savings reconciliation
- Risk-adjusted premium paid to a health plan
Correct answer: A single payment covering all services for an episode of care
Bundled payments consolidate reimbursement for all providers and services associated with a defined episode of care into a single payment.
Question 3: Which federal law requires hospitals to provide stabilizing treatment to any patient presenting to the emergency department regardless of ability to pay?
- Hill-Burton Act
- EMTALA (Correct answer)
- HIPAA
- Stark Law
Correct answer: EMTALA
EMTALA (Emergency Medical Treatment and Active Labor Act) mandates that Medicare-participating hospitals screen and stabilize emergency patients regardless of payment status.
Question 4: A state legislature is considering a certificate of need (CON) law for new hospital beds. CON programs are primarily intended to:
- Ensure adequate staffing ratios in new facilities
- Control healthcare costs by limiting duplicative capital investment (Correct answer)
- Set minimum quality standards for new service lines
- Protect physician employment in existing hospitals
Correct answer: Control healthcare costs by limiting duplicative capital investment
CON programs require regulatory approval before adding new facilities or services, aiming to prevent excess capacity and control costs.
Question 5: In U.S. health policy, 'global budgeting' most accurately refers to:
- The total federal budget allocated to CMS annually
- A fixed aggregate spending cap for all healthcare services in a region or system (Correct answer)
- Capitation rates set globally by CMS for Medicare Advantage plans
- WHO-coordinated international healthcare spending targets
Correct answer: A fixed aggregate spending cap for all healthcare services in a region or system
Global budgeting sets an overall spending limit for a defined population or geographic area, shifting financial risk to providers.
Question 6: When a physician executive testifies before a state health committee, this activity is best classified as:
- Lobbying if compensated by the organization (Correct answer)
- Direct advocacy regardless of compensation
- Legislative consultation exempt from conflict-of-interest rules
- Public comment under the Administrative Procedure Act
Correct answer: Lobbying if compensated by the organization
Paid testimony before a legislative committee on behalf of an organization generally constitutes lobbying under most state and federal definitions.
Question 7: The 'iron triangle' of healthcare policy describes the tension among which three competing goals?
- Safety, efficacy, and equity
- Cost, quality, and access (Correct answer)
- Prevention, treatment, and rehabilitation
- Federal, state, and local governance
Correct answer: Cost, quality, and access
The iron triangle framework holds that cost, quality, and access are interdependent—improving one typically comes at the expense of at least one other.
CPE Healthcare Policy & Advocacy 2
Under the ACA's employer mandate, organizations with how many full-time equivalent employees must offer minimum essential coverage or face a penalty?