CPE Healthcare System and Policy 2 — Questions and Answers
Question 1: 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?
- 100%
- 133% (Correct answer)
- 150%
- 200%
Correct answer: 133%
The ACA expanded Medicaid to non-elderly adults with incomes up to 133% FPL (effectively 138% with the 5% income disregard).
Question 2: Which federal program provides health insurance primarily to individuals with disabilities and end-stage renal disease, regardless of age?
- Medicaid
- CHIP
- Medicare (Correct answer)
- TRICARE
Correct answer: Medicare
Medicare covers people with qualifying disabilities and end-stage renal disease in addition to those aged 65 and older.
Question 3: The concept of 'never events' in healthcare policy refers to which of the following?
- Rare procedures that should never be performed
- Serious preventable adverse events that should never occur (Correct answer)
- Administrative denials that should never happen
- Emergency room visits that could have been avoided
Correct 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.
Question 4: A hospital's case mix index (CMI) reflects which of the following?
- The proportion of insured vs. uninsured patients
- The average acuity and resource intensity of its patient population (Correct answer)
- The ratio of inpatient to outpatient visits
- The number of specialty services offered
Correct 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.
Question 5: Which legislation established the Hospital Readmissions Reduction Program (HRRP) that penalizes hospitals for excess readmissions?
- HIPAA
- The Affordable Care Act (Correct answer)
- MACRA
- The Balanced Budget Act
Correct 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.
Question 6: In the context of U.S. health policy, 'cherry-picking' by insurers refers to:
- Selecting the highest-value providers for narrow networks
- Preferentially enrolling healthier, lower-risk individuals (Correct answer)
- Choosing only evidence-based treatments for coverage
- Prioritizing rural markets for expansion
Correct answer: Preferentially enrolling healthier, lower-risk individuals
Cherry-picking (favorable selection) occurs when insurers target healthier populations to reduce claims costs.
Question 7: 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:
- The referral is clinically necessary
- A specific statutory exception applies (Correct answer)
- The patient provides written consent
- The service is not covered by insurance
Correct 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.
CPE Healthcare System and Policy 2
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?