HAC Healthcare Policy & Legislation 2 — Questions and Answers
Question 1: Under Medicare, what does 'Part D' specifically cover?
- Prescription drug coverage (Correct answer)
- Inpatient hospital care
- Outpatient medical services and physician visits
- Medicare Advantage private health plans
Correct answer: Prescription drug coverage
Medicare Part D provides optional prescription drug coverage through private plans approved by Medicare.
Question 2: Which ACA provision expanded access to preventive services by requiring most health plans to cover them:
- Without cost-sharing (no copays or deductibles) for in-network services (Correct answer)
- Only after the annual deductible has been met
- With a fixed $20 copay per preventive visit
- Only for patients over age 65 enrolled in Medicare
Correct answer: Without cost-sharing (no copays or deductibles) for in-network services
The ACA mandates that non-grandfathered health plans cover USPSTF Grade A and B preventive services without imposing any cost-sharing on patients.
Question 3: The Stark Law (Physician Self-Referral Law) prohibits physicians from:
- Referring Medicare patients to entities in which they have a financial relationship, with limited exceptions (Correct answer)
- Prescribing controlled substances to patients without a valid doctor-patient relationship
- Accepting gifts valued over $25 from medical device manufacturers
- Billing for services not rendered to Medicare beneficiaries
Correct answer: Referring Medicare patients to entities in which they have a financial relationship, with limited exceptions
The Stark Law bars physicians from referring Medicare patients for designated health services to entities where the physician or immediate family has a financial interest, unless an exception applies.
Question 4: What is the primary purpose of a Certificate of Need (CON) law in healthcare?
- To require state approval before healthcare facilities can expand or add certain services (Correct answer)
- To certify that individual healthcare providers meet minimum competency standards
- To authorize hospitals to refuse services to patients who cannot pay
- To establish minimum staffing ratios in licensed healthcare facilities
Correct answer: To require state approval before healthcare facilities can expand or add certain services
CON laws require healthcare organizations to obtain state approval demonstrating community need before building facilities, purchasing major equipment, or adding new services.
Question 5: The Anti-Kickback Statute (AKS) makes it illegal to:
- Offer, pay, solicit, or receive remuneration to induce or reward referrals of federal healthcare program business (Correct answer)
- Charge Medicare patients more than the Medicare-approved amount for covered services
- Discriminate in providing care based on a patient's race, color, or national origin
- Bill for a higher level of service than was actually provided to a patient
Correct answer: Offer, pay, solicit, or receive remuneration to induce or reward referrals of federal healthcare program business
The AKS prohibits any exchange of value intended to influence referrals for services covered by federal healthcare programs like Medicare and Medicaid.
Question 6: Under the ACA, health insurance marketplaces (exchanges) primarily serve which population?
- Individuals and small businesses purchasing insurance who do not have access to affordable employer coverage (Correct answer)
- Medicare beneficiaries seeking supplemental Medigap coverage
- Medicaid recipients transitioning to private coverage
- Federal employees and military personnel seeking civilian health plans
Correct answer: Individuals and small businesses purchasing insurance who do not have access to affordable employer coverage
ACA marketplaces were designed to give individuals and small employers a structured place to shop for private health insurance, often with premium tax credits for eligible buyers.
Question 7: The 340B Drug Pricing Program requires pharmaceutical manufacturers to provide discounted drugs to:
- Qualifying safety-net healthcare providers serving high proportions of low-income patients (Correct answer)
- All licensed retail pharmacies in rural and underserved areas
- State Medicaid agencies for their formulary programs
- Medicare Part D plan sponsors for catastrophic coverage
Correct answer: Qualifying safety-net healthcare providers serving high proportions of low-income patients
The 340B program mandates deep discounts from drug manufacturers to covered entities such as federally qualified health centers, rural referral centers, and disproportionate share hospitals.
HAC Healthcare Policy & Legislation 2
Under Medicare, what does 'Part D' specifically cover?