HAC Healthcare Policy & Legislation 2

Question 1

Under Medicare, what does 'Part D' specifically cover?

Accepted Answer

Prescription drug coverage

Answer

Inpatient hospital care

Answer

Outpatient medical services and physician visits

Answer

Medicare Advantage private health plans

Question 2

Which ACA provision expanded access to preventive services by requiring most health plans to cover them:

Accepted Answer

Without cost-sharing (no copays or deductibles) for in-network services

Answer

Only after the annual deductible has been met

Answer

With a fixed $20 copay per preventive visit

Answer

Only for patients over age 65 enrolled in Medicare

Question 3

The Stark Law (Physician Self-Referral Law) prohibits physicians from:

Accepted Answer

Referring Medicare patients to entities in which they have a financial relationship, with limited exceptions

Answer

Prescribing controlled substances to patients without a valid doctor-patient relationship

Answer

Accepting gifts valued over $25 from medical device manufacturers

Answer

Billing for services not rendered to Medicare beneficiaries

Question 4

What is the primary purpose of a Certificate of Need (CON) law in healthcare?

Accepted Answer

To require state approval before healthcare facilities can expand or add certain services

Answer

To certify that individual healthcare providers meet minimum competency standards

Answer

To authorize hospitals to refuse services to patients who cannot pay

Answer

To establish minimum staffing ratios in licensed healthcare facilities

Question 5

The Anti-Kickback Statute (AKS) makes it illegal to:

Accepted Answer

Offer, pay, solicit, or receive remuneration to induce or reward referrals of federal healthcare program business

Answer

Charge Medicare patients more than the Medicare-approved amount for covered services

Answer

Discriminate in providing care based on a patient's race, color, or national origin

Answer

Bill for a higher level of service than was actually provided to a patient

Question 6

Under the ACA, health insurance marketplaces (exchanges) primarily serve which population?

Accepted Answer

Individuals and small businesses purchasing insurance who do not have access to affordable employer coverage

Answer

Medicare beneficiaries seeking supplemental Medigap coverage

Answer

Medicaid recipients transitioning to private coverage

Answer

Federal employees and military personnel seeking civilian health plans

Question 7

The 340B Drug Pricing Program requires pharmaceutical manufacturers to provide discounted drugs to:

Accepted Answer

Qualifying safety-net healthcare providers serving high proportions of low-income patients

Answer

All licensed retail pharmacies in rural and underserved areas

Answer

State Medicaid agencies for their formulary programs

Answer

Medicare Part D plan sponsors for catastrophic coverage