MHA Health Policy and Advocacy 2 — Questions and Answers
Question 1: What does 'EMTALA' require of hospital emergency departments?
- To report all infectious diseases to the CDC
- To provide a medical screening exam and stabilizing treatment to anyone who presents, regardless of ability to pay (Correct answer)
- To maintain a minimum nurse-to-patient ratio
- To post prices for all emergency services
Correct answer: To provide a medical screening exam and stabilizing treatment to anyone who presents, regardless of ability to pay
The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals with emergency departments to screen and stabilize any patient presenting with an emergency condition, regardless of insurance or ability to pay.
Question 2: Which federal office investigates healthcare fraud and abuse under programs like Medicare and Medicaid?
- The Joint Commission
- Office of Inspector General (OIG) of HHS (Correct answer)
- Agency for Healthcare Research and Quality
- National Institutes of Health (NIH)
Correct answer: Office of Inspector General (OIG) of HHS
The HHS Office of Inspector General investigates fraud, waste, and abuse in Medicare, Medicaid, and other HHS programs, issuing exclusions and civil monetary penalties.
Question 3: What is a 'health insurance exchange' (marketplace) established by the Affordable Care Act?
- A stock market for health insurance companies
- A regulated online marketplace where individuals and small businesses can compare and purchase health insurance plans (Correct answer)
- A government-run hospital network
- A federal program for uninsured children
Correct answer: A regulated online marketplace where individuals and small businesses can compare and purchase health insurance plans
ACA marketplaces are regulated competitive insurance markets where qualified plans must cover essential health benefits, and income-based subsidies are available to eligible enrollees.
Question 4: What does the 'dual eligible' designation mean in US health coverage policy?
- Patients who have both commercial and employer insurance
- Individuals who qualify for both Medicare and Medicaid simultaneously (Correct answer)
- Providers credentialed in two specialties
- Hospitals certified for both acute and long-term care
Correct answer: Individuals who qualify for both Medicare and Medicaid simultaneously
Dual eligibles are individuals who qualify for both Medicare (typically due to age or disability) and Medicaid (due to low income), with coordination between the two programs covering their costs.
Question 5: What is the '340B Drug Pricing Program' and who benefits from it?
- A Medicare drug formulary management system
- A federal program requiring drug manufacturers to sell outpatient drugs at discounted prices to qualifying safety-net providers (Correct answer)
- A state Medicaid preferred drug list program
- An FDA program for approving generic medications
Correct answer: A federal program requiring drug manufacturers to sell outpatient drugs at discounted prices to qualifying safety-net providers
The 340B program requires drug manufacturers participating in Medicaid to provide discounted outpatient drugs to eligible healthcare organizations that serve large numbers of low-income or uninsured patients.
Question 6: Which policy tool allows the federal government to withhold Medicare and Medicaid funding from states that do not comply with certain healthcare requirements?
- Certificate of need laws
- Conditions of Participation (CoPs) (Correct answer)
- State plan amendments
- Managed care contracting
Correct answer: Conditions of Participation (CoPs)
CMS Conditions of Participation set minimum health and safety standards that Medicare and Medicaid participating providers must meet or risk losing federal reimbursement.
MHA Health Policy and Advocacy 2
What does 'EMTALA' require of hospital emergency departments?