Quality of Life Requirements Flashcards

Under Medicaid managed care Quality of Life standards, which principle ensures that enrollees retain the right to make personal decisions about their daily lives?

Answer: Self-determination

Self-determination is a core Quality of Life principle that allows enrollees to make their own choices about daily activities, routines, and life decisions.

When surveying a Medicaid managed care plan's Quality of Life protections, what does 'dignity and respect' primarily require staff to do?

Answer: Treat enrollees as capable adults regardless of disability status

Dignity and respect standards require that staff treat all enrollees as capable adults, honoring their individuality and autonomy regardless of disability or condition.

A surveyor finds that an LTSS plan restricts enrollees from receiving visitors without staff approval. This most likely violates which Quality of Life requirement?

Answer: Freedom from unnecessary restrictions

Controlling visitor access without justification constitutes an unnecessary restriction on the enrollee's freedom and social connections, violating Quality of Life standards.

Which federal regulation primarily establishes Quality of Life requirements for Medicaid managed care LTSS enrollees?

Answer: 42 CFR Part 438

42 CFR Part 438 governs Medicaid managed care regulations, including Quality of Life standards that plans must meet for LTSS enrollees.

During a SMQT survey, which finding would indicate a plan is NOT meeting Quality of Life privacy requirements?

Answer: Care staff discuss enrollee conditions in public hallways

Discussing enrollee health conditions in public spaces violates privacy protections that are a fundamental component of Quality of Life requirements.

Under Quality of Life requirements, an enrollee's right to participate in community activities is best described as which type of right?

Answer: A fundamental right that plans must actively support

Community integration is a fundamental right for LTSS enrollees, and managed care plans are required to actively support access to community activities.

A surveyor reviewing Quality of Life documentation should expect to find evidence that the plan does which of the following regarding person-centered service plans?

Answer: Incorporates enrollee preferences, goals, and strengths

Person-centered service plans must reflect the enrollee's own preferences, goals, and strengths, not just clinical findings or standardized templates.