AHIP Exam AHM-250 Topic 1 Question 93 Discussion

Actual exam question for AHIP's AHM-250 exam

Question #: 93
Topic #: 1

The following statements are about the various Health Plan Accountability Models adopted by the NAIC.

AUnder the terms of the Health Plan Network Adequacy Model Act, all health plans would be required to hold covered persons harmless against provider collections and provide continued coverage for uncompleted treatment in the event of plan insolvency

BThe Health Carrier Grievance Procedure Model Act requires all health carriers to maintain a first-level grievance review, but it does not require any second-level review

CAccording to the Health Care Professional Credentialing Verification Model Act, a health plan must select all providers who meet the plan's credentialing criteria

DThe Quality Assessment and Improvement Model Act exempts closed plans from implementing a quality improvement program.

Show Suggested Answer

Suggested Answer: A

by Merlyn at Jul 18, 2024, 01:41 PM

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Lasandra

3 months ago

Alright, time to put on my regulatory nerd hat. I'm feeling pretty confident that A is the right answer here.

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Valentin

4 months ago

Wait, there's a 'Health Care Professional Credentialing Verification Model Act'? Sounds like a mouthful. I bet the NAIC had fun coming up with that one.

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Brittani

3 months ago

I wonder how long it took them to come up with all these different models and acts.

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Gennie

3 months ago

I know, it's like they wanted to make sure everyone knew exactly what each model was about.

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Gail

3 months ago

Yeah, the names of these models can be quite long and complicated.

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Devora

4 months ago

Hmm, I'm going with A. It's the only one that sounds accurate based on my understanding of the NAIC's accountability models. The others seem a bit off the mark.

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Antonio

4 months ago

D sounds like a joke. The Quality Assessment and Improvement Model Act doesn't exempt anyone from having a quality improvement program. That would kind of defeat the whole purpose.

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Johnna

2 months ago

Definitely, quality improvement should be a priority for all health plans to ensure the best outcomes for patients.

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Rutha

3 months ago

Yeah, it's important for all health plans to continuously assess and improve the quality of care they provide.

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Laurel

3 months ago

I agree, that would defeat the purpose of having a quality improvement program in the first place.

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Leanora

3 months ago

D does sound like a joke. It doesn't make sense to exempt closed plans from quality improvement.

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Merlyn

4 months ago

B is definitely wrong. The Health Carrier Grievance Procedure Model Act requires a second-level review, not just a first-level one.

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Alaine

4 months ago

Option C seems a bit off to me. I thought the Health Care Professional Credentialing Verification Model Act allowed plans to select providers based on their own criteria, not that they had to select all providers who met the criteria.

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Clarence

3 months ago

I think you're right, the wording in option C could be clearer.

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Ona

4 months ago

I agree, option C does seem a bit confusing.

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Mignon

4 months ago

As for the Quality Assessment and Improvement Model Act, I think all plans should be required to implement a quality improvement program.

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Shaunna

4 months ago

I see your point, having a second-level review could provide more thorough resolution for grievances.

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Filiberto

4 months ago

I'm not sure about the Health Carrier Grievance Procedure Model Act though, it seems like it could be improved with a second-level review.

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Mignon

4 months ago

I agree, it's crucial to ensure continued coverage for uncompleted treatment in case of insolvency.

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Dorothy

5 months ago

I'm pretty sure the correct answer is A. The Health Plan Network Adequacy Model Act requires plans to hold members harmless and provide continued coverage in the event of insolvency.

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Florinda

3 months ago

I'm not sure about option D. Do closed plans really not need to implement a quality improvement program?

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Slyvia

3 months ago

I think option C is also important. Health plans must select providers who meet credentialing criteria to ensure quality care.

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Odette

4 months ago

I agree, option A is correct. It ensures that covered persons are protected in case of plan insolvency.

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Alexia

4 months ago

I'm not sure about option D, do closed plans really not need to implement a quality improvement program?

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Merissa

4 months ago

I think option C is also important, as it ensures that providers meet the plan's credentialing criteria.

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Gayla

4 months ago

I agree, option A is correct. It ensures that covered persons are protected in case of plan insolvency.

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Shaunna

5 months ago

I think the Health Plan Network Adequacy Model Act is really important for protecting covered persons.

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