AHIP Exam AHM-250 Topic 6 Question 91 Discussion

Actual exam question for AHIP's AHM-250 exam

Question #: 91
Topic #: 6

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 Cristal at Jul 03, 2024, 03:58 AM

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Denna

4 months ago

I bet the people who wrote these questions had a good laugh coming up with that one. Quality improvement is like the bare minimum for a health plan.

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Gracia

3 months ago

It's interesting how each model focuses on different aspects of health plan accountability.

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Gracia

4 months ago

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

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Gracia

4 months ago

I agree, quality improvement should be a basic requirement for all health plans.

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Ria

4 months ago

Haha, imagine a health plan being like, 'Quality? Nah, we're good. No need for that.' That's just absurd.

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Ressie

4 months ago

D? Really? I can't imagine any health plan being exempt from quality improvement programs. That doesn't seem right at all.

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Thad

3 months ago

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

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My

4 months ago

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

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Lavonna

4 months ago

B) The 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

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Kerry

4 months ago

A) Under 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

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Kami

5 months ago

Hmm, I'm leaning towards C. Selecting all providers who meet the credentialing criteria seems like a reasonable requirement.

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Leana

3 months ago

I see your point, but having a grievance review process like in option B is also necessary for addressing any issues.

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Sueann

3 months ago

I think option A is also crucial, protecting covered persons in case of plan insolvency is a must.

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Antonio

3 months ago

I agree, ensuring that all providers meet the credentialing criteria is important for quality care.

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Denny

4 months ago

Definitely. It's crucial for the quality of care provided to covered persons.

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Donte

4 months ago

I agree. It helps ensure that the health plan is working with qualified professionals.

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Freeman

4 months ago

I think C is a good choice too. It's important to make sure providers meet the credentialing criteria.

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Dulce

5 months ago

I'm not sure about that. I think B might be the right answer since it only requires a first-level grievance review.

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Dwight

5 months ago

I think the correct answer is A. The Network Adequacy Model Act seems to provide protections for consumers in the event of plan insolvency.

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Martina

5 months ago

I think option B is also important as it ensures a first-level grievance review for all health carriers.

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Martina

5 months ago

I agree, option A seems to prioritize consumer protection in case of plan insolvency.

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Dominga

5 months ago

I disagree, closed plans may have different challenges and should be exempt from certain requirements.

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Emiko

5 months ago

I believe the Quality Assessment and Improvement Model Act should apply to all plans, not just open ones.

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Clorinda

5 months ago

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

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Paola

5 months ago

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

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