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  • Exam Name: Governance and Regulation
  • Last Update: 16-Jun-2025
  • Questions and Answers: 76
  • Single Choice: 76 Q&A's

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AHM-510 Questions and Answers

Question # 1

Health plans should monitor changes in the environment and emerging trends, because changes in society will affect the managed care industry. One true statement regarding recent changes in the environment in which health plans operate is that

A.

Women as a group receive more healthcare and interact more often with health plans than do men over the course of a lifetime

B.

The focus of healthcare during the past decade has shifted away from outpatient care to inpatient hospital treatment

C.

The uninsured population in the United States has been decreasing in recent years

D.

The decline in overall inflation in the 1990s failed to slow the growth in healthcare inflation

Question # 2

There are several approaches to the interagency division of responsibility for managed care entity (MCE) oversight. In State M, the state Medicaid agency, the state department of health, and the state insurance department are all responsible for ensuring that quality improvement programs are in place among the same group of MCEs and that these programs meet each agency's rules and regulations for such programs. This information indicates that State M uses the approach known as the

A.

Parallel model

B.

Shared model

C.

Concurrent model

D.

PACE model

Question # 3

The Opal Health Plan complies with all of the provisions of the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA). Samantha Hill and Debra Chao are Opal enrollees. Ms. Hill was hospitalized for a cesarean birth, and Ms. Chao was hospitalized for a normal delivery. From the following answer choices, select the response that indicates the minimum hospital stay for which Opal, under NMHPA, must provide benefits for Ms. Hill and Ms. Chao.

A.

Ms. Hill: 72 hours; Ms. Chao: 24 hours

B.

Ms. Hill: 72 hours; Ms. Chao: 48 hours

C.

Ms. Hill: 96 hours; Ms. Chao: 24 hours

D.

Ms. Hill: 96 hours; Ms. Chao: 48 hours

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