UHC 2021 Chronic Condition and Dual Special Needs Plans Certification(Q&A)

When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members that lose Medicaid eligibility? - ANSWER Wrong - The month after they are notified by the plan of the loss of Medicaid eligibilit ...

When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members that lose Medicaid eligibility? - ANSWER Wrong - The month after they are notified by the plan of the loss of Medicaid eligibility; Wrong - After the Grace Period ends Which consumer might benefit the most by enrolling in a DSNP? - ANSWER A: Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+) Which statement best describes a care management program that varies depending upon the level of the member's health risk? - ANSWER Wrong - Support provided only to members who have multiple chronic conditions and receive state Medicaid benefits Which statement best describes a DSNP? - ANSWER A: The monthly premium is at or below the Low Income Subsidy benchmark to cover drug costs When selling DSNPs, agents must: - ANSWER A: Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B The consumer states they currently pay a percentage of charges when they receive medical care. This means: - ANSWER A: Wrong - Medicaid Supplemental Plan Which of the following consumer characteristics demonstrates a good fit for a CSNP? - ANSWER A: A consumer with a qualifying chronic condition who wants a plan that will help them manage their illness and health care costs On July 19, each of the following consumers met with an agent. Based on the information provided, which consumer must wait until the Annual Election Period (AEP) or Open Enrollment Period (OEP) to enroll? - ANSWER A: Joy has a cardiovascular disorder, is enrolled in a CSNP that covers the condition, and wants to enroll in another CSNP offered by the plan that covers the same condition. Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level? - ANSWER A: ALL of the responses Which statement is true about physician information on the Chronic Condition Verification Form? - ANSWER A: The physician indicated on the form does not have to be contracted with the plan. Which statement is true about the Medicaid program? - ANSWER A:It helps pay medical costs for certain groups of people with limited income and resources. Which statement is true of DSNP members? - ANSWER A: Members who are QMB+ or are Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a DSNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs. Using the post-enrollment method, when will a new member be disenrolled from their CSNP if a qualifying condition cannot be verified? - ANSWER A: At the end of the second month of enrollment A DSNP member loses his eligibility due to a change or loss of Medicaid status. What cost sharing is he responsible for while in the grace period? - ANSWER A: All, such as premiums, deductibles, copayments, and coinsurance Dual Special Needs Plans (DSNP) are defined as which of the following: - ANSWER A: Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid Meredith, a DSNP member, loses Medicaid eligibility. What impact does this have on her DSNP enrollment? - ANSWER A: She will enter a grace period during which she is responsible for plan cost sharing, and she will be disenrolled at the end of the grace period if she does not reestablish Medicaid eligibility. What program is available to support CSNP and DSNP members who may have unique health care needs? - ANSWER A: Wrong - A care management program that assigns a care manager to each member regardless of the member's health risk level Select the statement that best describes a feature of DSNPs - ANSWER A: DSNPs are network-ba