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Course 3B_L3 - Quiz 3

 

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1)
This course tells us that there is ONE LEVEL OF PROVIDER RISK available in a managed care system - i.e., 'sub-capitation'.
 
True False
 
2)
For Chemical Dependency (CD), a ‘case rate’ package may include specialized outpatient services such as an Intensive Outpatient Program (IOP), but would ordinarily not cover detox unless your agency provides that service.
 
True False
 
3)
Under a _________________ , the provider is typically free to do whatever is needed for the client at any moment in time without additional ‘utilization review’ by the HMO, so long as the services that are provided are covered.
 
FEE-FOR-SERVICE arrangement
CASE RATE arrangement
 
4)
A CASE RATE is the same as SUB-CAPITATION.
 
True False
 
5)
In this lesson, we learned that the State of Pennsylvania has barred CASE RATE contracting due to negative outcomes for providers and consumers.
 
True False
 
6)
This lesson tells us that being _________________ can allow a provider to take part in some creative contract scenarios – special program and fee arrangements which are ‘in between’ routine fee-for-service and the high-risk arrangements.
 
a Preferred or Specialty Provider
a private practitioner
a traditional provider
a dual diagnosis specialist
 
7)
This lesson tells us that HMOs may be open to _________________ if pressed for approval.
 
flexibility in credentialing requirements
having no licensed staff in the program
no 24 hour on-call response
 
8)
Managed Care Companies tend to limit approval of Case Rate contract arrangements to
 
clients with a relatively brief history of major dysfunction.
clients who have had an admission to an inpatient facility.
clients who are at the greatest risk for (re)admission to the most intensive levels of care.
 

 

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