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AHM Medical Management
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The following statements are about chronic and disabling conditions among children eligible for Medicaid. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.
Children with chronic conditions use more physician and nonphysician professional services than do children in the general population.
The majority of chronic conditions affecting children in Medicaid programs are the same as those affecting children in the general population.
Medicaid-eligible children are at risk for seriousmental and physical conditions.
Children in Medicaid programs have a higher incidence of chronic disabling conditions than do children in the general population.
Determine whether the following statement is true or false:
The key to successfully managing the quality and cost-effectiveness of healthcare services for Medicaid enrollees is to merge Medicaid recipients into existing plans.
True
False
Access to services is an important issue for both fee-for-service (FFS) Medicaid and managed Medicaid programs. Access to services under managed Medicaid is affected by the
lack of qualified providers in provider networks
lack of resources necessary to establish case management programs for patients with complex conditions
unstable eligibility status of Medicaid recipients
inability of Medicaid recipients to change health plans or PCPs
Serena Wilson, a registered nurse, is employed at a TRICARE Service Center (TSC) located at a military installation. Ms. Wilson serves as a primary point of contact between enrollees and the TRICARE system and answers enrollees’ questions about plan options, eligibility, provider selection, and claims. This information indicates that Ms. Wilson serves as a
lead agent
beneficiary services representative
health plan support contractor
primary care manager (PCM)