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Provider integration has two components: operational integration and structural integration. An example of operational integration in health plans is the:

A. Acquisition of the Leopard Health Plan by the Hickory Health Plan.

B. Joint venture entered into by the Eclipse Health Plan and a local hospital system to create a new health plan in which Eclipse and the hospital system share ownership.

C. Formation of an organization by a group of providers to carry out billing, collections, and contracting with health plans for the entire group of providers.

D. Consolidation of the Carver Health Plan and the Limestone Health Plan.

Individuals can use HSAs to pay for the following types of health coverage:.

A. Qualified disability insurance

B. COBRA continuation coverage.

C. Medigap coverage (for those over 65).

D. All of the above.

Lansdale Healthcare, a health plan, offers comprehensive healthcare coverage to its members through a network of physicians, hospitals, and other service providers. Plan members who use in-network services pay a copayment for these services. The copayment

A. specified dollar amount charge that a plan member must pay out-of-pocket for a specified medical service at the time the service is rendered

B. percentage of the fees for medical services that a plan member must pay after Magellan has paid its share of the costs of those services

C. flat amount that a plan member must pay each year before Magellan will make any benefit payments on behalf of the plan member

D. specified payment for services that was negotiated between the provider and Magellan

The Ark Health Plan, is currently recruiting providers in preparation for its expansion into a new service area. A recruiter for Ark has been meeting with Dr. Nan Shea, a pediatrician who practices in Ark's new service area, in order to convince her to be

A. Has ever participated in any quality improvement activities.

B. Is a participating provider in a health plan that will compete with Ark in its new service area.

C. Meets the requirements of the Ethics in Patient Referrals Act.

D. Has had a medical malpractice claim filed or other disciplinary actions taken against her.

The following statements are about standards set forth in the Quality Improvement System for Managed Care (QISMC), established by the Health Care Financing Administration (HCFA, now known as the Centers for Medicare and Medicaid Services).

A. As a result of the Balanced Budget Refinement Act (BBRA), PPOs are required to meet all QISMC quality requirements.

B. QISMC standards typically do not apply to such Medicare services as mental health or substance abuse services.

C. Medicaid primary care case manager (PCCM) programs are subject to the same QISMC quality standards and performance measures as are all other Medicare and Medicaid programs.

D. QISMC standards and guidelines are required for Medicare MCOs, but they are applicable to Medicaid MCOs at the discretion of the individual states.