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AHIP AHM-510 Exam - Topic 1 Question 27 Discussion

Posted by Fabiola on May 07, 2022 at 03:14 AM

Greenpath Health Services, Inc., an HMO, recently terminated some providers from its network in response to the changing enrollment and geographic needs of the plan. A provision in Greenpath's contracts with its healthcare providers states that Greenpath can terminate the contract at any time, without providing any reason for the termination, by giving the other party a specified period of notice.

The state in which Greenpath operates has an HMO statute that is patterned on the NAIC HMO Model Act, which requires Greenpath to notify enrollees of any material change in its provider network. As required by the HMO Model Act, the state insurance department is conducting an examination of Greenpath's operations. The scope of the on-site examination covers all aspects of Greenpath's market conduct operations, including its compliance with regulatory requirements.

From the following answer choices, select the response that identifies the type of market conduct examination that is being performed on Greenpath and the frequency with which the HMO Model Act requires state insurance departments to conduct an examination of an HMO's operations.

Suggested Answer: B

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10 comments · newest first
KA
Karl 1 year ago
I thought it was annually, but three years seems reasonable too.
EL
Elina 1 year ago
Totally agree with B, makes sense for a thorough check.
HY
Hyman 1 year ago
Wait, they can just drop providers without a reason? That's sketchy.
RA
Ranee 1 year ago
I think it's B, comprehensive every three years sounds right.
LE
Leigha 1 year ago
Greenpath can terminate contracts anytime, wow!
SU
Sunshine 1 year ago
Okay, I think the answer is that the charter doesn't cover the main functionality of the user story, which is about informing the customer of the delivery time. The charter is focused on the wrong thing.
ER
Erick 1 year ago
This one seems pretty straightforward. I think the longer the term to maturity, the higher the risk and return associated with the bond.
TA
Tamra 1 year ago
I'd be hesitant to just terminate the interview and skip that section. That could make the situation even worse. I'd want to try to find a way to get the information I need while maintaining a professional and cooperative tone.
AN
Annett 1 year ago
I think statement A is true because patient satisfaction is often a key quality measure in BH, but I can't remember if clinical outcomes assessments are always included.
EL
Elenore 1 year ago
Hmm, I'm a bit unsure about this one. Disabling remote support and putting servers in maintenance state seem like good ideas, but I'm not sure if that's the complete answer. I'll need to review the options more closely.
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