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AHIP AHM-510 Exam - Topic 5 Question 55 Discussion

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.The contracts between Greenpath and its healthcare providers contain a termination provision known as
D) A 'without cause' termination provision
A) An 'economic credentialing' termination provision
B) A 'breach of contract' termination provision
C) A 'fair procedure' termination provision

AHIP AHM-510 Exam - Topic 5 Question 55 Discussion

Actual exam question for AHIP's AHM-510 exam
Question #: 55
Topic #: 5
[All AHM-510 Questions]

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.

The contracts between Greenpath and its healthcare providers contain a termination provision known as

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Suggested Answer: D

Contribute your Thoughts:

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Thea
4 days ago
This is why I prefer PPOs over HMOs.
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Von
9 days ago
Wait, can they really just terminate without a reason? That seems unfair.
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Carlene
14 days ago
Totally agree, that's how HMOs usually operate.
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Julio
19 days ago
Sounds like a 'without cause' termination provision to me.
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Terry
24 days ago
Based on what I studied, I’m leaning towards 'without cause' too. It fits the scenario where they can terminate contracts at any time without justification.
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Shenika
30 days ago
I feel like the 'fair procedure' termination provision could apply, but it seems more about the process rather than the ability to terminate without cause.
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Freida
1 month ago
I'm not entirely sure, but I remember something about 'economic credentialing' in a similar practice question. It might be related, but I don't think that's the right answer here.
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Donette
1 month ago
I think the termination provision is likely a 'without cause' termination provision since they can terminate without giving a reason.
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