AHIP FWA UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS
✔✔Under ACA Section 1557, a health plan premium sold through a state exchange
may, based on an individual's age, - ✔✔charge higher premiums.
✔✔Which of the following statements best describes Section 1557 of the Affordable
Care Act (ACA)? - ✔✔Section 1557 incorporates earlier civil rights protections in regard
to race, color, national origin, disability, age and sex.
✔✔ACA Section 1557 rules for disability concern - ✔✔Policies and procedures, physical
access, and communication.
✔✔As a result of violations of ACA Section 1557 nondiscrimination rules, - ✔✔
✔✔Which Medicare programs are covered by ACA Section 1557? - ✔✔Parts A, C, and
D, but not B.
✔✔As a result of violations of ACA Section 1557 nondiscrimination rules, - ✔✔a health
plan may revoke an agent or broker's appointment with the health plan.
✔✔Section 1557 of the Affordable Care Act applies to - ✔✔all health programs and
activities administered by or receiving federal financial assistance from HHS.
✔✔Auxiliary aids and services must be provided to individuals with disabilities, such as
those suffering from vision or hearing impairments, free of charge, and in a timely
manner. Auxiliary aids and services include which of the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software - ✔✔I, II, III and IV
✔✔Under Section 1557, 2020 Final Rule issued during the Trump Administration sex
was initially defined____________ - ✔✔to include discrimination based on gender
identity.
✔✔For a health plan, what are the possible consequences of violations of ACA Section
1557? - ✔✔Loss of federal business and compensatory damages.
✔✔Which of the following statements best describes the scope of operations subject to
Section 1557 under the 2020 Final Rule? - ✔✔Health insurers under the 2020 Final
Rule are not considered to be principally engaged in delivering health care, and thus
lines of business that do not receive federal funding or administered under Title I of the
ACA, such as life insurance, do not fall under the scope of 1557.
, ✔✔Which entity enforces Section 1557 for programs that receive funding from on are
administered by HHS? - ✔✔The Office of Civil Rights (OCR) of HHS.
✔✔Which of the following would be considered permissible under Section 1557 and the
2020 Final Rule? - ✔✔Broker Mary Jones has recruited a diverse workforce. She
encourages her agents to prospect through community-based marketing and within their
community of influence.
✔✔Which of these actions is most likely to be permitted in dealing with a person with
limited English proficiency? - ✔✔Allowing a child to interpret in an emergency.
✔✔Under ACA Section 1557, a health plan - ✔✔cannot deny coverage to LEP
individuals and is required to provide language assistance to them, free of charge.
✔✔Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid
Services (CMS) for the purpose of payment. As part of this job, you use a process to
verify the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's
process and to adjust or add risk diagnosis codes for certain individuals. What should
you do? - ✔✔Report the incident to the compliance department (via compliance hotline
or other mechanism)
✔✔You are performing a regular inventory of the controlled substances in the
pharmacy. You discover a minor inventory discrepancy. What should you do? -
✔✔Follow your pharmacy's procedures.
✔✔Which of the following requires intent to obtain payment and the knowledge the
actions are wrong? - ✔✔Fraud
✔✔You are in charge of paying claims submitted by providers. You notice a certain
diagnostic provider ("Doe Diagnostics") requested a substantial payment for a large
number of members. Many of these claims are for a certain procedure. You review the
same type of procedure for other diagnostic providers and realize Doe Diagnostics'
claims far exceed any other provider you reviewed. What should you do? - ✔✔Consult
with your immediate supervisor for next steps or contact the compliance department (via
compliance hotline, Special Investigations Unit [SIU], or other mechanism)
✔✔A person drops off a prescription for a beneficiary who is a "regular" customer. The
prescription is for a controlled substance with a quantity of 160. This beneficiary
normally receives a quantity of 60, not 160. You review the prescription and have
concerns about possible forgery. What is your next step? - ✔✔Call the prescriber to
verify the quantity
✔✔Under ACA Section 1557, a health plan premium sold through a state exchange
may, based on an individual's age, - ✔✔charge higher premiums.
✔✔Which of the following statements best describes Section 1557 of the Affordable
Care Act (ACA)? - ✔✔Section 1557 incorporates earlier civil rights protections in regard
to race, color, national origin, disability, age and sex.
✔✔ACA Section 1557 rules for disability concern - ✔✔Policies and procedures, physical
access, and communication.
✔✔As a result of violations of ACA Section 1557 nondiscrimination rules, - ✔✔
✔✔Which Medicare programs are covered by ACA Section 1557? - ✔✔Parts A, C, and
D, but not B.
✔✔As a result of violations of ACA Section 1557 nondiscrimination rules, - ✔✔a health
plan may revoke an agent or broker's appointment with the health plan.
✔✔Section 1557 of the Affordable Care Act applies to - ✔✔all health programs and
activities administered by or receiving federal financial assistance from HHS.
✔✔Auxiliary aids and services must be provided to individuals with disabilities, such as
those suffering from vision or hearing impairments, free of charge, and in a timely
manner. Auxiliary aids and services include which of the following:
I. large print materials
II. qualified sign language interpreters
III. braille materials and displays
IV. screen reader software - ✔✔I, II, III and IV
✔✔Under Section 1557, 2020 Final Rule issued during the Trump Administration sex
was initially defined____________ - ✔✔to include discrimination based on gender
identity.
✔✔For a health plan, what are the possible consequences of violations of ACA Section
1557? - ✔✔Loss of federal business and compensatory damages.
✔✔Which of the following statements best describes the scope of operations subject to
Section 1557 under the 2020 Final Rule? - ✔✔Health insurers under the 2020 Final
Rule are not considered to be principally engaged in delivering health care, and thus
lines of business that do not receive federal funding or administered under Title I of the
ACA, such as life insurance, do not fall under the scope of 1557.
, ✔✔Which entity enforces Section 1557 for programs that receive funding from on are
administered by HHS? - ✔✔The Office of Civil Rights (OCR) of HHS.
✔✔Which of the following would be considered permissible under Section 1557 and the
2020 Final Rule? - ✔✔Broker Mary Jones has recruited a diverse workforce. She
encourages her agents to prospect through community-based marketing and within their
community of influence.
✔✔Which of these actions is most likely to be permitted in dealing with a person with
limited English proficiency? - ✔✔Allowing a child to interpret in an emergency.
✔✔Under ACA Section 1557, a health plan - ✔✔cannot deny coverage to LEP
individuals and is required to provide language assistance to them, free of charge.
✔✔Your job is to submit a risk diagnosis to the Centers for Medicare & Medicaid
Services (CMS) for the purpose of payment. As part of this job, you use a process to
verify the data is accurate. Your immediate supervisor tells you to ignore the Sponsor's
process and to adjust or add risk diagnosis codes for certain individuals. What should
you do? - ✔✔Report the incident to the compliance department (via compliance hotline
or other mechanism)
✔✔You are performing a regular inventory of the controlled substances in the
pharmacy. You discover a minor inventory discrepancy. What should you do? -
✔✔Follow your pharmacy's procedures.
✔✔Which of the following requires intent to obtain payment and the knowledge the
actions are wrong? - ✔✔Fraud
✔✔You are in charge of paying claims submitted by providers. You notice a certain
diagnostic provider ("Doe Diagnostics") requested a substantial payment for a large
number of members. Many of these claims are for a certain procedure. You review the
same type of procedure for other diagnostic providers and realize Doe Diagnostics'
claims far exceed any other provider you reviewed. What should you do? - ✔✔Consult
with your immediate supervisor for next steps or contact the compliance department (via
compliance hotline, Special Investigations Unit [SIU], or other mechanism)
✔✔A person drops off a prescription for a beneficiary who is a "regular" customer. The
prescription is for a controlled substance with a quantity of 160. This beneficiary
normally receives a quantity of 60, not 160. You review the prescription and have
concerns about possible forgery. What is your next step? - ✔✔Call the prescriber to
verify the quantity
