UHC Chronic Condition and Dual Special Needs Plans (CSNP-DSNP) 2022 100% solved

The three types of Special Needs Plans are: - ANSWER Dual, Chronic Condition and Institutional/Institutional-Equivalent. When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members that lose Medicaid eligibility? - ANSWER The month after they are notified by the plan of the loss of Medicaid eligibility A DSNP might be in the best interest of which of these consumers? - ANSWER Joe, whose low income qualifies him for full Medicaid coverage Which program is available to support the unique health care needs of CSNP and DSNP members? - ANSWER A care management program that varies depending upon the level of the member's health risk level Which statement best describes a DSNP? - ANSWER The monthly premium is at or below the Low-Income Subsidy benchmark to cover drug costs When selling DSNPs, agents must: - ANSWER Ensure that the consumer only has Medicare Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B Which consumer may be a good candidate for a DSNP? - ANSWER Anne, who does not pay a percentage of charges when she receives medical care Which of the following consumers is best suited for a CSNP? - ANSWER Mary, who has been seeing a specialist for a qualifying chronic condition On May 10, Michael meets with an agent and says he is enrolled in another carrier's CSNP due to his diabetes. When can Michael enroll in a different CSNP that also covers diabetes (his only chronic condition), assuming he has not moved out of his current plan's service area? - ANSWER During the Annual Election Period (AEP) or Open Enrollment Period (OEP) Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level? - ANSWER Ongoing reassessment of risk level for status changes What is the purpose of the Chronic Condition Verification form? - ANSWER It authorizes the plan to contact the provider identified on the form in order to verify that the consumer has at least one of the qualifying chronic conditions covered by the CSNP. Which statement is true about the Medicaid program? - ANSWER It helps pay medical costs for certain groups of people with limited income and resources. Which statement is true of DSNP members? - ANSWER Members who are QMB+ or are Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a DSNP in-network provider. How long do plans using the CSNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request? - ANSWER Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer). Lucille is no longer eligible for her state Medicaid program and has lost her eligibility for the DSNP in which she is enrolled. What is her responsibility for cost sharing? - ANSWER All, such as premiums, deductibles, copayments, and coinsurance Which statement is true about how loss of Medicaid affects a member's enrollment in a DSNP? - ANSWER Special Election Period (SEP Dual/LIS Change in Status) is available for DSNP members that lose their Medicaid eligibility. Which statement is true about CSNPs, DSNPs, and prescription drug coverage? - ANSWER CSNPs and DSNPs include Medicare Part D prescription drug coverage Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a req