Indiana Navigator State Certification Exam Questions With Verified Answers

What are the types of assistants that may help Hoosiers? - Answer Indiana Navigators, Authorized Representatives and Health Insurance Agents Another authorized consumer assistant title consumers may seeis Obama care guidance Specialists (OGCs)? - Answer False Marketplace will automatically certify consumer assistants called federal navigators and CACs, are they automatically valid in Indiana? - Answer False Who needs to be certified as an Indiana Navigator? - Answer Individuals with denied, revoked or suspended insurance or broker license, has been convicted of a disqualifying felony or other crime made by Indiana department of Insurance (IDOI), or individuals who fail to pay state income taxes or failed to pay child support, and those who admit or have been convicted of unfair trade practice or fraud insurance business practices What is the Navigator certification process? - Answer Apply, complete pre-certification training and pass certification examination. Application Organizations (AOs) are - Answer organizations with employees and/or volunteers assisting Hoosier consumers with application in the federal marketplace, qualifying health plans and cost lowering programs. Indiana Navigators never suggest specific health plans? - Answer True What is conflict of loyalty? - Answer Ex: Indiana Navigator and AO have a close relationship with a hospital The IDOI can respond to complaints against Navigators and AOs how? - Answer Reprimand, civil penalty (fine), suspension of certification, revocation of certification (temp/perm) Security breech/disclosure of personal information must notify the consumer - Answer within 10 days and the IDOI within 5 days of the incident Brokers cannot be Navigators? - Answer True Complaints about Indiana Navigators should be addressed by whom? - Answer IDOI Questions regarding the ACA affordable Care Act should be addressed where? - Answer Federal Marketplace call center Who cannot become a Navigator? - Answer Individuals with denied, revoked or suspended insurance or broker license, has been convicted of a disqualifying felony or other crime made by Indiana department of Insurance (IDOI), or individuals who fail to pay state income taxes or failed to pay child support, and those who admit or have been convicted of unfair trade practice or fraud insurance business practices Authorized Representatives (ARs) are not required to be certified as Navigators? - Answer True 115C waiver - Answer is a vehicle by which the Centers for Medicare & Medicaid Services (CMS) may waive certain Medicaid and Children's Health Insurance Program (CHIP) regulations, allowing a state to test new or existing ways to deliver and pay for health care services under these two programs. In Indiana, the Healthy Indiana Plan (HIP) operates under an 1115 (c) waiver. 1634 Status - Answer is a federal designation given to states for determining Medicaid eligibility for the aged, blind, and disabled populations. Under this program, recipients of Supplemental Security Income (SSI) through the federal Social Security Administration (SSA) obtain automatic Medicaid enrollment and need not complete a separate state Medicaid application. In addition, 1634 Status states may, but are not required to, operate a Medicaid spend-down program. Indiana became a 1634 Status state in 2013. Authorized Representative - Answer is an individual or organization designated by a Medicaid or insurance affordability program applicant or beneficiary to act responsibly on his or her behalf to assist with the individual's application and renewal of eligibility and other ongoing communications. Authorized representatives may be authorized to sign an application on the applicant's behalf, complete and submit a renewal form and receive copies of the applicant or beneficiary's notices and other communications from the Medicaid agency. Auto Assignment - Answer is the process by which an individual who does not select a Hoosier Healthwise (HHW) or Healthy Indiana Plan (HIP) Managed Care Entity (MCE) at the time of the HHW or HIP application, or within fourteen (14) days of the submission of the application, is automatically assigned to a Managed Care Entity. Behavioral & Primary Healthcare coordination Program (BPHC) - Answer is a program that provides access to Medicaid Rehabilitation Option (MRO) services to individuals with Serious Mental Illness (SMI) whose income would otherwise be too high to qualify for Medicaid coverage. A person deemed eligible for BPHC receives full Medicaid benefits. Benefits Portal - Answer is a website developed and managed by the Indiana Department of Family Resources (DFR) by which Hoosier insurance consumers may apply for Indiana Health Coverage Programs (IHCPs) as well as check the status of pending applications. The DFR Benefits Portal is located at Care Management Organization (CMO) - Answer is an organization contracted with Indiana Health Coverage Programs (IHCPs) to perform the care management, prior authorization, and utilization management of physical, behavioral, and transportation services for members in Care Select. The CMO manages care for Care Select members through its network of Primary Medical Providers (PMPs), specialists, and other providers. Currently, MDwise and Advantage Health Solutions serve as Indiana's Care Management Organizations. Care Select - Answer is an optional health care program for Indiana Medicaid enrollees who have special health needs or would benefit from specialized attention. Care Select includes comprehensive care coordination for members. Individuals eligible for Care Select include those who are eligible for Medicaid on the basis of being aged, blind, disabled, a ward of the court or foster child or a child receiving adoptive services or adoption assistance and have a specific medical condition. Children's Health Insurance Program (CHIP) - Answer is a health coverage program for children authorized in 1997 under Title XXI of the Social Security Act. CHIP provides health coverage to children whose income is too high to qualify for Medicaid. CHIP is administered by states with joint funding from the federal government and the states. States can implement CHIP though a Medicaid expansion, separate CHIP or combination of the two approaches. Indiana operates CHIP through both a Medicaid expansion and separate CHIP program. Division of Family Resources (DFR)- - Answer is a division of the Indiana Family and Social Services Administration (FSSA), which establishes eligibility for Medicaid, the Supplemental Nutrition Assistance Program (SNAP - food assistance), and the Temporary Assistance for Needy Families (TANF - cash assistance). DFR also manages the DFR Benefits Portal, where consumers may apply for an Indiana Health Coverage Program (IHCP). Eligibility Group - Answer (also referred to as aid category) refers to a particular group/category that is eligible for Medicaid. An individual is determined eligible for the appropriate group/category based on factors of eligibility such as age, income, pregnancy, disability or blindness. See Table 29 for the 2014 list of Medicaid eligibility groups. Eligibility Hierarchy - Answer is the system used to determine a Medicaid applicant's eligibility for the most comprehensive Medicaid benefit package, in the absence of a stated preference. Eligibility Redetermination - Answer refers to the annual requirement for Medicaid recipients to have their Medicaid eligibility re-determined. If sufficient information is available in a beneficiary's electronic account to renew eligibility, an eligibility notice is sent and the individual is required to contact the Medicaid Agency if any information is inaccurate. If insufficient data is available to renew eligibility, a pre-populated renewal form is sent to the beneficiary detailing the required information. Family Planning Eligibility Program - Answer is an Indiana Medicaid program that allows eligible men and women the ability to receive certain family planning services and supplies for the primary purpose of preventing or delaying pregnancy Federal Poverty Level - Answer is a figure released each year by the federal government that estimates the minimum amount an individual or family would need to make to cover basic living expenses. Measure reflects income and household size, and changes annually. For 2014, the FPL for a single person is $973 per month, and $1,988 per month for a family of four. Health Maintenance Organization (HMO)- - Answer is a designation given to health insurers offering products or services in any market segment (individual, small group, large group, or self-insured) in order to also provide or arrange for the delivery of health care services to enrollees on a prepaid basis. Individuals covered under a HMO will have a prescribed set of providers that may provide covered services. Except for certain services, including emergency services, HMOs are not required to cover services provided by out of network providers. Healthy Indiana Plan (HIP) - Answer is Indiana's health coverage program for Hoosier adults between the ages of 19-64 whose incomes are at or below 100% FPL and who are not covered by Medicare or other Minimum Essential Coverage (MEC). HIP is authorized through an 1115 Waiver with the federal Centers for Medicare & Medicaid Services (CMS). Covered individuals and the State make monthly contributions to a POWER Account. Home and Community Based Services (HCBS) Waiver- - Answer authorized under Section 1915(c) of the Social Security Act, is an Indiana Medicaid waiver designed to provide an array of services to enrollees to prevent institutionalization. The HCBS waiver "waives" the requirement of an admission to an institution in order for Medicaid to pay for the needed home and community-based services. The different types of HCBS waivers that Indiana offers are outlined in Table 20.