Chronic Condition and Dual Special Needs Plans (CSNP-DSNP) Test Questions and Answers with complete solution

Dual Special Needs Plans (DSNP) are defined as which of the following: - Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members that lose Medicaid eligibility? - Upon notification or effective date of the loss, whichever is earlier A DSNP might be in the best interest of which of these consumers? - Joe, whose low income qualifies him for full Medicaid coverage Which statement best describes a care management program that varies depending upon the level of the member's health risk? - Support provided to CSNP and DSNP members that may have unique health care needs Select the statement that best describes a feature of DSNPs. - NOT ***********A member can see any participating Medicaid provider Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of: - Selling DSNPs The consumer states they currently pay a percentage of charges when they receive medical care. This means: - The consumer is not likely to be a Full Dual-Eligible and may be better suited for enrollment in another type of plan. The following is a characteristic of consumers for whom a CSNP may be most appropriate: - Consumers who have a qualifying chronic condition, are focused on their health issues and may have concerns with having to manage their illness or dealing with multiple providers John, 68, is currently enrolled in a Medicare Supplement Plan with a stand-alone Prescription Drug Plan. Newly diagnosed with a chronic condition, he calls agent Charles on May 3 to ask if there are plans thatwill help him manage his condition. Can John enroll in a Chronic Special Needs Plan (CSNP) that covers his chronic condition? - Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic) How is a CSNP or DSNP member's care management health risk levels determined initially? - The member completes a Health Assessment that asks a series of questions about their health status and assistance they may need with activities of daily living. What is the purpose of the Chronic Condition Verification form? - 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? - Benefits vary from state to state. You must advise consumers enrolling in a DSNP that: - They are not required to pay copayments for Medicare-covered services received from a DSNP network provider if they are Full Dual-Eligible or determined DSNP eligible by our plan agreement with the state in which they reside. Their provider should bill the state Medicaid program. Using the post-enrollment method, when will a new member be disenrolled from their CSNP if a qualifying condition cannot be verified? - At the end of the second month of enrollment A DSNP member loses his eligibility due to a change or loss of Medicaid status. What cost sharing is he responsible for while in the grace period? - All, such as premiums, deductibles, copayments, and coinsurance