2021 United HealthCare Chronic Condition And Dual Special Needs Plans (CSNP-DSNP) Test

6 September 2022
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question
Dual Special Needs Plans (DSNP) are defined as which of the following:
answer
Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid
question
Which statement is true about how loss of Medicaid affects a member's enrollment in a DSNP?
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Special Election Period (SEP Dual/LIS Change in Status) is available for DSNP members that lose their Medicaid eligibility.
question
Which consumer might benefit the most by enrolling in a DSNP?
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Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+)
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What program is available to support CSNP and DSNP members who may have unique health care needs?
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A care management program that varies depending upon the level of the member's health risk level
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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:
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Selling DSNPs
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The consumer states they currently pay a percentage of charges when they receive medical care. This means:
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The consumer is not likely to be a Full Dual-Eligible and may be better suited for enrollment in another type of plan.
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Which of the following consumer characteristics demonstrates a good fit for a CSNP?
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A consumer with a qualifying chronic condition who wants a plan that will help them manage their illness and health care costs
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On July 19, each of the following consumers met with an agent. Based on the information provided, which consumer must wait until the Annual Election Period (AEP) or Open Enrollment Period (OEP) to enroll?
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Joy has a cardiovascular disorder, is enrolled in a CSNP that covers the condition, and wants to enroll in another CSNP offered by the plan that covers the same condition.
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Which service will a CSNP or DSNP member in the high risk care management category receive?
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Case Management (telephonic, digital and/or face-to-face) according to individual needs
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It is very important for consumers enrolling in a CSNP to know the following about accessing providers:
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Some CSNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers, generally with higher cost sharing.
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Which statement is true about the Medicaid program?
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It helps pay medical costs for certain groups of people with limited income and resources.
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You must advise consumers enrolling in a DSNP that:
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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.
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Ginny just enrolled in a CSNP that uses the post-enrollment verification method. When will the plan send her a termination notification letter if it has not yet been able to verify a qualifying chronic condition?
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At the end of her first month of enrollment
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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?
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All, such as premiums, deductibles, copayments, and coinsurance
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When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members that lose Medicaid eligibility?
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Upon notification or effective date of the loss, whichever is earlier
question
Which statement is true about CSNPs, DSNPs, and prescription drug coverage?
answer
CSNPs and DSNPs include Medicare Part D prescription drug coverage
question
When selling DSNPs, agents must:
answer
Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B
question
Which consumer may be a good candidate for a DSNP?
answer
WRONG - Larry, who has a qualifying chronic condition and wants a plan that will help him manage his illness and health care costs
question
Which of the following consumers is best suited for a CSNP?
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Mary, who has been seeing a specialist for a qualifying chronic condition
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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 that will help him manage his condition. Can John enroll in a Chronic Special Needs Plan (CSNP) that covers his chronic condition?
answer
Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic)
question
Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level?
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All of the responses are correct.
question
It is very important for consumers enrolling in a CSNP to know the following about accessing providers:
answer
Some CSNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers, generally with higher cost sharing.
question
Which statement is true about the Medicaid program?
answer
Benefits vary from state to state.
question
Alice is enrolling in a DSNP. What should her agent remind her about?
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She is not required to pay copayments for Medicare-covered services when she uses a provider in the DSNP network because she is Full Dual Eligible. Her provider should bill the state Medicaid program, as appropriate, for these costs.
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Members who lose their eligibility for the DSNP due to a change or loss of Medicaid status are responsible for what cost sharing?
answer
All, such as premiums, deductibles, copayments, and coinsurance
question
Which statement best describes a care management program that varies depending upon the level of the member's health risk?
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Support provided to CSNP and DSNP members that may have unique health care needs
question
Which statement best describes a DSNP?
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The monthly premium is at or below the Low Income Subsidy benchmark to cover drug costs
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The consumer states they currently pay a percentage of charges when they receive medical care. This means:
answer
The consumer is not likely to be a Full Dual-Eligible and may be better suited for enrollment in another type of plan.
question
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?
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During the Annual Election Period (AEP) or Open Enrollment Period (OEP)
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Which service will a CSNP or DSNP member in the high risk care management category receive?
answer
Case Management (telephonic, digital and/or face-to-face) according to individual needs
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Which statement is true about physician information on the Chronic Condition Verification Form?
answer
The physician indicated on the form does not have to be contracted with the plan.
question
Which statement is true about the Medicaid program?
answer
It helps pay medical costs for certain groups of people with limited income and resources.
question
Melanie wants to enroll in a DSNP. Which of the following must her agent do?
answer
Confirm that Melanie is entitled to Medicare Part A, enrolled in Part B, and her Medicaid level
question
Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level?
answer
WRONG - Ongoing reassessment of risk level for status changes
question
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?
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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).
question
Meredith, a DSNP member, loses Medicaid eligibility. What impact does this have on her DSNP enrollment?
answer
She will enter a grace period during which she is responsible for plan cost sharing, and she will be disenrolled at the end of the grace period if she does not reestablish Medicaid eligibility.
question
Which statement describes the primary characteristic of a consumer who may benefit from a DSNP?
answer
Is enrolled in their state Medicaid program, typically as a Full Dual, with their Medicare cost sharing paid by the state in which they reside.
question
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.
question
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
question
Which statement best describes a care management program that varies depending upon the level of the member's health risk?
answer
Support provided to CSNP and DSNP members that may have unique health care needs
question
The consumer states they currently pay a percentage of charges when they receive medical care. This means:
answer
WRONG** The consumer is enrolled in a Medicare Supplement Insurance Plan.
question
How is a CSNP or DSNP member's care management health risk levels determined initially?
answer
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.