Dual, Chronic Condition and Institutional/Institutional-Equivalent.
question
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
question
A DSNP might be in the best interest of which of these consumers?
answer
Joe, whose low income qualifies him for full Medicaid coverage
question
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
question
Which statement best describes a DSNP?
answer
The monthly premium is at or below the Low Income Subsidy benchmark to cover drug costs
question
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
question
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
question
Which of the following consumers is best suited for a CSNP?
answer
Mary, who has been seeing a specialist for a qualifying chronic condition
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?
answer
During the Annual Election Period (AEP) or Open Enrollment Period (OEP)
question
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
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
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
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.
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?
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).
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 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.
question
Which statement is true about CSNPs, DSNPs, and prescription drug coverage?
answer
CSNPs and DSNPs include Medicare Part D prescription drug coverage
question
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:
answer
Selling DSNPs
question
Which of the following consumers may not be a good candidate for a DSNP?
answer
Maria, who pays a percentage of charges when she receives medical care
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.
question
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?
answer
All, such as premiums, deductibles, copayments, and coinsurance
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