| Based on Chapter 19: Health Care Fraud and Abuse | | |
| What types of steps can managed health care plans take to improve their ability to detect fraud? | 10 | |
| Based on Chapter 20: Member Services | | |
| Describe the legal and regulatory milieu affecting member services, and provide hypothetical descriptions of different scenarios to illustrate those effects. | 15 | |
| Based on Chapter 23: Information Systems and Electronic Data Interchange in Managed Health Care | | |
| Describe and discuss a data warehouse and its key attributes. | 10 | |
| Based on Chapter 24: Health Plans and Medicare | | |
| Discuss the approaches CMS uses to monitor plan performance, as well as how CMS uses this data to address any performance issues. | 15 | |
| Based on Chapter 25: Medicaid Managed Health Care | | |
| Why has the extension of Medicaid managed care to “special need populations” been so slow and why is it now becoming a more prominent priority? | 5 | |
| What factors are contributing to greater reliance in the future on managed care models in state Medicaid programs? | 5 | |
| Based on “The Rise and Fall of Medicaid Managed Care in Mississippi: Lessons for Public Health Policy Makers,” what caused the demise of the program and what lessons can be learned for policy makers | 20 | |
| Total points lost | | |
| Grade based on 100 | | |
| Grade based on 20% | | |
