Quiz 1: Medi-Cal Managed Care

The flashcards below were created by user Vsuberville on FreezingBlue Flashcards.

  1. The ______ regulates all the Health Plans serving Medi-Cal at the Federal Level.
    Center of Medicare and Medicaid Services (CMS)
  2. Name the three systems a beneficiary may receive medical services under Medi-Cal
    Medi-Cal Fee For Service, Medi-Cal SOC, Medi-Cal Managed Care
  3. Who regulates the health plans servicing Medi-Cal at the State level.
    DHCS- Dept of Health Care Services
  4. Which model in the Medi-Care Managed Care system is offered in Los Angles County?
    a. County organized health systems
    b  Geographic manged care
    c. Two-plan model
    d. Full scope Medi-Cal
    C. Two-Plan Model
  5. When did LA Care go live in the Medi-Cal Managed program?
    April 1997
  6. Name LA Care Health Plan Partners.
    Anthem Blue Cross, Care 1st, Kaiser, LA Care Health Plan
  7. Who does L.A care Heath Plan serve?
    The vulnerable, low income population of LA County
  8. MCLA is a/ an ____ Providing health care services to its members through contracted medical group, hospital, pharmacies and ancillary facilities.
    A. HMO / Plan
    B. Managed Care
    C. Carved-out
    D. Regular Med-Cal
    E. Fee for service
    A. HMO /PLAN
    (this multiple choice question has been scrambled)
  9. Members are assigned to a ____ who manages and coordinates all of their health care needs.
  10. What is the difference between Clinic and IPA?
    ~A Clinic has PCP, specialist, ancillary services all in the same building and the doctors are employee of the clinic.

    ~ An IPA the doctors own their own practices and is contracted with the medical association
  11. What does S/R mean? Explain what it is.
    Shared Risk- is when the health plan delegates to the Medical group to be responsible for all the professional services and fee while the plan  is responsible for all the facility services.
  12. What two aid code categories qualify for the Med-Cal Managed Care program?
    Mandatory and Voluntary
  13. What is PPG? Explain what it is
    Participating Physicians Group- They are all the medical groups contracted under LA Care directly or indirectly
  14. If the member asks you "what is the difference between LA Care and Health Net" What would you say?
    They both have the same services. Only the doctors, hospital, and pharmacy be different. Health net has 2 plan partners: Molina , Health net and LA Care has 4 plan partners: BCSC, CFST, KAIS, MCLA
  15. Who are our Medi-Cal Members? Name the groups who make up our membership?
    • 1.Pregnant women
    • 2.Parents with minor children
    • 3.0-21 yrs
    • 4.65 and older
    • 5.blind, aged and disabled
    • 6.Foster Care
    • 7.Cal Works and SSI
    • 8.250% of FPL
    • 9.US citizens, Documented immagrants
    • 10. Lives in LA county
  16. Explain the process for member to see the specialist?
    the PCP must submit a referral to the medical group for authorization to see the specialist who is contracted with the members medical group.
  17. When a Medi-Cal member is enrolled into the Managed Care program they are assigned to:
    A.Health pla, pharmacy, hospital
    B. Health plan, medical group and PCP
    C.parent health plan, clinic, doctor
    D.health plan, medical group, HMO and PCP
    B. Health plan, medical group, PCP
    (this multiple choice question has been scrambled)
  18. Name the 5 Primary doctors specialties with code and age range:
    • codes       Doctors                Age~Range
    • 01      General Practice        0-150; 10-150
    • 08      Family Practice              0-150
    • 16         OB/GYN                     16-75
    • 40      Pediatrician                    0-21
    • 41      Internal Medicine    16-150 14 if CHDP Certified
  19. Name LA Care health plan lines of business
    Medi-Cal, Healthy Families, Healthy kids, Medicare SNP, IHSS
Card Set:
Quiz 1: Medi-Cal Managed Care
2013-10-22 21:00:57
Medi Cal Managed Care

Show Answers: