With Regard to the Laws and Regulations on Access and Adequacy

question 40

Multiple Choice

With regard to the laws and regulations on access and adequacy of provider networks, it can correctly be stated that:

• A) most access and adequacy guidelines relate to preferred provider organizations (PPOs) or managed indemnity products
• B) corporate practice of medicine laws require staff model HMOs to hire physicians directly, even if the physicians do not own the HMO
• C) any willing provider laws prevent a health plan from making exclusive or semi-exclusive arrangements with a provider or a group of providers
• D) the NAIC Managed Care Plan Network Adequacy Model Act requires states to use provider- enrollee ratios as the sole measure of network adequacy

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Definitions:

Incentive Contract

An agreement designed to motivate performance by aligning the interests of parties, typically involving rewards for achieving specified objectives.

Additional Risk

Extra exposure to uncertainty or potential financial loss that comes with certain investments or business activities.

Employee Level Risk

The exposure to potential adverse effects on employees' health, safety, and well-being within the workplace.

Incentive Pay

A form of compensation used to motivate employees, usually tied to their performance or accomplishments.