AHIP Exam AHM-250 Topic 6 Question 86 Discussion

Actual exam question for AHIP's AHM-250 exam

Question #: 86
Topic #: 6

The NAIC adopted the HMO Model Act in order to provide a system of ongoing regulatory monitoring of HMOs. All of the following statements are correct about the HMO Model Act EXCEPT that it:

ARegulates HMO operations in two critical areas: financial responsibility and healthcare delivery.

BRequires each HMO to send state regulators an annual report describing the HMO's finances and operations.

CFocuses on three key aspects of healthcare delivery: network adequacy, quality assurance, and grievance procedures.

DRequires state insurance departments to conduct annual examinations of an HMO's operations, quality assurance programs, and provider networks.

Show Suggested Answer

Suggested Answer: B

by Lai at Apr 27, 2024, 02:25 PM

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Bulah

4 hours ago

Annual examinations? That's just the government trying to stick their nose where it doesn't belong. I'll go with D, the sane choice.

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Cecil

12 days ago

A, B, and C all sound like reasonable regulations, but D just seems like bureaucratic overreach. I'm going with D as the exception.

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Ocie

18 days ago

I think the correct answer is D. The HMO Model Act doesn't require annual examinations of HMOs by state insurance departments. That's just too much oversight for my liking.

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