Impact of Health Policy

Question 1

There are ______ branches of government

Answer 1

3

Question 2

_____ work with federal and state legislator to get a bill introduced

Answer 2

legislature branch

Question 3

______ get involved with implementation of the law through development of rules and regulations

Answer 3

executive branch (a bill becomes a law after the executive branch signs it)

Question 4

_____ implementations of laws have been delayed by the courts until change could be made via legislature process

Answer 4

judicial branch

Question 5

T/F As the role of the govt in health care delivery INCREASES, so does the number of rx paid for by govt programs

Answer 5

TRUE;
Medicare and Medicaid 1965
Medicare Part D 2006

Question 6

Who is eligible for Medicare: (3)

Answer 6

• people greater than or equal to age 65
• disabled individuals
• patients with End Stage Renal Disease

Question 7

Medicare Part A

Answer 7

hospital cost

Part A is provided free of cost for everyone

Question 8

Medicare Part B

Answer 8

outpatient costs

Part B is optional

Question 9

Medicare Part C

Answer 9

Medicare Advantage (MA)

Question 10

Medicare Part D

Answer 10

prescription costs

coverage is voluntary (may change plans during open enrollment)

Question 11

• Fee for Service plans run by the Federal Govt

- original Medicare

Answer 11

Medicare Part A and B

Question 12

-prescription drug coverage via PDP

Answer 12

Part D

Question 13

Supplemental insurance via a private insurer

Answer 13

Medicare Supplemental Insurance (Medigap)

Question 14

T/F Pharmacy is the revenue generating center.

Answer 14

FALSE: pharmacy is the cost center

Question 15

Medicare Part A

Answer 15

-payment is prospective and dependent on patient’s diagnosis

Question 16

How can pharmacist DECREASE cost and improve outcomes for PartA: (2)

Answer 16

• decrease adverse drug events

- conducting Med Rec

Question 17

T/F Under Medicare Part B, RPh MAY bill for outpatient services except as “incident to” MD services

Answer 17

FALSE : MAY NOT

examples include diabetes, education, anticoag therapy

Question 18

T/F Pharmacies may elect to be a Medicare supplier and bill for DME

Answer 18

TRUE (competitive bidding process)

Question 19

Medicare Advantage Plans vary depending on…….

Answer 19

where the beneficiary lives

Question 20

YES or NO

Part A and B COVER vision and dental services

Answer 20

NO

Question 21

Medicare Part C (3)

Answer 21

• plans may be offered by an HMO or private plan
• beneficiaries do not need a supplemental policy
• restricted to plan’s provider network

Question 22

T/F The plans offer under Part C MUST cover all services covered under Part A and B, and prescription services

Answer 22

TRUE

Question 23

You need parts ___ and ____ to get Part D

Answer 23

A and B

Question 24

__________ established Medicare Part D

Answer 24

Medicare prescription drug improvement and modernization act of 2003

Question 25

T/F Under Part D, Private insurance companies submit bids to, and follow CMS rules

Answer 25

TRUE

Question 26

Medicare Part D

Most plans use a ______ copayment

Answer 26

tiered

Question 27

Medicare beneficiaries who qualify for Medicaid
Before 2006:________
After 2006:______

Answer 27

before: rx covered by medicaid
after: rx covered by part d

Question 28

T/F Dual eligibles who do NOT choose a plan will be assigned a Part D plan

Answer 28

TRUE

Dual eligible have reduced premiums and/or co-pays

Question 29

Providing _____ for targeted beneficiaries was a MMA 2003 requirement

Answer 29

MTM services

Question 30

Challenges of Part D (3)

Answer 30

• low reimbursement
• slow reimbursement
• complexity of plans

Question 31

Opportunities of Part D (3)

Answer 31

• INCREASE opportunities for community RPh to provide and receive payment for MTM services
• INCREASED rx volume
• INCREASED opportunities for the profession to lobby for changes in the Part D program

Question 32

Medicaid (3)

Answer 32

• program for low income individuals
• jointly funded by fed and state govt
• required to provide basic services

Question 33

Who is eligible for Medicaid? (4)

Answer 33

• medicare beneficiaries
• pregnant women
• children
• parents w/dependent children

Question 34

T/F Coverage for Medicaid was expanded in 2014 to include private health insurance through “marketplaces”

Answer 34

TRUE

Question 35

T/F CHIP is an entitlement program

Answer 35

FALSE: CHIP is NOT an entitlement program unlike Medicaid

Question 36

Purpose of CHIP

Answer 36

to increase the percentage of children with health insurance (covered children not