FCCM: Section 1A – Quiz
Service Coordinator Name:
Section 1A – Medicaid Laws and Regulations
Quiz
1. I located the definition of case management in Title 40, Texas Administrative
Code, Part 2, Chapter 108, subchapter D, and it defines Case Management as which of the following:
a. Services provided to children with developmental disabilities or developmental delays.
b. Services provided to children who reside in a low income family.
c. Services provided to assist an eligible child and their family in gaining access to the rights and procedural safeguards under Part C, and to needed medical, social, educational, developmental, and other appropriate services.
d. Services designed to enhance development in the physical/motor, communication, adaptive, cognitive, social or emotional and sensory domains, or to teach compensatory skills for deficits that directly result from medical, developmental or other health-related conditions.
2. I located the Medicaid State Plan and found that it is which of the following:
a. An annual codification of the general and permanent rules published in the
Federal Register by the executive departments and agencies of the
Federal Government
b. The officially recognized document describing the nature and scope of the State of Texas Medicaid program.
c. A federal lawsuit that was settled in May 2005 and requires the Health and
Human Services Commission (HHSC) to comply with Title XIX of the
Social Security Act (42 U.S.C. §1396 et seq.) by providing all medically necessary in-home Medicaid services to children under 21 years of age that are eligible for the Medicaid Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.
d. A prospective payment method that pays a managed care organization a uniform amount on a monthly basis for each enrolled member for the provision of covered services.
3. I located the ECI Case Management rules and found that all of the following contacts made by the Service Coordinator are a part of case management and must be documented in the child’s record but are not separately billable to Medicaid as Targeted Case Management except for one. The type of contact that is billable is:
a. Contacts made with other individuals (not the child and/or the child’s parent as defined in 20 U.S.C. §1401) when directly related to identifying the eligible child’s needs and helping the eligible child access services,
b. Contacts made with other individuals (not the child and/or the child’s parent as defined in 20 U.S.C. §1401) to identify needs and supports to assist the eligible child in obtaining services,
c. Contacts made with other individuals (not the child and/or the child’s parent as defined in 20 U.S.C. §1401) to provide the Service Coordinator with useful feedback, and alert the Service Coordinator to changes in the eligible child’s needs.
d. Contacts made directly with the child and/or the child’s parent.
4. According to the case management rules in Title 40, Texas Administrative Code, Part 2, Chapter 108, subchapter D, billablecase management includes all of the following except:
- Following up with families to assist the child with timely access to services, discuss the disposition of the referral with the family, and determine if the services have met the child’s needs
- Monitoring and reassessment of the delivery of and effectiveness of services through contacts with the child, family members, service providers, or other entities or individuals
- Coordinating with medical and other health providers
- Referring the family to a community food pantry before determining the child’s eligibility for ECI services
5. Which state agency is responsible for overseeing the Medicaid program in Texas?
a. Centers for Medicare and Medicaid Services
b. Department of Assistive and Rehabilitative Services
c. Department of State Health Services
d. Health and Human Services Commission
6. I located the Medicaid State Plan on the HHSC website and believe that the following statement is true or false:
Essentially, the plan is our state's agreement that it will conform to the requirements of the Social Security Act and the official issuances of the U.S. Department of Health and Human Services.
7. Which volume and chapter of the Texas Medicaid Provider Procedures Manual contains the information on the ECI Targeted Case Management Program?
a. Volume 1, Section 2, Texas Medicaid Reimbursement
b. Volume 2, Medical Transportation Program Handbook
c. Volume 2, Children’s Services Handbook, Subsection 2.5
d. Volume 2, Medicaid Managed Care Handbook
8. According to Title 42, Public Health, Chapter IV—Centers for Medicare and
Medicaid Services, Department of Health and Human Services Part 440_Services: General Provisions, Subpart A, Definitions, Sec. 440.169 Case management services (d)(4), Monitoring and follow-up activities include activities and contacts that are necessary to ensure that the care plan is effectively implemented and adequately addresses the needs of the eligible individual. It also states that the contacts may be with the individual, family members, service providers, or other entities or individuals. It goes on to say that the monitoring and follow-up activities are conducted as frequently as necessary, and include which of the following:
a. At least one monthly monitoring
b. At least one weekly monitoring
c. At least one annual monitoring
d. At least one daily monitoring
9. I located the Case Management rule in the in Title 40, Texas Administrative
Code, Part 2, Chapter 108, subchapter D, and believe that the following is true or false: Case management services associated with the following are not payable as optional Targeted Case Management services under Medicaid:
- Medicaid eligibility determinations and redeterminations;
- Medicaid preadmission screening;
- Prior authorization for Medicaid services; and
- Medicaid eligibility intake processing.
10. In looking at all of the federal and state rules and the procedures in the Texas Medicaid Provider Procedures Manual (TMPPM), what do I do if they say different things? (You may consult with your supervisor to answer this question)
a. Comply with the least stringent requirement
b. Comply with the most stringent requirement
c. If the federal rule doesn’t include the requirement, then I can ignore it if it is in the TMPPM
d. If the TMPPM doesn’t state the requirement, I can just comply with what is stated in the TMPPM manual and I will be fine