CMS has developed two prototype programs--Programs of All-inclusive Care for the Elderly (PACE) and the Social Health Maintenance Organization (SHMO) demonstration project--to deliver healthcare services to Medicare beneficiaries. From the answer choices below, select the response that correctly identifies the features of these programs.
A. PACE-annual limits on benefits for nursing home and community-based care SHMO-no limits on longterm care benefits
B. PACE-provide long-term care only SHMO-provide acute and long-term care
C. PACE-enrollees must be age 65 or older SHMO-enrollees must be age 55 or older
D. PACE-enrollment open to nursing home certifiable Medicare beneficiaries only SHMO- enrollment open to all Medicare beneficiaries
One true statement about state regulation of case management activities is that the majority of states
A. have enacted laws that list specific quality management requirements for a case management program
B. consider case management files to be medical records that must be retained for a specified length of time
C. view case management similarly and follow similar patterns with their laws and regulations
D. have enacted laws or regulations requiring licensure or certification of case managers
One method of transferring the information in electronic medical records (EMRs) is through a health information network (HIN). The following statements are about HINs. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.
A. A HIN may afford a health plan better measurements of outcomes and provider performance.
B. The use of a HIN typically increases a health plan's exposure to liability for poor care.
C. Most HINs are Internet-based rather than built on proprietary computer networks.
D. Currently, the majority of health plans do not have HINs that are capable of transferring medical records among their network providers.
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