ADRC Long-Term Care Program Education (LTCPE) Certification Test

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* 1. Long-term Care (LTC) is the only component of Statewide Medicaid Managed Care (SMMC).

a. True

b. False

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* 2. Only people age 65 or older can get Medicare coverage.

a. True

b. False

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* 3. Which of the following is an eligibility requirement for PACE?

a. Must be age 55 or older.

b. Must be able to live safely in the community.

c. Must reside in the service area.

d. All of the above.

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* 4. People who receive Supplemental Security Income (SSI) are already financially eligible for Medicaid benefits in Florida.

a. True

b. False

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* 5. Which of the following provides health coverage to low-income individuals with income and assets as the main eligibility criteria?

a. Medicaid

b. Meals on Wheels

c. Both (a) and (b)

d. None of the above

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* 6. What does the enrollment broker do?

a. Assists individuals with enrolling, changing plans, or disenrolling from SMMC LTC.

b. Searches for providers, assisted living facilities, specialists, hospitals, and clinics to ensure that individuals make an informed choice when choosing a health plan.

c. Both (a) and (b)

d. None of the above

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* 7. Influencing the choice of a managed care plan for an individual is:

a. A prohibited activity

b. Sometimes necessary if an individual does not know which managed care plan to choose.

c. Part of the enrollment process.

d. None of the above.

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* 8. What must occur before an individual is considered fully eligible for SMMC LTC?

a. The individual must be released from the waitlist, be Medicaid eligible, and have received a Level of Care (LOC).

b. The individual must be released from the waitlist, be Medicaid eligible, and have applied for an LOC.

c. The individual must be released from the waitlist, have applied for Medicaid eligibility, and have received an LOC.

d. All of the above.

e. None of the above.

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* 9. What happens if an individual who is pending enrollment does not choose a managed care plan within his or her 30-day Choice Period after receiving (a) welcome letter(s) sent by the enrollment broker?

a. The individual will not be enrolled and will not receive any services.

b. The individual will be auto-assigned to a managed care plan but will not be told which plan it will be.

c. The individual will be auto-assigned to the managed care plan listed in his or her welcome letter(s).

d. All of the above.

e. None of the above.

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* 10. PACE, and the iBudget waiver are examples of:

a. Other Florida programs that offer Medicaid home and community-based services (HBCS).

b. Programs which, if enrolled, an individual may not also enroll in SMMC LTC.

c. All of the above.

d. None of the above.

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* 11. What should you do if an individual wants to leave his or her current HCBS Medicaid program and enroll in SMMC LTC?

a. Refer him or her to the enrollment broker.

b. Refer him or her to the local CARES office.

c. Tell him or her that he or she cannot enroll in SMMC LTC.

d. Screen him or her for placement on the SMMC LTC waitlist and explain that, in order to enroll in SMMC LTC, he or she will have to disenroll from his or her Medicaid HBCS program from the agency administering the program, if offered SMMC LTC enrollment.

e. None of the above.

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* 12. How can an individual choose an SMMC LTC managed care plan?

a. Online by visiting the enrollment broker’s website.

b. Over the telephone with the enrollment broker.

c. In person with enrollment broker staff.

d. All of the above.

e. None of the above.

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* 13. How long does an SMMC LTC enrollee have to change plans without cause following enrollment?

a. 60 days

b. 30 days

c. 120 days

d. 90 days

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* 14. What is “Open Enrollment?”

a. The 90-day window in which SMMC LTC enrollees can change plans for any reason after they first enroll in SMMC LTC.

b. The 60-day period before the end of an enrollee’s enrollment year, during which the enrollee may choose to change plans for the following enrollment year.

c. Open Enrollment does not apply to SMMC LTC.

d. None of the above.

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* 15. What two things have to be in place before an individual can choose to enroll in SMMC LTC?

a. Medicaid eligibility and an LOC.

b. A Medicaid application and an application for an LOC.

c. A Medicaid application and an LOC.

d. None of the above.

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* 16. What happens if an individual fails to submit a complete Medicaid application?

a. The client is put back on the waitlist for SMMC LTC, if more than six months have passed since their release date.

b. Both (a) and (c).

c. The individual is terminated from pipeline (APPL) status. The individual may request to return to applied status if they contact the ADRC and wish to re-apply for Medicaid, if six or fewer months have passed since their release date.

d. None of the above.

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* 17. What will occur If an enrolled SMMC LTC individual experiences a loss of Medicaid eligibility?

a. The individual will have 60 days to regain their Medicaid eligibility before they are disenrolled.

b. The individual will be disenrolled from their managed care plan.

c. The individual will have 30 days to regain their Medicaid eligibility before they are disenrolled.

d. None of the above.

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* 18. If an SMMC LTC individual experiences a loss of Medicaid eligibility, how long do they have to be re-enrolled with their former plan if his or her eligibility is reinstated?

a. 3 months

b. 6 months

c. 9 months

d. 12 months

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* 19. If an SMMC enrollee is moving between counties or regions within Florida, he/she needs to contact whom to provide notification of the address change?

a. The Social Security Administration and/or DCF.

b. Both (a) and (c).

c. His/her current SMCC LTC managed care plan.

d. None of the above.

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* 20. When an individual disenrolls from SMMC LTC, he or she can still receive SMMC benefits through MMA.

a. True

b. False

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* 21. DOEA is the primary state agency responsible for administering human services programs to which population?

a. Children

b. Infants

c. Elders

d. Pregnant women

e. None of the above

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* 22. The CARES program must perform a face-to-face assessment in order for an individual to enroll in SMMC LTC.

a. True

b. False

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* 23. Which of the following are goals of SMMC LTC?

a. To provide coordinated long-term care across different health care settings.

b. To provide an individual a choice of the best long-term care plan for his or her needs.

c. To provide long-term care plans with the ability to offer more services.

d. To provide access to cost-effective, community-based long-term care services.

e. All of the above.

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* 24. The ADRCs play a key role in SMMC LTC by providing a coordinated, streamlined, multi-access system of integrated information, referral, and eligibility determination functions for elders, persons with disabilities, and caregivers.

a. True

b. False

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* 25. SMMC LTC managed care plans are available to individuals based on which of the following residential criteria?

a. The county in which the individual resides.

b. The city in which the individual resides.

c. The school one in which the individual resides.

d. The region in which the individual resides.

e. The water management district in which the individual resides.

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* 26. Each region has at least four (4) LTC managed care plans from which eligible individuals may choose.

a. True

b. False

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* 27. Which of the following is not an LTC covered service?

a. Adult companion care

b. Caregiver training

c. Cosmetic surgery

d. Homemaker

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* 28. When interacting with an individual, ADRC staff should avoid establishing a personal relationship or friendship.

a. True

b. False

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* 29. Which of the following are Prohibited Activities?

a. Expressing a preference or dislike for any of the managed care plans

b. Providing false information in advertising that is untrue, deceptive, or misleading to the public.

c. Misrepresenting the benefits, advantages, or conditions of a managed care plan.

d. Knowingly misleading individuals as to the availability of providers.

e. All of the above.

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* 30. PACE is only available in which counties?

a. Broward, Charlotte, Collier, Duval, Lee, Miami-Dade, Palm Beach, and Pinellas.

b. Escambia, Santa Rosa, Okaloosa, and Walton.

c. Bay, Calhoun, Holmes, Jackson, and Washington.

d. Baker, Clay, Duval, Nassau, and Volusia.

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* 31. If an individual wishes to become eligible for MMA, who should he or she contact?

a. The Department of Elder Affairs.

b. The Aging and Disability Resource Center.

c. The enrollment broker

d. The Department of Children and Families

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* 32. Does an individual need Medicaid to enroll in MMA?

a. Yes

b. No

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* 33. Will an SMMC enrollee have the same managed care plan for both MMA and LTC if eligible for both?

a. Yes

b. No

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* 34. What is the minimum age requirement for an individual to participate in SMMC LTC?

a. 65

b. 18

c. 4

d. 21

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* 35. If someone is in a nursing facility or wishes to be in a nursing facility, how does he or she become medically eligible for SMMC LTC nursing facility services?

a. Get assessed by CARES for nursing home level of care.

b. Get screened by the ADRC and put on the SMMC LTC waitlist.

c. Contact the enrollment broker to pick a nursing home.

d. None of the above.

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* 36. If a provider is not receiving payment for contracted services by a managed care plan, who should the provider contact?

a. The Elder Helpline

b. The Department of Elder Affairs

c. The Governor’s office

d. The AHCA complaint hub

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* 37. If a provider wishes to become an SMMC LTC provider, where should the provider apply?

a. The Department of Children and Families website

b. The Department of Elder Affairs website

c. The Agency for Health Care Administration website

d. Any of the above

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* 38. Which program staff can assist an individual with enrolling in a Medicare plan?

a. A SNAP counselor

b. A Medicaid benefits counselor

c. The enrollment broker

d. A SHINE counselor

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* 39. Is an individual automatically eligible for a Medicaid benefit plan if he or she is already receiving Medicare benefits?

a. Yes

b. No

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* 40. Medicare is a federal program.

a. True

b. False

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* 41. Every state offers the same Medicaid long-term care programs, so an individual can transfer his or her Medicaid from one state to another without reapplying.

a. True

b. False

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* 42. SMMC LTC is a(n):

a. Entitlement program

b. Part of the Affordable Care Act

c. Medicaid Waiver Program

d. Medicare Program

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* 43. You must be a resident of Florida to be eligible for SMMC LTC.

a. True

b. False

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* 44. An individual needs to apply for which Medicaid benefit plan in order for DCF to determine SMMC LTC financial eligibility?

a. Medical assistance for the aged, blind, or disabled

b. Medicare savings program

c. Medical assistance for individuals in nursing homes

d. Medical assistance for individuals in HCBS/Waivers

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* 45. For individuals released from the waitlist, the ADRC needs to provide verification of an individual’s medical eligibility to the Department of Children and Families (DCF) prior to DCF determining SMMC LTC Medicaid eligibility.

a. True

b. False

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* 46. The following should occur when an enrollee calls the ADRC complaining that his or her provider never came to provide his or her services.

a. The enrollee should be referred to the enrollment broker and told to disenroll from his or her managed care plan because they are not getting his or her services.

b. The enrollee should be advised to get a new provider.

c. The ADRC should contact the provider on the enrollee’s behalf to file a complaint.

d. The enrollee should be referred to his or her managed care plan to file a complaint, and the ADRC should enter a complaint into AHCA’s complaint hub on the individual’s behalf. If the individual’s health, safety, or welfare is in jeopardy, the ADRC must also file a report with DCF’s Adult Protective Services.