The following statements are about market conduct examinations of health plans. Select the answer choice that contains the correct statement.

• A. Once an examination report is provided to the state insurance department, a health plan is not given an opportunity to present a formal objection to the report.
• B. Multistate examinations are not appropriate for financial examinations, because regulatory requirements concerning a health plan's financial condition tend to vary from state to state.
• C. In imposing sanctions on health plans, state insurance departments are required to follow federal sentencing guidelines.
• D. Market conduct examinations of a health plan's advertising and sales materials include comparing the advertising materials to the policies they advertise.

The following situations illustrate per se violations of federal antitrust laws:
Situation A - Two groups of providers agreed among themselves that each provider will do business with health plans only on a fee-for-service basis.
Situation B - In order to avoid competing with each other, two independent, competing physician-hospital organizations (PHOs) divide the geographic areas in which they will market their services.
From the following answer choices, select the response that correctly identifies the types of per se violations illustrated by these situations.

• A. Situation A: horizontal group boycott; Situation B: horizontal division of markets
• B. Situation A: price fixing; Situation B: tying arrangement
• C. Situation A: price fixing; Situation B: horizontal division of markets
• D. Situation A: horizontal group boycott; Situation B: tying arrangement

In the paragraph below, a statement contains two pairs of terms enclosed in parentheses.
Determine which term in each pair correctly completes the statement. Then select the answer choice containing the two terms that you have chosen.
Inflation plays a role in the health plan environment by influencing the prices of healthcare services, supplies, and coverage. During an inflationary period, consumers typically have (more / less) purchasing power because the prices of goods and services increase (more / less) quickly than income.

• A. Less / more
• B. Less / less
• C. More / more
• D. More / less

State X issued a nonresident license to Tamara Pensky, a sales representative of the Verity Health Plan. In doing so, State X imposed a countersignature requirement, which requires that

• A. An officer of Verity sign a written statement which indicates that Verity appoints Ms. Pensky as an agent who is authorized to market Verity's products
• B. Applications solicited by Ms. Pensky must be signed by an individual who holds a resident License
• C. An officer of Verity sign a written statement which certifies that Verity has investigated Ms. Pensky's qualifications and background and believes she is trustworthy and competent
• D. Applications solicited by Ms. Pensky must be signed by an officer of Verity

The Balanced Budget Act (BBA) of 1997 created the Medicare+Choice plan. One provision of the BBA under Medicare+Choice is that the BBA

• A. Requires health plans to qualify as either a competitive medical plan (CMP) or a federally qualified HMO in order to participate in the Medicare program
• B. Increases Graduate Medical Education (GME) payments to hospitals for the training and cost of educating and training residents
• C. Narrows the geographic variations in payments to Medicare health plans by lowering the growth rate of payments in high-payment counties and raising the rates in low-payment counties
• D. Eliminates funding for demonstration projects such as the Medicare Enrollment Demonstration Project