备战的北美精算师的童鞋们们，大家身在何处呢？考试的*7复习资料由高顿网校[*{7}*]发布哦——SOA北美精算师2014年真题November2003Course8M（Part 8）
　　Managed Care Segment
　　Afternoon Session
 
　　19. (5 points) You are a consulting actuary for an HMO that wishes to control utilization, yet
　　maintain high quality of care.
　　(a) Describe traditional approaches to quality assessment.
　　(b) Review regulatory issues relating to quality assurance and their impact on HMOs.
　　(c) Describe managed care methods used to control medical utilization and the types
　　of services impacted by each method.
　　(d) Review state regulations that may limit an HMOs ability to manage utilization
　　and costs.
 
　　20. (4 points) You serve on a professional task force advising a State Senator on health
　　insurance reform issues. New health reform legislation is being proposed which is
　　intended to meet the following objectives:
　　?  Promote a reduction in the working uninsured population
　　?  Promote job mobility
　　?  Facilitate the ability of individuals and small employers to compare insurance
　　policies offered by different health carriers
　　?  Reduce variation in, and volatility of premium rates charged to different groups
　　(a) Describe key recommendations regarding the above objectives to be included in
　　reform legislation.
　　(b) The legislature is also reviewing risk adjustment mechanisms for Medicaid HMO
　　plans. Compare and contrast methods of risk adjustment and recommend a
　　method to be included in the legislation. Justify your recommendation.
　　COURSE 8: Fall 2003 - 16 - STOP
　　Managed Care Segment
　　Afternoon Session
 
　　21. (5 points) You are a consulting actuary retained by Capitalized Health Plan, a licensed
　　HMO in a state that has passed the NAIC Risk-Based Capital For Health Organizations
　　Model Act (RBC Model). The CFO is unfamiliar with risk-based capital and has asked
　　you to make a presentation to educate him and his staff. In your research, you have
　　extracted the following information from Capitalized HP’s 2002 Statutory Annual
　　Statement:
　　Assets (Non-Affiliated)
　　-  U.S. Government Bonds $ 4.6 million
　　高顿网校之考试励志：梦想是人们与生俱来的重要宝物之一，它等待你的珍视和实践。——邹金宏