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Question 1: Federal law addresses the relationship between Medicare- or Medicaidcontracting health plansand providers who are at "substantial financial risk."
Under federal law, Medicare- or Medicaid-contracting health plans
A. Place a provider at "substantial risk" whenever incentive arrangements put the provider at risk for
amounts in excess of 10% of his or her total potential reimbursement for providing services to
Medicare and Medicaid enrollees
B. Must provide stop-loss coverage to a provider who is placed at "substantial financial risk" for
services that the provider does not directly provide to Medicare or Medicaid enrollees
C. Both A and B
D. A only
E. B only
F. Neither A nor B
Correct Answer: C
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