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Medicaid and Behavioral Health

Module 1: Medicaid’s Importance to Mental Health and Substance Use Services

1. The Federal-State Medicaid program is currently the single largest funder of services to treat mental and substance use conditions, referred to as behavioral health services.

A. True

B. False


How Has Medicaid Spending on Behavioral Health Changed Over Time?

2. While historically inpatient hospitalization in state facilities was the main treatment option for many behavioral health conditions, Medicaid financing has facilitated the expansion of many needed services, including each of the following EXCEPT:

A. Crisis intervention

B. Case management

C. Partial hospitalization

D. Residential treatment


What Is the Impact of Behavioral Health Spending by State?

3. Spending per person on behavioral health services varies considerably by state, depending on the behavioral health services needs of the population, accessibility of behavioral health care facilities and providers, size of the behavioral health workforce, availability of funding, and other economic and non-economic factors.

A. True

B. False


Module 2: Medicaid Overview

4. Since the federal government created the authority for the Medicaid program in 1965, participation in the program has been mandatory for all states.

A. True

B. False


Social Security Act Title XIX: Grants to States for Medical Assistance

5. The concept of _____________ ensures that although Medicaid programs will vary considerably from state to state, within a state its Medicaid program must be consistent and uniform.

A. Statewideness

B. Reasonable domain

C. Prudent locality

D. None of the above


Individual/Consumer Right to a Fair Hearing

6. Which of the following is NOT one of the circumstances in which a state agency must grant an opportunity for a fair hearing?

A. Denial of eligibility

B. The claim is not acted upon with reasonable promptness

C. If limits were placed on a service based on such criteria as medical necessity

D. Termination, suspension, or reduction of eligibility or covered services


Social Security Act Title XXI: Children’s Health Insurance Program

7. The Children’s Health Insurance Program (CHIP) is an entitlement program that is administered by the states and funded by the federal government.

A. True

B. False


Who is Eligible for Medicaid?

8. Mandatory and optional populations who receive Medicaid are considered categorically needy, while certain individuals who are not otherwise eligible for Medicaid but may receive services are known as_____________ populations.

A. Transiently needy

B. Medically needy

C. Provisionally needy

D. Therapeutically needy


Mandatory Eligibility Groups

9. Children are in a mandatory Medicaid eligibility group if they are:

A. Infants born to women who are eligible for Medicaid

B. Children younger than 6 years old whose families earn up to 133 percent of the federal poverty guideline or those aged 6–18 years whose families earn up to 100 percent of the federal poverty guideline

C. Certain children who receive adoption assistance or are in foster care

D. All of the above


Certain Individuals Earning Up to 133 Percent of the Federal Poverty Guideline and Former Foster Children

10. Two mandatory Medicaid eligibility groups added as part of the The Affordable Care Act are former foster care children through age 25 who were enrolled in foster care and Medicaid when they turned 18 or aged out of foster care and nonelderly, non-pregnant adults with income at or below 133 percent of the federal poverty guideline who are not otherwise eligible.

A. True

B. False


What Services Does Medicaid Cover?

11. Which of the following services must be covered under a state’s Medicaid State Plan?

A. Physical and occupational therapy

B. Prescription drugs

C. Transportation to medical care

D. Speech, hearing, and language disorder therapy


How is Medicaid Financed?

12. The costs of Medicaid are shared between the federal and state governments, with the share paid by the federal government ranging from:

A. 60 to 85 percent

B. 50 to 75 percent

C. 35 to 60 percent

D. 25 to 50 percent


How States Finance the State Portion

13. Although states may use various funding mechanisms to fund their state match, a provision in section 1902(a)(2) of the Act mandates that state governments pay for at least 60 percent of the non-federal share of Medicaid.

A. True

B. False


Module 3: The Medicaid Behavioral Health Services Benefit Package

14. According to SAMHSA, a good and modern mental health and substance use system should be designed and implemented using a set of principles in which _______________, treatment is effective, and people recover.

A. Prevention works

B. Early intervention is available

C. Support is provided

D. Productivity is essential


15. Each of the following is an accurate statement about providing services under the rehab option EXCEPT:

A. Under this option, rehabilitative services are not limited to clinical treatment of a person’s mental and/or substance use disorder

B. Rehabilitative services can be used to attain achievement of skills that are necessary to function in the world

C. Medicaid may fund room and board, education, or vocational services under the rehab option

D. Covered services might also include individual and group therapy, crisis intervention, family psychosocial education


Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

16. Under EPSDT, children and youth who are eligible for Medicaid are entitled to evaluation and treatment of developmental and behavioral health problems, along with the full scope of physical health needs.

A. True

B. False


Case Management-How Case Management Services May Be Delivered

17. Case management that is restricted to specific beneficiary groups, which can be defined by disease or medical condition or by geographic regions, is known as definitive case management (DCM).

A. True

B. False


Figure 3-1 Good and Modern Addictions and Mental Health Service System

18. Assessment, specialized evaluations, service planning, consumer/family education, outreach, and prevention fall under which category of services?

A. Engagement Services

B. Intensive Support Services

C. Community Support

D. Recovery Supports


Module 4: Providers of Behavioral Health Services-Medicaid Providers

19. The provider requirements and reimbursement rates that states set must consider efficiency, economy, and:

A. Adaptability

B. Productivity

C. Resourcefulness

D. Quality


State-Specific Professional Practice Acts

20. While a Medicaid provider is the provider agency or independent practitioner who has a direct relationship with the state, the distributing provider is the clinician, therapist, program staff, or paraprofessional who provides hands-on care to the Medicaid consumer.

A. True

B. False


Federally Qualified Health Centers (FQHCs)

21. Health Center grantees are grant-supported FQHCs that focus on certain populations including migrant and seasonal farm workers, residents of public housing, and:

A. Adults with developmental disabilities

B. Individuals and families experiencing homelessness

C. Pregnant women

D. Inpatient health programs or facilities operated by tribal organizations


22. Health centers are required to provide primary health services with an identified team of health professionals as well as other health-related services such as substance use disorder and mental health services.

A. True

B. False


Institutions for Mental Diseases (IMD)

23. Exclusions to the Social Security Act prohibiting the federal government from reimbursing states for services rendered to a Medicaid beneficiary who is a patient in an IMD include each of the following EXCEPT:

A. It does not apply to adults aged 65 years and older residing in a Medicare-certified hospital or nursing facility

B. It does not apply to individuals younger than age 21 or, in certain circumstances, younger than age 22 receiving services under the inpatient psychiatric services for individuals under age 21 benefit

C. It does not apply to institutions with 32 or fewer beds

D. It does not apply to partial hospitalization and day-treatment programs that do not institutionalize their patients


The Medicaid Emergency Psychiatric Demonstration

24. Under Section 2707 of the Affordable Care Act, participating states can provide payment to non-government psychiatric hospitals for inpatient emergency psychiatric care, targeting Medicaid recipients aged 21 to 64 years who have expressed suicidal or homicidal thoughts or gestures and are determined to be dangerous to themselves or others.

A. True

B. False


Module 5: Structure and Reimbursement Methodologies

25. Historically, states structured their Medicaid programs as Fee for Service (FFS) delivery systems where a provider renders a service to a Medicaid consumer, submits a bill to the state Medicaid agency, and is paid a fee by the Medicaid agency for the provision of that service.

A. True

B. False


Managed Care: Arrangements

26. While states recognize physicians, physician group practices, or clinics under primary care case management (PCCM) programs that provide services to Medicaid enrollees, they do not acknowledge nurse practitioners, nurse midwives, and physician assistants as primary care providers.

A. True

B. False


Managed Care: Authorities

27. States are able to provide different benefits to people enrolled in a managed care delivery system by waiving:

A. Freedom of choice

B. Selective application

C. Mandatory implementation

D. Comparability of service


Section 1915(a) Voluntary Contracting

28. Which of the following is NOT one of the components of Section 1915(a) managed care authority?

A. It prohibits mandatory statewide managed care for certain populations

B. It allows the state to offer managed care statewide or limit the program by geography

C. It allows the state to offer a unique benefit package to specific populations

D. It prohibits the state from selectively contracting with plans


How Do States Set Reimbursement Rates for Services?

29. States have significant latitude in deciding how to structure reimbursement methodologies for the Medicaid services they provide as long as they meet payment standards.

A. True

B. False


Fee-for-Service (FFS) Rates

30. States may develop FFS rates based on the costs of providing the service, a percentage of what Medicare pays for equivalent services, and:

A. Generally accepted actuarial principles and practices

B. A review of what commercial payers pay in the private market

C. What is appropriate for the populations to be covered

D. None of the above


Prospective Payment Rates

31. In most states, Medicaid reimbursement for inpatient and outpatient hospital services is a retrospective, cost-based system based on what it has cost an efficient provider to serve patients in the past.

A. True

B. False


32. A patient-specific, prospective payment that is intended to cover the costs of care for all covered services delivered over a defined period is a:

A. Global payment

B. Individualized payment

C. Case rate payment

D. Bundled payment


Reimbursement Methodology for Federally Qualified Health Centers

33. FQHCs are guaranteed a minimum payment for services provided to Medicaid beneficiaries with each of the following stipulations EXCEPT:

A. The all-inclusive payment is specific to each health center and is calculated using an initial-year, per-visit rate based on the health center’s reasonable cost per visit

B. Each per-visit rate is based on a minimum reasonable fee

C. Payments are adjusted annually for inflation and increase if there is growth in the center’s scope of service

D. The payment is capped at a maximum upper payment limit


Module 6: Care Coordination Initiatives

34. Section 2703 of the Affordable Care Act allows states the option of amending their Medicaid State Plans to provide health home services for enrollees with chronic conditions.

A. True

B. False


35. Chronic conditions described in the Affordable Care Act include a mental and/or substance use disorder, ________, diabetes, heart disease, being overweight as evidenced by a BMI over 25, or having another condition that is approved by the HHS Secretary.

A. Epilepsy

B. Chronic pain

C. Asthma

D. Neurodegenerative disease


Money Follows the Person

36. The Money Follows the Person (MFP) Rebalancing Demonstration was enacted to assist states in developing community-based long-term care opportunities for individuals with intellectual disabilities or serious mental illness who are over age 55.

A. True

B. False


Module 7: Recent Federal Legislation and Medicaid and Medicare

37. The Mental Health Parity and Addiction Equity Act of 2008 mandates that health plans must provide mental health and substance abuse benefits, and applies to fully insured and self-insured group health plans covering more than 30 employees.

A. True

B. False


Mental and/or Substance Use Disorder (M/SUD) Benefits as Part of the Essential Health Benefits Package

38. According to the Institute of Medicine (IOM) Committee on Determination of Essential Health Benefits, requirements for a broad and robust M/SUD benefit should include coverage for and access to:

A. The full range of quality M/SUD prevention, treatment, rehabilitation, and recovery support, including the clinically appropriate type, level, and amount of care

B. All services, interventions, and strategies to help people avoid disease and to help people with these illnesses achieve and maintain long-term wellness

C. Services for children and families and services that are culturally appropriate

D. All of the above


The Affordable Care Act of 2010-Medicaid Expansion

39. The Affordable Care Act establishes a new Medicaid eligibility category for low-income adults between 19–64 years of age and with income at or below 133 percent of the federal poverty level (FPL), which is an annual income of approximately ________ for an individual and ________ for a family of four in 2013.

A. $13,864; $28,477

B. $15,282; $31,322

C. $17,963; $34,190

D. $19,441; $37,538


Implications for States that Implement the Medicaid Expansion

40. Under the terms of the expansion, all children in families earning between 0 and 133 percent of the federal poverty guidelines will be in Medicaid beginning in 2014, and Medicaid eligibility for this expansion group will be based on income only, with no asset or resource test.

A. True

B. False


Prevention and Wellness

41. The Affordable Care Act expands the current Medicaid State Plan rehab option to include any clinical preventive service recommended with a grade of A or B by the United States Preventive Services Task Force, such as alcohol misuse counseling, depression screening, and tobacco use counseling.

A. True

B. False


Module 8: The Relationship Between Medicare and Medicaid

42. Which of the following are NOT considered Medicare-Medicaid enrollees:

A. Those receiving Medicare and full Medicaid benefits

B. Those receiving assistance from a state’s Medicaid program to pay their Medicare premiums and, in some cases, cost sharing

C. Those who are enrolled in a Medicaid advantage plan and a Medicare managed care plan

D. Those receiving assistance in paying Medicare out-of-pocket costs and receiving full Medicaid benefits


Behavioral Health Services Covered by Medicare

43. Medicare Part A helps cover medically necessary inpatient hospital behavioral health care provided in a general hospital or in a psychiatric hospital, including an individual’s room, meals, private duty nursing, and necessary personal items.

A. True

B. False


44. Behavioral health outpatient services covered under Medical Part B include:

A. Family counseling, if the main purpose is to help with treatment

B. Support groups to increase socialization skills

C. Prescribed smoking and tobacco-use cessation agents

D. All of the above


Module 9: Practical Guides to Medicaid State Plans and Waivers

45. A Medicaid State Plan is a contractual agreement that dictates the procedures for administering a Medicaid program, including those related to the methods of administration, eligibility criteria, covered services, and reimbursement methodologies.

A. True

B. False


Process for Amending the State Plan

46. Common reasons for amending the State Plan include changes in budgetary factors, additions or changes in the amount, scope, or duration of a service, changes in eligibility determination processes, and changes in a reimbursement methodology.

A. True

B. False


Types of Waivers

47. States use waiver authority under section 1915(b) of the Social Security Act to create a mandatory managed care program which allows individuals up to age 25 in managed care programs and prohibits authorities from limiting programs based on geography.

A. True

B. False


Module 10: Basic Information and Tools

48. Medicaid staff and behavioral health agency staff will likely have a cross-cultural relationship by definition and must learn to work together even with competing and complementary interests.

A. True

B. False


49. Any well-developed Medicaid-related policy requires good clinical judgment, ______________, understanding of the system-level implications for consumers, and knowledge of associated regulatory and implementation considerations.

A. Clear communication strategies

B. Project management input

C. Financial consideration

D. Established ground rules


Behavioral Health Staff Working With Regional and Central Office Staff from the Centers for Medicare & Medicaid Services

50. The primary relationship of regional and central office staff from the Centers for Medicare & Medicaid Services must be with behavioral health staff that they are working with, so the health staff should turn to these experts for definitive answers when Medicare or Medicaid issues arise.

A. True

B. False


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