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Medicaid and Behavioral Health Overview

Module 3: The Medicaid Behavioral Health Services Benefit Package

1. The Affordable Care and the Mental Health Parity and Addiction Equity Act (MHPAEA) provide a number of options and changes that can have a dramatic and positive impact on the lives of those requiring behavioral health services, including each of the following EXCEPT:

A. An emphasis on behavioral health parity

B. New home and community-based behavioral health service options

C. Case management and personal care

D. Payment reform initiatives that facilitate integrated systems of care


Behavioral Health Services Included in the State Plan

2. The State Plan rehab option is one of the most important and commonly used service components of Medicaid by which states provide noninpatient services to individuals with mental and substance use disorders.

A. True

B. False


3. One benefit of providing services under the rehab option is that the services can only be performed by individuals who are licensed under professional scope of practice laws, which helps to ensure treatment credibility.

A. True

B. False


Inpatient Psychiatric Care for Individuals Younger Than 21 Years

4. Inpatient psychiatric services are provided to children and young adults who need intensive treatment for a longer period than acute hospitalization, and inpatient psychiatric care is mandatory when it is determined that the child requires an institutional level of care and when:

A. A child’s condition is diagnosed through an EPSDT screen

B. It is recommended by a physician, psychologist, social worker, nurse, or other licensed health care practitioner covered by Medicaid

C. When the child or young adult requires treatment or remediation of a condition that results in an individual’s loss of functioning

D. None of the above


Section 1915(i) Services

5. Under section 1915(i) of the Social Security Act, states have the ability to offer a variety of home and community-based service (HCBS) to individuals with chronic mental illness, including each of the following EXCEPT:

A. Day treatment or other partial hospitalization services

B. Psychosocial rehabilitation services

C. Clinic services

D. Respite care


Behavioral Health Services Provided as Part of a Waiver or Voluntary Managed Care Program

6. A state may use its authority to implement a voluntary managed care program simply by executing a contract with plans that the state has procured using a competitive bidding process and by obtaining Centers for Medicare & Medicaid Services (CMS) approval.

A. True

B. False


Case Management

7. Case management is integral in helping individuals understand their health situation, how to access physical and behavioral health treatment options available to them, and:

A. How to enhance their involvement in their own healthcare plan

B. Ways in which they can access other community support

C. How to access customized goods and services, as well as family training and supports

D. How to improve their personal care and individual support


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

8. In addictions and mental health systems, assessment, specialized evaluations, service planning, consumer/family education, and outreach fall under the category of Healthcare/Preventative Health Services.

A. True

B. False


Module 4: Providers of Behavioral Health Services-Medicaid Providers

9. The ability to ensure that Medicaid consumers can access needed services in a reasonably timely manner depends on having a sufficient number and type of providers in a given area, and these providers must be willing to participate in the Medicaid program.

A. True

B. False


10. When setting provider requirements and reimbursement rates, states must consider efficiency and economy as well as:

A. Avaliability of providers

B. Quantity of service available

C. Quality of care

D. Consistency of resources


Is It a Service or a Provider?

11. While prescription drugs, dentures, family planning, and respiratory care are classified as services, a federally qualified health center (FQHC), inpatient hospital, nurse midwife, rural health clinic, and nursing facility are specific types of providers of certain services.

A. True

B. False


State-Specific Professional Practice Acts

12. The provider agency or independent practitioner who has a direct relationship with the state is known as the Medicaid provider, while the clinician, therapist, program staff, or paraprofessional who provides hands-on care to the Medicaid consumer is known as the benefit provider.

A. True

B. False


Providers of Behavioral Health Services-Community Mental Health Centers

13. Community Mental Health Centers were created to develop an array of medical, social, __________ and rehabilitative supports and services designed to address the practical needs of individuals who were being discharged from state psychiatric hospitals.  

A. Educational

B. Spiritual

C. Vocational

D. Environmental


Federally Qualified Health Centers

14. A health center that receives grant funding to serve homeless populations is required by statute to provide mental health and employment services, either with staff or under contract with outside specialty providers.

A. True

B. False


Institutions for Mental Diseases and Substance Use Disorder Services (IMD/SUD)

15. In evaluating IMDs with regard to SUD services, the continuum of care for chemical dependency includes on one end of the spectrum treatment that follows a psychiatric model and is performed by medically trained and licensed personnel, and at the other end facilities that provide services based on peer counseling models and meetings to promote group support.

A. True

B. False


Medication-Assisted Treatment Providers

16. Which of the following is NOT one of the Food and Drug Administration approved drugs that has proven effective in the treatment of alcohol dependence in the United States?

A. Disulfiram

B. Naltrexone

C. Acamprosate

D. Buprenorphine


Module 7: Recent Federal Legislation and Medicaid and Medicare

17. Application of The Mental Health Parity and Addiction Equity Act of 2008 to Children’s Health Insurance Program (CHIP), a federal/state funded health insurance program for children, is much more specific and limited than its application to Medicaid.

A. True

B. False


The Relationship of the Affordable Care Act’s Essential Health Benefits to the Mental Health Parity and Addiction Equity Act

18. The Affordable Care Act requires that by 2014, health plans in the individual and small group markets offer an essential health benefits package and calls for the recommendation of:  

A. A process for defining and updating the package

B. A specific list of benefits

C. Both a process for defining and updating the package and a specific list of benefits

D. None of the above


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

19. Under the Affordable Health Care Act, requirements for a broad and robust M/SUD benefit should include coverage for ongoing supports to help people manage their disease throughout their lifetimes, as well as services that are culturally appropriate.

A. True

B. False


Provisions Included in the Affordable Care Act That Impact Medicaid

20. Through the Health Insurance Marketplace, individuals earning more than their state’s Medicaid eligibility threshold but less than _________ of the federal poverty guidelines have access to federal premium tax credits and/or cost sharing reductions to help pay for private health insurance.  

A. 200 percent

B. 300 percent

C. 400 percent

D. 500 percnet


Implications for States that Implement the Medicaid Expansion

21. Under the Medicaid expansion, Medicaid eligibility will be based on income only, with no asset or resource test.

A. True

B. False


Hospital and Other Quality Initiatives- Reducing Avoidable Hospital Readmissions in Medicare

22. For discharges from hospitals occurring on or after October 1, 2012, there will be a reduction in inpatient reimbursement for hospitals with excess readmissions for certain conditions, which will initially include heart attacks, congestive heart failure, and:

A. Healthcare associated infections

B. Chronic kidney disease

C. Pneumonia

D. Stroke


Module 8: The Relationship Between Medicare and Medicaid

23. Individuals who are dually eligible for Medicare and Medicaid have Medicaid as their primary coverage, and Medicare as the payer of last resort.

A. True

B. False


24. Medicare-Medicaid enrollees are among the most chronically ill and costly individuals enrolled in both the Medicare and Medicaid programs, and they are heavy users of behavioral health services.

A. True

B. False


Who is Eligible for Medicare?

25. In order for individuals younger than age 65 to qualify for Medicare because of a mental disorder, the evaluation of the disability requires:

A. Documentation of a medically determinable impairment

B. Consideration of the degree of limitation such impairment may impose on the individual's ability to work

C. Consideration of whether these limitations have lasted or are expected to last for a continuous period of at least 12 months

D. All of the above


Utilization and Cost

26. Social characteristics of Medicare-Medical enrollees include each of the following EXCEPT:  

A. Overall, Medicare-Medicaid enrollees have less education and much lower income than all other individuals enrolled in Medicare

B. These individuals are primarily those under age 65 with a poorly treated disability

C. Medicare-Medicaid enrollees are more likely than Medicare enrollees who are not dually eligible to have mental health needs

D. They have more significant and costly health needs and require more long-term services and supports than Medicare enrollees who are not dually eligible


What Services Does Medicare Cover?

27. Individuals younger than 65 are eligible for hospital insurance (Medicare Part A) without having to pay a premium if they have received Social Security or Railroad Retirement Board disability benefits for 24 months.

A. True

B. False


28. Psychiatric evaluation and medication management are outpatient services covered under Medicare Advantage (Medicare Part C).

A. True

B. False


Prescription Medications, Medicare Part D, and Medicaid Implications

29. With the advent of Medicare Part D, plans must now provide coverage for most antidepressant, anticonvulsant, and antipsychotic medications as well as benzodiazepines and barbiturates.

A. True

B. False


30. As coordinating and integrating care for Medicare-Medicaid enrollees continues to be a priority, behavioral health policymakers must be attuned to developments and involved in shaping policy in ways that help ensure success for consumers and providers.

A. True

B. False


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