Quantum Units Education®

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:

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.

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.

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:

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:

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.

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:

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.

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.

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

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.

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.

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.  

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.

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.

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?

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.

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:  

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.

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.  

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.

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:

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.

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.

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:

Utilization and Cost

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

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.

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

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.

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.