Module 7 Flashcards

1
Q

Schizophrenia, bipolar disorder, and major depressive order are this type of disorder. They profoundly disrupt a person’s feeling, thinking, mood, ability to relate, and capacity to cope with life’s demands.

A

Biological based disorder

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2
Q

This type of program separates mental health and chemical dependency services from a medical plan and provides them under a separate contract from a separate company known as a managed behavioral health care organization.

A

Behavioral health carve-out

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3
Q

This act extended mental health benefits coverage to include substance use disorder benefits. Financial requirements and treatment limitations for mental health/substance abuse can’t be more restrictive than for medical/surgical benefits.

A

Mental Health Parity and Addiction Equity Act of 2008

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4
Q

This type of program first focused on substance abuse problems and currently is used in a comprehensive approach to support members with a range of employee and family issues.

A

Employee Assistance Plan

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5
Q

A behavioral health facility designed to treat the most serious cases such as those who are unable to care for themselves and may have suicidal/homicidal tendencies

A

Acute inpatient facility

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6
Q

A cost containment practice that requires preauthorization to access treatment

A

Preauthorization for care access

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7
Q

A cost containment practice that analyzes claims data and identifies high-risk, potentially high-cost members and intervenes to avoid preventable treatment costs

A

Predictive modeling and risk assessment

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8
Q

A cost containment practice that collects data after the fact via provider assessment reports and claims data

A

Performance measurement

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9
Q

Cost containment that uses a manager to coordinate members’ care in collaboration with treating providers, facilities, community resources, + family members to ensure patients receive the right level of care

A

Case management

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10
Q

Cost containment that determines the medical necessity and appropriateness of treatment provided

A

Utilization review and management

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11
Q

Cost containment that uses developed tools to assess treatment effectiveness and quantify results

A

Outcomes management

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12
Q

Cost containment that considers medical and behavioral health care service results in conjunction with one another

A

Coordination of care

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13
Q

Cost containment that supports the clinicianpatient relationship and plan of care and emphasizes prevention of disease-related issues and complications using evidence-based guidelines and patient empowerment tools.

A

Depression disease management program

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14
Q

Cost containment that offers after-care programs to members who complete a course of chemical dependency treatment

A

Substance abuse relapse program

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15
Q

Drugs that affect psychic function, behavior, or experience that are part of the medical benefit and are generally administered by pharmacy benefit managers (PBMs).

A

Psychotropic medications

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16
Q

The majority of behavioral health benefits are purchased by large groups. Smaller groups are more likely to have behavioral benefits integrated into the general health plan, which may/may not have a specialty MBHO provide the behavioral benefit.

A

Market composition of behavioral health care benefits

17
Q

This law plays an important part in protecting sensitive patient information gathered during behavioral treatment

A

Health Insurance Portability and Accountability Act

18
Q
  • Fully insured
  • Shared risk
  • Administrative services only (ASO)
A

MBHO funding arrangements

19
Q
  1. Employee/employer awareness of the program’s services/value
  2. Appropriate use of benefits
  3. How well a vendor and its providers prevent/manage costly disorders
A

Requirements for an effective behavioral health care program

20
Q

Granted by the National Committee for Quality Assurance

A

MBHO accreditation