Public Policy

Question 1

Fee for Service:

Answer 1

Type of indemnity insurance. Insurance pays whatver bills are submitted that meet enrollee benefit criteria.

Question 2

Traditional plans:

Answer 2

Type of indemnity insurance. No managed care techniques.

Question 3

What is a managed care organization?

Answer 3

Company that manages insurance benefits by reviewing and approving treatment interventions based on medical necessity.

Question 4

Capitation:

Answer 4

Provider gets a fixed monthly fee per insured person (enrollee), irrespective of how many enrollees receive treatment adn how much it costs.

Question 5

Mental Health Parity and Addiction Equity Act

Answer 5

2008 federal law that provides mental health and substance use disorder coverage parity with meical/surgical coverage. Copay is 20%.

Question 6

What does Medicare Part A cover?

Answer 6

Hospital inpatient mental helath care. Room, meals, nursing care, and related services/supplies.

Question 7

What does Medicare Part B cover?

Answer 7

Outpatient services including visits with psychiatry, psychology, or clinical SW. Lab tests, partial hospitalization services. Covers depression screenings and tobacco cessation counseling.

Question 8

What does Medicare Part C cover?

Answer 8

Run by private insurers. Capitation fee to insurers, may cover vision, plans cover services provided y Medicare Part A, B, and sometimes D.

Question 9

What does Medicare Part D cover?

Answer 9

Prescription Drugs.

Question 10

Physician Accepting Assignment of Medicare

Answer 10

Physician agrees to abide by Medicare rules and must accept only the amounts medicare approves for services. To only chare pt or other insurance the pt may have, the medicare deductible, or the coinsurance (copay) amount.

Question 11

Medicaid ‘spend down’, and also what services does medicaid provide that medicare does not?

Answer 11

Must spend down one’s wealth to become eligible for medicaid . Medicaid offers the nursing home services and home health care whereas medicare does not.

Question 12

IDEA act

Answer 12

Requirements include the least restrictive environment and free appropriate public education

Question 13

How long does a school have to implement an IEP after it is determined that it is needed?

Answer 13

30 days

Question 14

Community Mental Health Centers Act of 1963

Answer 14

Federal govt funds community health centers across the USA.

Question 15

“Grassroots” organization to help destigmatize mental help?

Answer 15

National Alliance on Mental Illness (NAMI), is a grassroots organization that seeks to destigmatize mental illness and increase government awareness of the needs and rights of people with mental illness

Question 16

Under what condition can a pharm company person sit in with a psychiatrist and patient?

Answer 16

Never

Question 17

IEP must be reviewed at least how often?

Answer 17

once per year

Question 18

What is going on with an Individualized Family Service Plan (IFSP)?

Answer 18

An Individualized Family Service Plan (IFSP) provides special services for young children with developmental delays. An IFSP only applies to children from birth to three years of age

Question 19

Olmstead Decision

Answer 19

The 1999 Olmstead decision set out clear standards for integrated community services for individuals with severe, chronic psychiatric illness who had, to that point, been largely cared for in state hospitals. The decision mandated states to create public health services to meet the needs of chronically mentally ill persons to allow them to live in the community, including housing.

Question 20

Disabilities Education Act (IDEA) (1975 and updated in 2004). Private school associated with this?

Answer 20

The public school district in which the private school is located has a responsibility to identify any students in their area in need of services and to serve them

Question 21

What is the role of the special ed teacher?

Answer 21

Supplementary aids and services that the child may need