Public Policy Flashcards
Fee for Service:
Type of indemnity insurance. Insurance pays whatver bills are submitted that meet enrollee benefit criteria.
Traditional plans:
Type of indemnity insurance. No managed care techniques.
What is a managed care organization?
Company that manages insurance benefits by reviewing and approving treatment interventions based on medical necessity.
Capitation:
Provider gets a fixed monthly fee per insured person (enrollee), irrespective of how many enrollees receive treatment adn how much it costs.
Mental Health Parity and Addiction Equity Act
2008 federal law that provides mental health and substance use disorder coverage parity with meical/surgical coverage. Copay is 20%.
What does Medicare Part A cover?
Hospital inpatient mental helath care. Room, meals, nursing care, and related services/supplies.
What does Medicare Part B cover?
Outpatient services including visits with psychiatry, psychology, or clinical SW. Lab tests, partial hospitalization services. Covers depression screenings and tobacco cessation counseling.
What does Medicare Part C cover?
Run by private insurers. Capitation fee to insurers, may cover vision, plans cover services provided y Medicare Part A, B, and sometimes D.
What does Medicare Part D cover?
Prescription Drugs.
Physician Accepting Assignment of Medicare
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.
Medicaid ‘spend down’, and also what services does medicaid provide that medicare does not?
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.
IDEA act
Requirements include the least restrictive environment and free appropriate public education
How long does a school have to implement an IEP after it is determined that it is needed?
30 days
Community Mental Health Centers Act of 1963
Federal govt funds community health centers across the USA.
“Grassroots” organization to help destigmatize mental help?
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
Under what condition can a pharm company person sit in with a psychiatrist and patient?
Never
IEP must be reviewed at least how often?
once per year
What is going on with an Individualized Family Service Plan (IFSP)?
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
Olmstead Decision
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.
Disabilities Education Act (IDEA) (1975 and updated in 2004). Private school associated with this?
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
What is the role of the special ed teacher?
Supplementary aids and services that the child may need
