CEBS GBA 2 CONCLUDING REVIEW SHEET
PRACTICE SOLUTION BUNDLED FULLY
VERIFIED ONE HUNDRED PERCENT PASS
GUARANTEED
⩥ Discuss the provisions of MHPAEA and how they interact with ACA
(Mod 7.3).
Answer: -Plans may not impose financial requirements
(deductibles/coinsurance) or treatment limitations on MH/SA that are
more restrictive than med/surg. Parity required for both quantitative
(freq of treatment, number of visits) and non-quantitative (formulary
design) treatment limitations.
-Parity applies separately to Inpatient In-Network, Inpatient Out of
Network, OutPatient In-Network, OutPatient Out of Network,
Emergency Care, Prescription Drugs
-Separate cost sharing requirements for MH/SA are not allowed even if
they are equal to med/surg: can't have combined deductible
-2 Disclosure requirements - plans must make available criteria for
determining medical necessity of MH/SA and reasons for denials.
Under ACA, MH/SA are essential benefits and as such, annual/lifetime
limits may not be imposed.
,Also under ACA, nongrandfathered groups must provide preventative
services without cost sharing however not required to provide full range.
⩥ Under MHPAEA, what restrictions are imposed on a plan with
multitier networks? (Mod 7.3).
Answer: If there are an uneven number of tiers, the plan must treat the
least restrictive financial requirement or quantitative treatment limitation
applying to substantially all MH/SA benefits across all provider tiers.
⩥ Discuss the cost increase provision as it applies to MHPAEA (Mod
7.3).
Answer: If compliance requires changes that increase plan costs by at
least 2% in the 1st year or at least 1% in any subsequent year, law
exempts the plan from MHPAEA for following plan year; lasts for one
year and applies for alternating years.
⩥ Describe plan features of behavioral health plan (Mod 7.4).
Answer: Cover inpatient and outpatient mental health treatment services
- residual treatment and partial or day hospitalizations and intensive
outpatient (psych rehab, case management)
⩥ What are the basic types of funding arrangements of a MBHO? (Mod
7.4).
Answer: -Fully Insured (Avg 3-6% of Med Plan Prem)
,-Shared Risk (Prem based on Proj Claims Cost; if claims exceed certain
amount, MBHO picks up; can refund prem if below)
-Administrative Services Only (For a fee, MBHO handles claim
management - larger ER's)
⩥ How have EAPs formed? (Mod 7.4).
Answer: Originally focused on substance abuse problems but today take
a comprehensive approach to support members with many issues -
prevention/health & wellness/HR support
⩥ What is involved in provided an effective behavioral health program?
(Mod 7.5).
Answer: Should include integrated health/chemical dependency benefit
that includes inpatient/outpatient as well as EAP.
-EE and ER awareness of services/value
-Appropriate use of benefits
-How well vendor/network prevent and manage costly claims/disorders
⩥ Who makes up behavioral health network? (Mod 7.5).
Answer: Individual and multispecialty: clinical psych, social workers,
therapists, psych nurses
⩥ Compare differences of behavioral health treatments: inpatient, partial
(day), outpatient (Mod 7.5).
, Answer: -Acute inpatient: most severe, unable to care for themselves:
suicidal, homicidal
-Partial hospital: offer intensive day treatment but patient returns home
overnight
-Intensive Outpatient: patient needs more intensive than weekly, but
fewer hours each day than partial facilities
⩥ Describe cost containment practices of MBHO (Mod 7.5).
Answer: -Care Access (Patient calls call center for referral - intake asks
q's)
-Predictive Modeling/Risk Assessment
-Performance Management
-Case Management
-Utilization Review/Management
-Outcomes Management
-Coordination of Care
-Depression Disease Management
-Substance Abuse Relapse Program
⩥ What is highest level of accreditation granted by MBHOs by the
National Committee for Quality Assurance? (Mod 7.5).
Answer: Full - effective for 3 years.
PRACTICE SOLUTION BUNDLED FULLY
VERIFIED ONE HUNDRED PERCENT PASS
GUARANTEED
⩥ Discuss the provisions of MHPAEA and how they interact with ACA
(Mod 7.3).
Answer: -Plans may not impose financial requirements
(deductibles/coinsurance) or treatment limitations on MH/SA that are
more restrictive than med/surg. Parity required for both quantitative
(freq of treatment, number of visits) and non-quantitative (formulary
design) treatment limitations.
-Parity applies separately to Inpatient In-Network, Inpatient Out of
Network, OutPatient In-Network, OutPatient Out of Network,
Emergency Care, Prescription Drugs
-Separate cost sharing requirements for MH/SA are not allowed even if
they are equal to med/surg: can't have combined deductible
-2 Disclosure requirements - plans must make available criteria for
determining medical necessity of MH/SA and reasons for denials.
Under ACA, MH/SA are essential benefits and as such, annual/lifetime
limits may not be imposed.
,Also under ACA, nongrandfathered groups must provide preventative
services without cost sharing however not required to provide full range.
⩥ Under MHPAEA, what restrictions are imposed on a plan with
multitier networks? (Mod 7.3).
Answer: If there are an uneven number of tiers, the plan must treat the
least restrictive financial requirement or quantitative treatment limitation
applying to substantially all MH/SA benefits across all provider tiers.
⩥ Discuss the cost increase provision as it applies to MHPAEA (Mod
7.3).
Answer: If compliance requires changes that increase plan costs by at
least 2% in the 1st year or at least 1% in any subsequent year, law
exempts the plan from MHPAEA for following plan year; lasts for one
year and applies for alternating years.
⩥ Describe plan features of behavioral health plan (Mod 7.4).
Answer: Cover inpatient and outpatient mental health treatment services
- residual treatment and partial or day hospitalizations and intensive
outpatient (psych rehab, case management)
⩥ What are the basic types of funding arrangements of a MBHO? (Mod
7.4).
Answer: -Fully Insured (Avg 3-6% of Med Plan Prem)
,-Shared Risk (Prem based on Proj Claims Cost; if claims exceed certain
amount, MBHO picks up; can refund prem if below)
-Administrative Services Only (For a fee, MBHO handles claim
management - larger ER's)
⩥ How have EAPs formed? (Mod 7.4).
Answer: Originally focused on substance abuse problems but today take
a comprehensive approach to support members with many issues -
prevention/health & wellness/HR support
⩥ What is involved in provided an effective behavioral health program?
(Mod 7.5).
Answer: Should include integrated health/chemical dependency benefit
that includes inpatient/outpatient as well as EAP.
-EE and ER awareness of services/value
-Appropriate use of benefits
-How well vendor/network prevent and manage costly claims/disorders
⩥ Who makes up behavioral health network? (Mod 7.5).
Answer: Individual and multispecialty: clinical psych, social workers,
therapists, psych nurses
⩥ Compare differences of behavioral health treatments: inpatient, partial
(day), outpatient (Mod 7.5).
, Answer: -Acute inpatient: most severe, unable to care for themselves:
suicidal, homicidal
-Partial hospital: offer intensive day treatment but patient returns home
overnight
-Intensive Outpatient: patient needs more intensive than weekly, but
fewer hours each day than partial facilities
⩥ Describe cost containment practices of MBHO (Mod 7.5).
Answer: -Care Access (Patient calls call center for referral - intake asks
q's)
-Predictive Modeling/Risk Assessment
-Performance Management
-Case Management
-Utilization Review/Management
-Outcomes Management
-Coordination of Care
-Depression Disease Management
-Substance Abuse Relapse Program
⩥ What is highest level of accreditation granted by MBHOs by the
National Committee for Quality Assurance? (Mod 7.5).
Answer: Full - effective for 3 years.
