Module 7 Flashcards
(20 cards)
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.
Biological based
disorders
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.
Behavioral health
carve-out
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.
Mental Health Parity
and Addiction Equity
Act of 2008
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.
Employee Assistance
Plan
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
Acute inpatient
facility
A cost containment
practice that
requires preauthorization to
access treatment
Preauthorization for
care access
A cost containment
practice that analyzes
claims data and
identifies high-risk,
potentially high-cost
members and intervenes
to avoid preventable
treatment costs
Predictive modeling
and risk assessment
A cost containment
practice that collects
data after the fact via
provider assessment
reports and claims data
Performance
measurement
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
Case management
Cost containment that
determines the
medical necessity and
appropriateness of
treatment provided
Utilization review and
management
Cost containment
that uses
developed tools to
assess treatment
effectiveness and
quantify results
Outcomes
management
Cost containment
that considers
medical and
behavioral health
care service results
in conjunction with
one another
Coordination of care
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.
Depression disease
management
program
Cost containment that
offers after-care
programs to members
who complete a
course of chemical
dependency
treatment
Substance abuse
relapse program
Drugs that affect psychic
function, behavior, or
experience that are part
of the medical benefit
and are generally
administered by
pharmacy benefit
managers (PBMs).
Psychotropic
medications
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.
Market composition
of behavioral health
care benefits
This law plays an
important part in
protecting sensitive
patient information
gathered during
behavioral
treatment
Health Insurance
Portability and
Accountability Act
- Fully insured
- Shared risk
- Administrative
services only (ASO)
MBHO funding
arrangements
- Employee/employer
awareness of the
program’s services/value - Appropriate use of
benefits
3) How well a vendor
and its providers
prevent/manage costly
disorders
Requirements for an
effective behavioral
health care program
Granted by
the National
Committee for
Quality
Assurance
MBHO accreditation
