HCMG EXAM QUESTIONS AND ANSWERS LATEST
EDITION ALREADY GRADED A+
Explain the parity laws
Some states enacted laws ensuring mental and physical illnesses received the same benefits for
insurance (initiated because of discrimination for MI people). Mandated mental health benefits.
However, these weren't covering that many people - they did not apply to self-insured firms (small
firms) —> only really applies to 50% of the population
What is the mental health parity and addiction equity act? What groups do these laws extend to?
Created in 2008. Aimed to eliminate historical differences in group HI coverage for mental health and
substance abuse benefits and medial/surgical benefits.
If an employer offers behavioral coverage, cost sharing and treatment limits for MH/SA benefits must =
those for medical/surgical - this wasn't mandated, though, so didn't do much.
*they do not extend to individual insurance market, only ESHI plans, Medicare, Medicaid
true or false? Under managed care, the provision of MH/SA benefits does not lead to a large increase
in costs
True
What is the drawback to managed care and mental health?
Although they provide services to a larger proportion of clients, they achieve this in part by decreasing
the intensity of care for those most severely disabled
How did congress take action a second time for mental health?
The ACA! They included mental health and substance abuse services as essential health benefits!
What are examples of quantitative treatment limitations?
Different cost sharing, visit limit
Non qualitative treatment limits examples:
Prior authorization, utilization review, reimbursement rates - making treatment inadequate for provider
What are the gaps that still remain for mental health Tx?
Lots of providers may not take your insurance; phantom providers (say they take your insurance, but do
not ever see people from that group)
Which specialty is least likely to take insurance - especially Medicaid. How is this combatted if
someone needs medication?
Psychiatrists; 80% of antidepressants are prescribed in primary care (not a specialist)
, What is a potential policy solution to improve access gap for mental health resources?
Broaden the scope of practice for nurse practitioners!! - allow them to write prescriptions. This has a
HUGE positive effect!!!
What is the systemic issue with mental illness and incarceration keeping in mind history of mental
illness?
Post deinstitutionalization period, many of the individuals were released into the community without
support and ended up incarcerated —> instead of being deinstitutionalized, many people ended up
being "trans-institutionalized" into jails and prisons :(
what is the most common mental disorder in incarcerated populations?
Depressive disorder, then manic-depression/bipolar/mania
T/F: mental disorders are the most costly conditions in the US
True
When do mental health disorders usually manifest?
Adolescence. National prevalence of >= 1 mental health disorder is 16.5%
What is the Currie and Stabile study (2009) - has to do with mental health. What are the findings?
Looked at relationship between common mental health conditions and future outcomes - used sibling
comparisons to try to control for family factors that may be correlated w/ mental health conditions and
poor outcomes.
findings: behavior problems have a large negative effect on educational outcomes, especially for ADHD
What does the Johnson, Schumer, and Shields (2011) data show?
there is a strong correlation between mental health of moms and kids (father doesn't correlate as
strongly as mother)
What outcomes do we care about when talking about health (think Molly Candon speaker)
Treatment working and lasting effect
What is the iron triangle model that Prof Candon talked about
Cost, access, quality
Which outcomes did the behavioral health shift to focusing on?
Value instead of volume — emergency room utilization, primary care visit (check ins for MH/SUD),
follow-up rates
What does QALY and DALY stand for?
Quality adjusted life years; disability adjusted life years
What is the behavioral health take on fee-for-service?
EDITION ALREADY GRADED A+
Explain the parity laws
Some states enacted laws ensuring mental and physical illnesses received the same benefits for
insurance (initiated because of discrimination for MI people). Mandated mental health benefits.
However, these weren't covering that many people - they did not apply to self-insured firms (small
firms) —> only really applies to 50% of the population
What is the mental health parity and addiction equity act? What groups do these laws extend to?
Created in 2008. Aimed to eliminate historical differences in group HI coverage for mental health and
substance abuse benefits and medial/surgical benefits.
If an employer offers behavioral coverage, cost sharing and treatment limits for MH/SA benefits must =
those for medical/surgical - this wasn't mandated, though, so didn't do much.
*they do not extend to individual insurance market, only ESHI plans, Medicare, Medicaid
true or false? Under managed care, the provision of MH/SA benefits does not lead to a large increase
in costs
True
What is the drawback to managed care and mental health?
Although they provide services to a larger proportion of clients, they achieve this in part by decreasing
the intensity of care for those most severely disabled
How did congress take action a second time for mental health?
The ACA! They included mental health and substance abuse services as essential health benefits!
What are examples of quantitative treatment limitations?
Different cost sharing, visit limit
Non qualitative treatment limits examples:
Prior authorization, utilization review, reimbursement rates - making treatment inadequate for provider
What are the gaps that still remain for mental health Tx?
Lots of providers may not take your insurance; phantom providers (say they take your insurance, but do
not ever see people from that group)
Which specialty is least likely to take insurance - especially Medicaid. How is this combatted if
someone needs medication?
Psychiatrists; 80% of antidepressants are prescribed in primary care (not a specialist)
, What is a potential policy solution to improve access gap for mental health resources?
Broaden the scope of practice for nurse practitioners!! - allow them to write prescriptions. This has a
HUGE positive effect!!!
What is the systemic issue with mental illness and incarceration keeping in mind history of mental
illness?
Post deinstitutionalization period, many of the individuals were released into the community without
support and ended up incarcerated —> instead of being deinstitutionalized, many people ended up
being "trans-institutionalized" into jails and prisons :(
what is the most common mental disorder in incarcerated populations?
Depressive disorder, then manic-depression/bipolar/mania
T/F: mental disorders are the most costly conditions in the US
True
When do mental health disorders usually manifest?
Adolescence. National prevalence of >= 1 mental health disorder is 16.5%
What is the Currie and Stabile study (2009) - has to do with mental health. What are the findings?
Looked at relationship between common mental health conditions and future outcomes - used sibling
comparisons to try to control for family factors that may be correlated w/ mental health conditions and
poor outcomes.
findings: behavior problems have a large negative effect on educational outcomes, especially for ADHD
What does the Johnson, Schumer, and Shields (2011) data show?
there is a strong correlation between mental health of moms and kids (father doesn't correlate as
strongly as mother)
What outcomes do we care about when talking about health (think Molly Candon speaker)
Treatment working and lasting effect
What is the iron triangle model that Prof Candon talked about
Cost, access, quality
Which outcomes did the behavioral health shift to focusing on?
Value instead of volume — emergency room utilization, primary care visit (check ins for MH/SUD),
follow-up rates
What does QALY and DALY stand for?
Quality adjusted life years; disability adjusted life years
What is the behavioral health take on fee-for-service?
