categories which mental disorders can loosely be placed
- adjustment disorders
- anxiety disorders
- childhood disorders
- eating disorders
- mood disorders
- cognitive disorders
- personality disorders
- psychotic disorders
- substance-related disorders
why did insurers start to place limits on outpatient mental healthcare
- treatment continued for indefinite amount of time
- subjectivity to treatment
Market composition of behavioral health care benefits:
- majority sold in US are purchased by large groups that buy comprehensive health care
- the smaller the group, the more likely they are sold at an integrated part of the general health plan
seperates, or carves out mental health and chemical dependency services from a medical plan and provides them separately from a company called a managed behavioral health care organization (MBHO)
behavioral health care carve out program
Cost containment practices of MBHO’s (9)
- care access
- predictive measurement
- performance measurement
- case management
- utlization review
- outcomes management
- coordination of care
- depression disease management programs
- substance abuse relapse programs
Some innovative approaches that might succeed in meeting critical needs of mental health patients (3)
- proactive disease mgmt programs
- outreach to people who want treatment but do not know how to access or finding a good therapist
- ways of delivering therapy that are most accesible and cost effective
drugs that affect psychic function, behavior or experience, and they are part of the medical benefit and generally administered by companies contracting with health plans called pharmacy benefit managers (PBM)
Psychotropic drugs
they take a comprehensive approach to support members with a range of employee and family issues
employee assistance programs (EAPs)
____ Plays an important part in protecting sensitive patient information gathered during behavioral treatment
Health Insurance Portability and Accountability Act (HIPAA)
3 basic types of funding arrangements of an MBHO
- fully insured
- shared-risk
- admin services only (ASO)
typical plan feature of behavioral health care benefit plans
- in and outpatient mental health treatments services
- intermediate mental health services
- parity benefit (severe mental illness benefit)
designed for the most acute tretment needs, meaning individuals who are unable to care for themselves and may be suicidal or homicidal`
inpatient facilities
reasons MBHO has a potentail for significant savings
- managed by firms specializing in behavioral health treatment
- allows large self funded employers to offer the same behavioral health benefits across all health plans offered
- allows health plan to minimize adverse selection
continues rules as to limits for mental health benefits and amends them to extend to substance use disorder benefits as well.
Mental Health Parity and Addiction Act of 2008
what challenge do Psychotropic drugs pose for MBHOs?
MBHOs are often unaware if Rx’s are the right doasges or types
offer intensive treatment during the day but patients return home over night
partial (day) treatment centers
Provisions of MHPAEA:
- plans may not impose financial requirements or treatment limitations on MH/SUD benefits that are more restrictive than the “predominant”
- the parity requirements apply separately to 6 classifications of benefits
- separate cost sharing requirements for MH/SUD benefits even if they are equivelant to those for medical/surgical benefits
- the law includes two disclosure requirements
the effectiveness of a behavioral health program depends on (3):
- employee and employer awareness of the programs services and value
- appropriate use of the benefits
- how well the behavioral vendor and its network providers prevent and manage costly disorders
the highest level of accreditation granted to MBHOs by the National Committee for Quality Assurance (NCQA) is ____ and effective for a _____ year period
full, 3
act was passed to establish parity between mental health benefits and other helth insurance
Mental Health Parity Act of 1996 (MHPA)
