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Course 3B_L1 - Quiz 1

 

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1)
One of the main themes of a managed system of care is 'containing costs' while also improving the quality of care.
 
True False
 
2)
For the past few years, the 'redesign of the delivery system' has meant that . . .
 
there was a reduction of the pre-managed care Provider Fee Structure by 50%.
the Federal government assumed responsibility for all health care.
there was a massive disqualification of historical providers from participation in the managed care plans.
the Insurance Companies began shifting 'where' and 'how' the treatment money was spent.
 
3)
Under the Affordable Care Act (ACA) we probably won't see any change in how the insurance Marketplace pays behavioral health providers for the care that is delivered.
 
True False
 
4)
The National Alliance For The Mentally Ill (NAMI) has never expressed a concern that the Managed Care industry might put COST CONTROLS ahead of the QUALITY of CARE .
 
True False
 
5)
Which answer is true, according to this lesson? .
 
The use of ‘NARROW NETWORKS’ is becoming the norm in most states, to reduce the cost of the Affordable Care Act
A reasonable goal of a new healthcare plan is to immediately 'fix the system'.
Managed Care is an issue ONLY in Public Health Care Programs. It does not affect private agencies or those in private practice.
 
6)
In the current implementation of the Affordable Care Act, 'Vertical Integration of Care' refers to . . .
 
a cost saving measure which would require us to treat men and women together in groups, regardless of gender and diagnoses.
a proposed ACA rule that would require a provider to treat mental health and addiction clients together, in the same treatment modalities.
physical health and behavioral health providers working as a team 'under the same umbrella', to treat the whole patient - perhaps being paid a single fee to be shared by all.
 
7)
In the Affordable Care Act (ACA), the term 'Bundled Payments' refers to . . .
 
a new practice in which insurance companies may delay payment to providers - perhaps paying providers only quarterly.
a new practice in which insurance payments must be SHARED among all providers who are involved in the patient's total health condition - for both physical health and behavioral health.
 
8)
One of the problems with managed care is that the Managed Care Companies are NOT allowed to SHIFT where and how the money is spent for treatment services.
 
True False
 
9)
Standardized Level of Care protocols (such as those typically used by Insurance Companies and MCOs in their Care Management process) are believed by many to result in ‘questionable clinical outcomes’ for Chemically Dependant consumers.
 
True False
 
10)
For both mental health and AOD clients, Managed Care Contractors make their ‘Care Management’ decisions (a.k.a. ‘Utilization Review’) based upon . . .
 
whether the treatment is having a POSITIVE IMPACT upon his or her condition.
whether the treatment is believed to be ESSENTIAL for persons with the patient’s specific DIAGNOSIS.
whether or not they believe that treatment is ‘MEDICALLY NECESSARY’ for stabilization and improvement.
All of the above
Only the second and third answers
 
11)
In order to approve a particular treatment for the AOD client, Care Managers must be convinced that
 
the individual is having an alcohol or drug related crisis.
the individual has experienced a recent relapse.
the treatment you are proposing to provide is consistent with the traditional way that things have been done.
All of the above.
None of the above.
 
12)
The Care Management process
 
places major emphasis upon LEAST-RESTRICTIVE recovery programs.
avoids ‘unnecessary’ hospital admissions, and the use of ERs, and the use of detox units for more than a very few days
discourages ‘residences’ such as 28 Day Programs
All of the above
Only the first and third answers above
 
13)
One thing that is important to the reduction of inpatient stays and admission to high-level services is _______________.
 
availability of extended stays in residential treatment, where clients can be monitored and kept out of trouble.
the development of ‘step-down’ services in the community.
a 'painful' penalty for providers who request inpatient admission more often than other providers.
 
14)
In a managed care plan, every enrolled individual is eligible for every service.
 
True False
 
15)
The Affordable Care Act is driven by OUTCOMES.
 
True False
 
16)
The emphasis upon 'OUTCOMES' of treatment is fairly new to the federal Substance Abuse and Mental Health Services Administration (SAMHSA) - becoming important only when the Affordable Care Act was made law in 2010.
 
True False
 
17)
One example of a good contractual outcome measure for AOD providers would be 'Contract requires a 90% success rate at maintaining contact with individuals who are discharged from a detox unit, for a period of 60 days following discharge.’
 
True False
 

 

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