Parity And Health Care Reform

Front 1

what does parity refer to?

Back 1

fair and equal coverage of mental health and substance use disorders

Front 2

what year and in what document did parity first appear?

Back 2

1993; Congressional agenda

Front 3

what does the 1996 mental health parity act require?

Back 3

requires health plans to meet a standard parity only for annual and lifetime dollar limits

Front 4

what 2 senators championed the 1996 Act and advocated for reforms to the act?

Back 4

Domenici and Wellstone

Front 5

what is the name of the newest expansion of the 1996 Act called and when did it go into affect?

Back 5

Wellstone-Domenici Mental Health Parity and Addiction Act of 1998; went into effect 10-3-09

Front 6

what does mental health parity do?

Back 6

ends health insurance benefits inequity between mental health/substance use disorders and medical/surgical benefits for group health plans with more than 50 employees

Front 7

what areas in coverage to all financial requirements are now equal due to the 2008 Act?

Back 7

-lifetime and annual dollar limits
-deductibles
-co-payments
-co-insurance
-out-of-pocket expenses
-treatment limitations

Front 8

what does the mental health parity NOT do?

Back 8

-don't require health insurers to cover mental health or substance use benefits
-don't impose requirements as to what conditions must be covered
-doesn't require health plans with 50 or fewer employees to meet federal standards (must meet state standards)
-don't apply to medicare patients
-don't impact reimbursement rates
-doesn't preempt state law unless state law is currently less protective than federal law

Front 9

will parity and addiction equity act be expanded to apply to health insurance plans offered to small businesses and individuals?

Back 9

yes! beginning in 2014!

Front 10

why is it important that OT be involved in mental health services?

Back 10

-there is an increase in number of diagnoses of mental illness so there is an increase in need for healthcare practitioners.
-increase in number of people eligible for coverage of services
-centennial vision wants growth of OT in mental health
-Increase in PTSD

Front 11

who does the US code of federal regulations include in the definition of core mental health practitioners?

Back 11

-psychiatrists, clinical psychologists, clinical social workers, psychiatric nurse specialists, and marriage and family therapists

Front 12

what is a QMHP?

Back 12

-qualified mental health practitioner
-criteria varies from state to state
-requires extensive coursework, education, supervision, and usually board certified

Front 13

what is LMHP?

Back 13

Licensed mental health practitioner
-required to have 3000 supervised hours of mental health practice (1500 direct client hours/1500 case management hours)

Front 14

what % of OTs work in mental health?

Back 14

2%

Front 15

what is the federal role in reimbursement for mental health?

Back 15

funding block grants, funding research, promoting evidence-based and best practices, establishing nationwide agendas for mental health policy

Front 16

what is the state's role in reimbursement for mental health?

Back 16

each state designs its own mental health system including mandates and options regarding eligibility, organizing structure, and services

Front 17

what is the single larges source of funding for public mental health system?

Back 17

medicaid

Front 18

medicaid

Back 18

-largest source for funding for public mental health system
-both federal and state funded
-must meet eligibility standards

Front 19

what source is funded by both federal and state?

Back 19

medicaid

Front 20

medicare

Back 20

-primary reimbursement of occupational therapy services OVERALL
-occupational therapy is listed as a medical necessity

Front 21

what source is the primary reimbursement for ot services?

Back 21

medicare

Front 22

what are the reimbursement options for medicaid: rehabilitation option?

Back 22

many types of settings, services and providers in outpatient mental health services;
-ot consulted only when "medically necessary"

Front 23

what is medicaid's clinic option?

Back 23

more of a medical model
-provide based services

Front 24

what do you bill for in the physical rehabilitation setting?

Back 24

bill for progress towards goals...not the medium

Front 25

what is ot's role in advocacy?

Back 25

-teach
-guide
-collaborate

Front 26

AOTA advocacy

Back 26

Representative Assembly Motions
Identified state associations with interest in promoting mental health practice to pursue statutory and regulatory inclusion
Advocate with Congress at federal level and assist state associations to educate them on the role of OT in mental health for specific legislative initiatives

Identify and survey existing OTs practicing in mental health with dual degrees that include QMHP related professions

Identify other organizations as allies

Explore strategies for improving opportunities in fieldwork

Front 27

who do policymakers listen to more?

Back 27

constituents more than lobbyists and representatives of association/organizations

Front 28

what are advocacy do's?

Back 28

-establish an on-going relationship and reputation for reliablity
-treat the person as a friend and intelligent person
-be specific and know your facts
-provide a brief, clearly written summary of position
-request specific action
-write thank you's

Front 29

what are advocacy don'ts?

Back 29

-try to talk to someone who is in a hurry
-be argumentative or abrasive
-overload people with written material
-assume the person is familiar with your issues
-bluff if you don't know the answer
-talk about too many issues at once
-be late or threaten

Front 30

what is MHSIS?

Back 30

mental health special interest section (MHSIS)

Front 31

what is MHSIS?

Back 31

mental health special interest section
-provides networking and information forum
-access clinical resources
-interact on an active listserv

Front 32

what are initiatives of MHSIS?

Back 32

-presentation of evidence-based OT practice models in multiple forums
-completing a survey of OT educational programs to determine the current mental health curricula content
-comopletion of a state-by-state review of OT practitioners' ability to be recognized as QMHP
-successfully collaborate with federal agencies to include occupational therapists in the list of mental health providers qualified to respond to nation disasters.
-board certification for mental health