CEBS: GBA 1, Module 7 Correct Questions & Answers(SCORED A+)
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CEBS: GBA 1, Module 7
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CEBS: GBA 1, Module 7
3 basic types of funding arrangements of an MBHO - ANSWER1. fully insured -MBHOs assume the financial risk for providing
behavioral services paying the claims submitted by providers for behavioral
services rendered. Financial risk falls on the MBHO. When overall plan costs
exceed expected levels...
CEBS: GBA 1, Module 7 Correct Questions &
Answers(SCORED A+)
3 basic types of funding arrangements of an MBHO - ANSWER1. fully insured -MBHOs assume the
financial risk for providing
behavioral services paying the claims submitted by providers for behavioral
services rendered. Financial risk falls on the MBHO. When overall plan costs
exceed expected levels, the MBHO absorbs those increased costs. Purchasers pay
MBHOs a predetermined, fixed premium for assuming financial risk for
behavioral treatment costs. On average, a monthly premium for a fully insured,
full-risk behavioral plan, excluding EAP fees, ranges between 3% and 6% of a
medical plan's premium.
2. shared risk-purchasers agree to assume the financial risk for claims payment up to a
certain amount. Premiums are based on projected claim costs. If claims exceed a
prespecified amount, the MBHO assumes those claim costs or a percentage of
those costs. If the claims come in below a prespecified amount, the balance can
be shared by the MBHO and client or refunded to the client.
3. administrative services only (ASO)-an MBHO, for a fee,
will handle medical management, utilization review, benefit and other administrative functions, such
as claims payments. Often called a self-funded or self-insured
arrangement, the purchaser assumes the financial risk of the health care costs for
its members. The larger the group, the more likely it is to self-fund because the financial risk is
spread across a greater number of employees and its budget is large
enough to absorb the risk. A key advantage of an ASO is that employers can offer
the same benefit to employees working in different states because ERISA exempts
self-funded health plans from compliance with state laws and regulations.
Are retiree plans subject to MHPAEA, and does the act preempt state insurance
laws? - ANSWERPlans covering fewer than two current employees, that is, retiree-only plans, are not
, subject to MHPAEA. MHPAEA does not preempt any state insurance laws except to
the extent that they interfere with MHPAEA.
ASO - ANSWERAdministrative-services-only
Behavioral health care
carve-out program - ANSWERA behavioral health care carve-out program is one that separates, or
carves out,
mental health and chemical dependency services from a medical plan and provides
them separately, usually under a separate contract and from a separate company
known as a managed behavioral health care organization (MBHO). Such a program has been viewed
as having the potential to produce significant
savings because (1) it is usually managed by firms that specialize in behavioral health
treatment; (2) it allows large, self-funded employers to offer the same behavioral
health benefits across all health plans offered; and (3) it allows a health plan to
cost increase provision that may exempt a plan from the parity rules of
MHPAEA - ANSWERIf MHPAEA compliance requires changes that increase plan costs by at least 2% in
the first year or at least 1% in any subsequent year, the law exempts the plan from
MHPAEA for the following plan year. The exemption lasts for one plan year and
applies for alternating plan years. The exemption test may be based only on cost
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