Advocacy & Systems Navigation Flashcards

A peer was denied a residential treatment authorization by their Medicaid managed care plan. What is the most appropriate first advocacy step for the recovery specialist?

Answer: Help the peer request the written denial and file an internal appeal within the plan's deadline

Managed care denials must first go through the plan's internal appeal process, which requires the written notice and timely filing.

Under the Mental Health Parity and Addiction Equity Act (MHPAEA), which situation most likely signals a parity violation?

Answer: A plan imposes stricter visit limits on substance use treatment than on comparable medical care

MHPAEA prohibits treatment limitations on mental health and SUD benefits that are more restrictive than those on comparable medical/surgical benefits.

A peer in recovery who uses methadone is told by a recovery residence that MOUD users are not accepted. How should the recovery specialist respond?

Answer: Inform the peer of possible Fair Housing Act/ADA protections and help locate MOUD-friendly housing or file a complaint

Blanket exclusion of people on MOUD may constitute disability discrimination, and the specialist should inform the peer of rights and options without pressuring medication changes.

Which best describes the difference between individual advocacy and systems advocacy?

Answer: Individual advocacy addresses one person's specific barrier; systems advocacy seeks to change policies or practices affecting many people

Individual advocacy resolves a person's situation, while systems advocacy targets the policies and structures that create barriers for groups.

A peer leaving jail has no ID, which is blocking their benefits application. What is the most effective navigation step?

Answer: Help the peer gather birth certificate or release paperwork and connect with reentry services that assist with ID replacement

Identification is a foundational document for benefits, housing, and employment, and reentry programs often help obtain it.

Under 42 CFR Part 2, what is generally required before a SUD treatment program can share a patient's records with an employer?

Answer: Written patient consent meeting Part 2 requirements

42 CFR Part 2 requires specific written patient consent before most disclosures of SUD treatment records to third parties like employers.

When accompanying a peer to a court hearing, what is the recovery specialist's appropriate role?

Answer: Offer support, help the peer prepare questions, and, with consent, share information about their recovery engagement

Peers provide support and, with consent, can speak to recovery progress, but they must not practice law or replace counsel.