Persistent Depressive Disorder Regulatory Frameworks & Compliance 2 — Questions and Answers
Question 1: Under the Mental Health Parity and Addiction Equity Act (MHPAEA), insurers covering PDD must ensure that mental health treatment limitations are no more restrictive than limitations for which type of coverage?
- Dental and vision care
- Medical and surgical care (Correct answer)
- Prescription drug plans
- Emergency services only
Correct answer: Medical and surgical care
MHPAEA requires that mental health and substance use disorder benefits be no more restrictive than medical and surgical benefits in the same plan.
Question 2: Which ICD-10-CM code is used for billing purposes when documenting a diagnosis of persistent depressive disorder (dysthymia)?
- F32.1
- F33.0
- F34.1 (Correct answer)
- F41.1
Correct answer: F34.1
F34.1 is the ICD-10-CM code assigned to persistent depressive disorder (dysthymia) for clinical documentation and insurance billing.
Question 3: Under HIPAA, a clinician treating a patient with PDD may share that patient's protected health information with another treating provider without explicit written authorization under which principle?
- Minimum necessary rule
- Treatment, Payment, and Operations (TPO) (Correct answer)
- The accounting of disclosures rule
- Business associate agreement
Correct answer: Treatment, Payment, and Operations (TPO)
HIPAA permits sharing PHI for Treatment, Payment, and Operations (TPO) purposes without patient authorization.
Question 4: Which federal law prohibits discrimination against employees with PDD in workplaces with 15 or more employees and may require reasonable accommodations?
- Family and Medical Leave Act (FMLA)
- Americans with Disabilities Act (ADA) (Correct answer)
- Rehabilitation Act of 1973
- Genetic Information Nondiscrimination Act (GINA)
Correct answer: Americans with Disabilities Act (ADA)
The ADA prohibits employment discrimination based on disability, including mental health conditions like PDD, and requires reasonable accommodations for qualified employees.
Question 5: When a clinician documents a PDD diagnosis in an electronic health record, HIPAA's Security Rule primarily requires safeguards to protect against which of the following?
- Unauthorized disclosure of paper records
- Unauthorized access to electronic protected health information (ePHI) (Correct answer)
- Verbal breaches during telehealth calls
- Loss of billing records only
Correct answer: Unauthorized access to electronic protected health information (ePHI)
HIPAA's Security Rule specifically requires administrative, physical, and technical safeguards to protect electronic protected health information (ePHI).
Question 6: A patient with PDD requests a copy of their mental health records. Under HIPAA's Privacy Rule, the covered entity must generally provide access within how many days?
- 10 days
- 30 days (Correct answer)
- 45 days
- 60 days
Correct answer: 30 days
HIPAA requires covered entities to provide patients access to their records within 30 days of the request, with one 30-day extension permitted.
Question 7: Under Medicare, cognitive behavioral therapy (CBT) for PDD delivered via telehealth must be provided by a licensed mental health professional operating under which regulatory requirement added after 2020?
- The provider must be physically present in the patient's state
- The provider must hold licensure in the patient's state of residence (Correct answer)
- Telehealth is not covered under any Medicare plan
- The provider must use only synchronous audio-video platforms approved by CMS
Correct answer: The provider must hold licensure in the patient's state of residence
Medicare requires that mental health telehealth providers be licensed in the state where the patient is located at the time of service.
Persistent Depressive Disorder Regulatory Frameworks & Compliance 2
Under the Mental Health Parity and Addiction Equity Act (MHPAEA), insurers covering PDD must ensure that mental health treatment limitations are no more restrictive than limitations for which type of coverage?