Mental health parity

Federal employees in the Federal Employees Health Benefits program will

receive the same coverage for mental health and substance abuse as they

do for other illnesses, starting with the 2001 plan year.

Beginning Jan. 1, coverage for men-tal health, substance abuse, med-ical,

surgical and hospital pro-viders under the program will all have the same

deduc-tibles, co-insurance, and co-pays. At present, FEHB health plans apply

higher patient cost-sharing and shorter day and visit limits to mental health

and substance abuse services than they do to services for physical illness,

injury or disease.

Of course, everyone's premium will go up, but it's unclear what portion

of next year's premium increase is attributable to increased mental health

benefits. Carriers will be allowed to "manage" their health care benefits.

This process can include directing you to a specific provider, requiring

you to get prior authorization from the plan for nonemergency services and

requiring you to follow a treatment regimen authorized by the plan. The

authorization process may require you to call your plan first.

Some health plans will manage your care through managed behavioral health

care organizations (MBHOs) and their provider networks, while others will

manage it through their own provider networks and internal processes. An

MBHO contracts with health plans to provide a range of behavioral health

services to the plan's enrollees. The health plan or its MBHO will typically

review a provider's prescribed services to make sure that they follow standard

practice and are appropriate.

Choice of providers depends on your health plan. All fee-for-service

plans, preferred provider organizations and some point-of-service options

offer coverage for providers outside the health plan's network for mental

health and substance abuse services. Health maintenance organizations usually

limit benefits coverage to providers participating in their networks.

I have mixed feelings about this development. I think people with mental

health problems should receive the same level of service as those with other

ailments. How-ever, people with mental illnesses are apt to be sensitive

about discussing their problems, and managed mental health care requires

they divulge lots of personal information about their illness in order to

get proper care. I'm afraid people with mental illnesses will not receive

proper care because they will resist efforts to find out more about their

illnesses.

On the other end of the spectrum are people who like to talk with a

shrink. They're not really ill and shouldn't be entitled to benefits. But

I bet you a nickel that their psychiatrists will certify that they are ill.

Where does this leave us? Sounds like another well- intentioned government

program that wasn't thought out very carefully.

—Zall is a retired federal employee who since 1987 has written the Bureaucratus

column for Federal Computer Week. He can be reached at miltzall@starpower.net.

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