Deliberations regarding mental health benefits offered under the Federal Employee Health Benefits Program (FEHB) are coming to closure, with the outcome likely to be of considerable interest to members of the American Psychoanalytic Association. FEHB covers 5 million federal employees and dependents nationwide.
This year, the Office of Personnel Management, under which auspices the program operates, has cut back benefits an average of 16 percent in an attempt to minimize premium increases and the government's share of expenses. The government currently pays approximately 60 percent of each employee's average premium. In negotiations with OPM for the 1982 package, Blue Cross/Blue Shield, the major carrier in the program and the one offering the most equitable package of mental health benefits, has contended that unless substantially lower ceilings are put on the mental health benefits, it may have to pull out of FEHB.
Under its existing High Option Plan, BC/BS now pays all hospital and related costs for 365 days of inpatient care for mental disorders. The plan also offers unlimited outpatient visits and 70 percent of routine psychiatric service charges. There is a $50,000 lifetime limit for nervous and mental disorders coverage. With this package, the company reports that mental health benefits account for 7.7 percent of total benefits paid annually. Under a new proposal for 1982, BC/BS would limit inpatient hospitalization to 60 days per year under the high option (30 days per year under the low option), limit outpatient visits to 50 per year, and cut its share of payments to psychiatrists from 70 to 50 percent.
In an attempt to prevent such a cut in benefits, Sen. D'Amato (R-N.Y.) has proposed a rider to the treasury, post-office, and general government appropriations bill that would freeze mental health benefits at existing levels. BC/BS advised federal officials that such a freeze could drive the company to the point where it would be unable to underwrite FEHB plans next year.
A more positive aspect of the reimbursement scene is the recent publication of final regulations that would waive current statutory requirements under Medicaid to allow states the option of reimbursing a broad range of services delivered in home and community settings. While community mental health services are not specified in the regulation, states may choose to incorporate mental health services as a subcategory of those which are cited: case management, habilitation, respite care, and other services requested by the state. The new regulations are designed to provide states maximum opportunity for innovation and flexibility in providing noninstitutional services with minimum federal regulation.
Herbert Pardes, M.D.
Director, National Institute of Mental Health