Federal Employee Health Benefits Program (FEHBP) legislation was introduced shortly after the 98th Congress convened by Congresswoman Mary Rose Oakar, Democrat of Ohio. The Oakar Bill (HR656), the most impressive and also the lead bill regarding FEHBP, has a separate section regarding the treatment of nervous, mental, or emotional disorders.
Section Five of that bill provides that all insurance plans offered under the FEHBP must provide “without discrimination”, regarding the co-insurance ratio or the deductible portion, for “50 outpatient visits and 60 inpatient days of nervous and mental disorder benefits.” The bill also stipulates that “such limits shall be exceeded on a case by case basis … to the extent that an established peer review mechanism determines such treatment to be medically or psychologically necessary and appropriate.” Thus, the legislation, while requiring a minimum of 50 outpatient visits or 60 psychiatric inpatient days per year, clearly requires that additional treatment must be provided if that treatment is determined to be medically necessary by peer review.
The Oakar Subcommittee plans hearings on this legislation in mid-June. Testimony in support of Section Five will be provided by the Washington Psychiatric Society, the American Psychiatric Association, and several other mental health treatment providing groups. We hope the bill will then be favorably acted on by the entire Post Office and Civil Service Committee, chaired by Congressman Ford of Michigan and then be passed by the full House.
On April 7, Section Five of the Oakar Bill was introduced as S 1004 in the Senate by Senators D'Amato, Stafford, Hawkins, and Sarbanes. This bill will now be the subject of both Washington-based and national grassroots efforts to secure additional bipartisan cosponsorship.
Members can actively participate in this process in a number of ways. Letters, telegrams, phone calls, or visits to Congressmen and Senators, advocating support of the House or Senate bills, are needed. Contributions to the political action committee of WPS or APA would be helpful. Contributions can be made to the Washington Psychiatric Society, which has been in the forefront of this effort at great expense to its members. In addition, it is important that members of the Association interested in advocacy of insurance coverage for psychoanalysis in the bellwether FEHBP plans remain informed and be particularly watchful, lest at some future date the peer review provision for additional visits beyond 50 or the catastrophic coverage provisions be removed.
Lawrence C. Sack, M.D.
Washington