Panel Urged to Include Mental Health/alcoholism Benefit for Federal Workers

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Panel Urged to Include Mental Health/Alcoholism Benefit for Federal Workers

Legislation (HR-4958) to replace the 30-year old Federal Employees Health Benefits Program (FEHBP) and its 26 fee-for-service options with a single two option plan, including generous benefits for mental health and substance abuse, was hailed as a "welcome step" by the President of the National Association of Private Psychiatric Hospitals (NAPPH).

But NAPPH President Doyle I. Carson urged the House Post Office and Civil Service Subcommittee on Compensation and Employee Benefits to expand the proposed mental health/substance abuse benefits to include partial hospitalization programs. Carson, who also appeared on behalf of the American Association for Partial Hospitalization (AAPH), said partial hospitlization for psychiatric disorders has "proven therapeutic and economic advantages."

He said, "It is appropriate for those needing more than outpatient care, but less than intensive, 24-hour care. It is not a substitute for clinically necessary inpatient care. However, its availability may shorten some patients' inpatient says or provide a transition from inpatient care. It may allow others to avoid hospitalization altogether."

Carson praised the bill by Subcommittee Chairman Gary L. Ackerman (D-NY) as providing federal employees "access to medically necessary psychiatric and substance abuse services." Ackerman's legislation would allow a maximum 50 visits for mental health/substance abuse outpatient services under the high option plan, and 25 for the low option, with 75% of fees covered for both. For inpatient hospitalization for mental health and substance abuse, no cap is provided, with 90% of charges covered by the high option plan and 80% for low option. Although no provision is made for residential, free-standing coverage, the proposed benefits for mental health and substance abuse were seen as more generous than most current plans offered to federal workers.

Ackerman's benefits package also surpasses that of his predecessor as Chairman of the Subcommittee on Compensation and Employee Benefits, Rep. Mary Rose Oakar (D-OH), whose bill, pushed vigorously by field interests, would have provided two life-time 28-day alcoholism inpatient stays, and 60 inpatient and 50 outpatient days for mental health services. After being unable to move her bill in the face of opposition from the Reagan Administration over a three-year period, Oakar abandoned it in 1985 in favor of a "sense of Congress" resolution that such coverage be afforded under the FEHBP. Alcohol and drug groups, joining larger mental health coalitions, had been pushing for Congressional action since 1982 when the federal Blue Cross/Blue Shield plan scrapped its inpatient alcoholism benefit ans sharply curtailed mental health coverage.

In introducing the bill, he said the FEHBP "has strayed from the principle of group insurance and is no longer meeting the needs of its 10 million beneficiaries."

Under his legislation, the new FEHBP would consist of a single two-option plan managed by the Office of Personnel Management (OPM) in consultation with a newly created FEHBP Board. …