APA and the Washington Psychiatric Society (WPS) are closely monitoring the implementation of a 1999 executive order instructing the federal Office of Personnel Management (OPM) to include parity for mental health care in insurance policies that cover federal government workers.

Last June, emphasizing that it was "high time that our health plans treat all Americans equally," President Bill Clinton issued an executive order mandating parity in copayments, day and office-visit limits, deductibles, and benefit caps for the 9 million federal workers and their families insured through the Federal Employees Health Benefits Program (FEHBP). More than 300 for-profit and not-for-profit health insurance organizations provide the coverage available through the program.

At the time of the executive order, the White House estimated that federal employees’ health insurance premiums would rise from 1 percent to 3 percent to accommodate the parity expansion. The parity benefits are scheduled to take effect with the start of the 2001 benefits year (Psychiatric News, July 2, 1999).

On April 11 OPM, the agency that oversees federal hiring, personnel, and benefits issues, sent a "call letter" to the insurance providers asking them to respond with their proposals for including parity for mental health and substance abuse care in their policies. They had until May 31 to respond to OPM, which will then review the proposals during June and July. OPM intends to complete negotiations with the carriers about the added benefits by August 25.

Because APA and the WPS wanted to clarify some of the wording of the call letter and offer their assistance in the implementation phase, representatives of the two organizations arranged a meeting with OPM and high-ranking federal mental health officials in the Capitol Hill office of Rep. Constance Morella (R-Md.).

Morella is a member of the House Committee on Government Reform, and many WPS members live or work in her suburban Washington district, as do thousands of federal employees whose health care will be impacted by how the parity mandate is carried out.

WPS President Eliot Sorel, M.D., represented the district branch at the meeting along with Lawrence Kline, M.D., and Lawrence Sack, M.D. APA was represented by Eugene Cassel, deputy director for regulatory affairs in the Division of Government Relations. National Institute of Mental Health Director Steven Hyman, M.D., and Bernard Arons, M.D., director of the Center for Mental Health Services, also attended, as did representatives from the AMA, the American Psychological Association, and several divisions of OPM.

APA and the WPS raised several concerns about the call letter to the federal officials at the meeting. They were troubled, for example, by wording that insurance carriers could interpret as meaning the government expected adding parity to be a cost-neutral undertaking. Mental health experts have pointed out that the costs of offering equal coverage for mental health care will not impose a heavy cost burden but will probably result in small increases that will appear in the form of slightly higher insurance premiums. OPM officials affirmed that they did anticipate that small cost increases will result from providing parity and that they expect the insurance carriers to explain in their responses to the call letter how they will handle such increases.

The APA and WPS representatives also informed OPM that it is critical that the agency makes sure that when the parity policy is implemented, there are a sufficient number of psychiatrists and mental health professionals to ensure adequate access for mental health services for the millions of federal employees and their families.

OPM also agreed to participate in, but not lead, a consensus conference on appropriate definitions for medical necessity so that such determinations would not vary among the insurance carriers or be used to make it difficult for beneficiaries to obtain needed mental health treatment.

The WPS also urged OPM to undertake an effort to educate primary care physicians about treating mental disorders and making referrals to specialists. Sorel offered the district branch’s assistance in such a project.

Sorel characterized the meeting as "very positive" in light of the attendance of representatives from the "highest levels of decision-making authority" and a member of the congressional committee that oversees OPM. He noted that Ed Flynn, OPM’s associate director for retirement and insurance, was "open and agreeable" to the points raised and suggestions made by WPS and APA. "With the WPS serving so many federal workers, we have a vested interest in making [parity] work," Sorel said.

Darrel Regier, M.D., M.P.H., who recently became executive director of the American Psychiatric Institute for Research and Education (APIRE) and head of APA’s Office of Research, noted that the institute’s Practice Research Network could make a valuable contribution to evaluating "this historic mental health benefit enhancement."

Since the Practice Research Network already has an "infrastructure for surveying psychiatrists and the characteristics of their patients’ treatment," Regier said, "it would be feasible to oversample psychiatrists providing services in the areas where there is a high concentration of federal employees—both before and after implementation of the parity benefit."