Members of the Washington (D.C.) Psychiatric Society continue to meet regularly with federal government officials to monitor the implementation of President Bill Clinton’s 1999 executive order mandating parity for federal workers and their families who are insured through the Federal Employees Health Benefits Program (FEHBP).

Clinton’s order stated that beginning in 2001 all companies that sell health insurance to the 9 million federal workers and their families must issue policies that contain the same copayments, deductibles, day and office-visit limits, and payment caps for mental health care as they do for other types of health care.

The first meeting initiated by the WPS and a group it formed called Partnership for Parity took place in June and brought together WPS members, APA leaders, federal mental health officials, staff of the Congressional office of Rep. Constance Morella (R-Md.), whose district has a substantial number of federal workers, and representatives of the government’s Office of Personnel Management (OPM)—the agency that oversees the FEHBP.

The most recent meeting was held in late summer in Washington, D.C., and focused in part on what mechanisms and timetable OPM will use to evaluate the initial phases of the FEHBP parity program, said Eliot Sorel, M.D., former WPS president and chair of its parity-monitoring effort, Partnership for Parity.

Sorel indicated that the partnership will devote its future energies to several "strategic areas" including planning for a "medical necessity consensus conference" scheduled to take place next spring. The conference’s goal is to explore issues that have become extremely troubling for psychiatrists since managed care began to rule the insurance roost, namely, how medical necessity is defined, who is best equipped to define it, and how decisions about medically necessary care are implemented. Sorel hopes that OPM will incorporate findings from the conference in the rules and standards it sets for insurers who want to be included in the FEHBP.

Sorel noted as well that the WPS and APA would like to be involved in whatever evaluations OPM conducts or contracts for in regard to the parity mandate.

Kevin Hennessy of the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services recently announced a contract award to ROW Associates for evaluating the impact of new parity regulations. Psychiatrist Howard Goldman, M.D., of the University of Maryland will be the principal investigator for the evaluation project, with Richard Frank, Ph.D., of Harvard University and Kenneth Wells, M.D., of the RAND Corportation and UCLA serving as coinvestigators, according to Darrel Regier, M.D., director of the APA Office of Research.

"The study will provide critically needed data on the impact of the FEHBP parity order on access, quality, and outcome of care for psychiatric patients," Regier explained. "It will be particularly important in monitoring the impact of the [parity mandate] on the administration and management of psychiatric patients’ insurance benefits.

"As staff of the American Psychiatric Institute for Research and Education [APIRE] complete plans for the next Practice Research Network [PRN] National Survey of Psychiatric Practice, we will coordinate our survey plans with the ROW team to assure complementary data collection from these two studies," said Regier, who is also executive director of APIRE. "In particular, the PRN plans to oversample psychiatrists in areas where there is a high concentration of federal employees to obtain information on the impact of the new benefit provisions on patient access to mental health services and on psychiatric practice."

Regier added that "it will be very helpful to have the support of APA district branches in areas where either the ROW or PRN studies are conducted to assure a high level of response to this scientific evaluation of a critical health policy initiative. As a result, we are very appreciative of the interest and leadership that Dr. Sorel and the Washington Psychiatric Society have taken in publicizing the importance of professional cooperation in obtaining the most objective and credible evaluation possible."