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Section IV: Insurance for Mental Health Care

Table 1. Key domains in the FEHB program parity evaluation

How have the following changed as a result of the parity requirement?

• The design of mental health and substance abuse (MH/SA) benefits offered by FEHB plans
• The policies and procedures related to the management of the MH/SA benefits offered by FEHB plans
• The structure and management of physical health benefits offered by FEHB plans

• Have aggregate and per-enrollee costs for MH/SA services within select FEHB plans changed after implementation of parity? How do these changes compare with secular trends?
• Have out-of-pocket costs to beneficiaries using MH/SA services (e.g., deductibles, copayments, and out-of-pocket limits) within select FEHB plans changed after implementation of parity? How do these changes compare with secular trends?
• Have FEHB plans incurred additional administrative costs attributable to the parity requirement?
• Has the Federal Government incurred additional expenses (e.g., premium costs) attributable to the parity requirement?
• Within select FEHB plans, is there evidence of either adverse or favorable risk selection among new enrollees or those disenrolling after the implementation of parity?

• What are the patterns of access to MH/SA services within select FEHB plans before and after the implementation of parity? How do any changes compare with secular trends?
• Do these patterns of access differ by use of in- vs. out-of-network providers, type of user, type of service, level of service, or type of condition? How do these patterns compare with secular trends?
• Are beneficiaries in select FEHB plans aware of any changes in MH/SA benefits related to the parity requirement?
• Do beneficiaries in select FEHB plans identify an unmet need for MH/SA services? How does any unmet need compare with secular trends?

• What are the patterns of service utilization for MH/SA services within select FEHB plans before and after implementation of parity? How do these changes compare with secular trends?
• Do these patterns of service utilization differ by use of in- vs. out-of-network providers, type of user, type of service, level of service, or type of condition? How do these patterns compare with secular trends?

• What types of quality assurance strategies have FEHB plans implemented as a result of the parity requirement (e.g., utilization review, case management, disease management protocols, patient care teams, outcomes monitoring)?
• Do FEHB plans use any evidence-based practice guidelines for the treatment of mental health, substance abuse conditions, or any other conditions? If so, how well do the patterns of care for MH/SA or other conditions (as evidenced in administrative claims/encounter data) reflect adherence to proposed guidelines? How do these patterns compare with secular trends?
• Are there any changes in either the use of guidelines or adherence to guidelines that are related to the implementation of parity? If so, how do these changes compare with secular trends?

• Are beneficiaries in select FEHB plans aware of any changes in MH/SA benefits related to the parity requirement, and how satisfied are they with the changes?
• Are beneficiaries who have used or attempted to use MH/SA benefits in select FEHB plans satisfied with their experiences?
• Are providers aware of any changes in the MH/SA benefits related to the parity requirement?

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