April 20, 2009

Office of Personnel Management FEBH Program Carrier Letter 2009-08

The federal Office of Personnel Management instructed health plans offering federal employee health benefits (FEBH) programs to implement mental health parity as required by the Wellstone and Domenici Mental Health Parity and Addiction Equity Act of 2008. The instructions specify the following:

• Plans must cover all categories of mental health or substance use disorders to the extent that the services are included in authorized treatment plans.

• Plans may manage care through referrals, prior authorization, treatment plans, pre-certification of inpatient services, concurrent review, discharge planning, case management, retrospective review, and disease management programs.

• Treatment plans should be developed in accordance with evidence-based clinical guidelines, and meet medical necessity criteria.

• Plans may continue to use managed behavioral health care organizations (MBHOs) to implement or supplement their programs.

• MBHOs may maintain networks of providers for the plans and manage in-network and out-of-network services using prior authorization, treatment plans, and care coordinators. Alternatively, MBHOs may manage the care delivered by the plan's existing network providers and authorize appropriate out-of-network care.