Defense Health Programs:

Changes in Administration of Mental Health Benefits

HRD-86-98FS: Published: Jun 12, 1986. Publicly Released: Jun 12, 1986.

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In response to a congress request, GAO reported on the mental health care program under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), specifically: (1) the 60-day per year limit on inpatient psychiatric care; and (2) recent revisions to the administrative controls of some of the CHAMPUS mental health benefits.

GAO found that: (1) for 1983, the year the limitation was in effect, CHAMPUS estimated savings of $34.2 million; (2) CHAMPUS has authority to grant waivers to the 60-day limit and, between January 1983 and December 1985, approved about 24 percent of the waiver requests; (3) according to CHAMPUS officials, the 60-day limit caused a shift from inpatient hospital care to alternative mental health treatment options to which the limit does not apply, such as residential treatment centers; (4) the categories of mental health care providers authorized to bill CHAMPUS independent of physician referral increased; (5) CHAMPUS developed a policy to limit its payments for residential treatment center care which will provide long-term control over cost escalation; and (6) under a demonstration project, CHAMPUS recently awarded a competitively bid contract for providing mental health services in a high-utilization area.

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