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Defense Health Care: CHAMPUS Mental Health Demonstration Project in Virginia

HRD-93-53 Published: Dec 30, 1992. Publicly Released: Jan 12, 1993.
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Highlights

Pursuant to a congressional request, GAO reviewed the Department of Defense's (DOD) mental health demonstration project for Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) beneficiaries, focusing on: (1) the extent of program cost-savings; and (2) whether DOD oversight was adequate to ensure CHAMPUS beneficiaries' access to quality care.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense In designing future mental health care projects, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to ensure that an effective independent quality-of-care monitor is established, and a system to follow-up on findings and implement corrective action is implemented.
Closed – Implemented
The National Quality Monitoring Contractor began operations on October 1, 1993, and will review utilization and quality-of-care decisions made by all mental health contractors. DOD will receive quarterly reports, determine corrective action, and sanction providers as appropriate.
Department of Defense In designing future mental health care projects, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to implement management controls to review and monitor the appropriateness of outpatient mental health care decisions.
Closed – Implemented
The study on outpatient care was sent to DOD on August 3, 1993, for comment. The study recommends that several additional studies be performed. The study identified several monitoring systems and procedures that would help determine the appropriateness of outpatient care. DOD developed guidelines for mental health assessments and treatment plans and follow-up procedures for outpatient records that lack the appropriate documentation.
Department of Defense In designing future mental health care projects, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to redefine "emergency admissions" so that CHAMPUS beneficiaries in crisis can be stabilized and obtain necessary assessments in an emergency department without leaving a hospital to have treatment assessments done by a contractor.
Closed – Implemented
DOD adjusted the contractor procedures, which were unique to the demonstration project, so that beneficiaries were allowed greater access to hospitals, particularly in emergencies. This change will be incorporated into future contracts for mental health care. However, DOD does not agree that the definition of an emergency requires changing.
Department of Defense In designing future mental health care projects, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to improve and maintain documentation of all internal processes designed to ensure that appropriate decisions are being made and develop internal systems that document the use of internal quality assurance results to help identify potential failures or errors of the managed mental health care system.
Closed – Implemented
DOD awarded a contract to monitor quality of care nationally (see recommendation 1). The contractor will help develop procedures to document mental health care processes and quality assurance results. Also, DOD's proposed contracts include requirements for comprehensive internal quality-monitoring and improvement programs.

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Topics

Emotionally disturbed personsFixed price contractsHealth care cost controlInternal controlsMedical care evaluationMedical expense claimsMedical services ratesMental health care servicesMilitary dependentsMilitary personnelPatient care servicesQuality of care