Administering a National Program of Mental Health Peer Review
In 1977, the Department of Defense (DOD), through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS1), initiated contracts that were to result in revolutionary changes in both practice and attitudes within the nation’s two major mental health professions. CHAMPUS contracted with the American Psychiatric Association and the American Psychological Association to develop and assist in the implementation of two essentially independent national programs to monitor the adequacy and necessity of mental health services delivered to beneficiaries of the CHAMPUS program. Called peer review programs, these efforts were intended to provide the CHAMPUS claims processors (referred to as fiscal intermediaries, or Fls) with the expertise necessary to decide which cases of psychiatric or psychological treatment warranted professional evaluation for adequacy and necessity, and with the mechanism to obtain review of these cases from consultant psychologists and psychiatrists. These consultants would review written treatment plans describing the care delivered by members of their own profession and give the FI written evaluations that could be used by FI personnel in deciding whether or not to pay for the treatment. Those affected by this program would be primarily independent practitioners treating CHAMPUS beneficiaries on a fee-for-service basis.
KeywordsMental Health Service American Psychiatric Association American Psychological Association Project Office Review Program
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