performance, but we also have an inspector general who, if the charges or allegations or issues are serious enough, can go at our request or on their own initiative and also make an effort to find out what is going on.

We also have the voice of the participants in the program. We have a very strong process by which people who feel they have received inadequate treatment, improper reimbursement, and so on and so forth, can have those disputes reviewed first by their health plan and then brought to us for a decision that is binding on the health plans.

Beyond that, I think it is important to point out that the 250 health plans that participate in the Federal Employees Health Benefits Program are the same 250 health plans that provide health insurance, health care services through their networks to Americans generally. And so you have the whole network of professional societies, credentialing bodies, and so on and so forth, that gives us some added assurance.

That is a very general answer, but I tried to perhaps categorize it broadly. It is not just one specific thing; it is a whole web of things that I think give us that assurance. I will say also that when we do surveys of Federal Employees Health Benefits Program participants, generally speaking the health plans in the program get quite high marks. So we have that as well.

Senator WELLSTONE. Thank you. Thank you, Mr. Chairman.
The CHAIRMAN. Senator Murray?

OPENING STATEMENT OF SENATOR MURRAY

Senator MURRAY. Thank you very much, Mr. Chairman, and thank you to Senator Wellstone and Senator Domenici and all of our testifiers today. This is a very important hearing. I apologize for being late. There are a number of hearings going on today that I am involved with and can't stay for the whole thing, but I did want to come by and express how important I think mental health parity is. Senator Wellstone's work on this is just extremely important.

I know a lot of people have traveled here from a long ways away to come and talk about this issue because it does affect their lives so dramatically. I have a number of constituents here from "the better Washington," and I want to thank them for having traveled all the way across the country. I think it says a lot about how important this issue is that they would take time out of their lives to come here to do that, and I want to thank them especially for that.

Mr. Chairman, I do have an opening statement that if I could include it in the record, I would appreciate it.

The CHAIRMAN. It will be so included.

[The prepared statement of Senator Murray follows:]

PREPARED STATEMENT OF SENATOR MURRAY

Mr. Chairman, I want to thank you for scheduling this important hearing.

I also want to thank Senators Domenici and Wellstone for their leadership on this issue and for testifying today.

We've got a lot of work to do to improve access to mental health benefits. That's why I'm a cosponsor of S. 543-and I'm pleased this Committee could begin marking up this legislation within the next several weeks. This progress is long overdue.

I also want to thank all of the advocates in the audience who have traveled to Washington, D.C. to be sure their voices are heard.

I'm pleased that we're joined today by many of my constituents from the "other Washington." I want to thank them for making the long trip here to speak on behalf of those who suffer from mental illness and their families.

We recognize that it doesn't make any sense to treat mental illness differently than any other illness. In fact, trying to separate them will only increase costs.

We know that mental health is as important as physical health. And, we know that lack of treatment for mental illness can result in serious physical illness.

Early diagnosis and effective treatment of mental illness must be a priority of any health care plan. Study after study has shown. that mental health parity reduces health care costs.

But it's not just cost, parity also affects research.

As a member of the Labor, HHS Subcommittee on Appropriations, I know how important NIH-supported research has been in treating life threatening diseases.

During the 1990's, NIH provided the necessary leadership and support to focus increased resources on understanding how diseases affect the brain. That focus has given us a far greater understanding of mental illness and how to effectively diagnosis and treat these devastating diseases.

I also believe this focus has reduced the stigma of mental illness. We need to do much more. We need to ensure that we expand our investment in the Mental Health Block Grant to guarantee that access to mental health benefits are not denied.

We must ensure that the uninsured benefit from parity as well. And we must fully-fund guarantee the SAMHSA reauthorization, which provides an increased focus on the mental health needs of children.

As an appropriator, I remain committed to these efforts and I urge my colleagues to remember that parity is more than just in

surance.

Senator MURRAY. I have a couple of questions for Mr. Flynn, and I appreciate your being here today.

Mr. Flynn, when the previous administration moved to implement mental health parity, one of the concerns, outside of the costs, was the ability of the plans to offer comprehensive mental health benefits and to ensure access to quality providers. We were concerned whether plans would be able to contract with enough providers to meet the participation requirements of those plans. Since many parts of the country, including my home State of Washington, are mental-health-provider-shortage areas, I know that was a real concern and topic of discussion.

How was OPM able to ensure that plans achieved parity and included enough providers within their networks to meet the needs of FEHBP beneficiaries?

Mr. FLYNN. Senator Murray, I think I would answer that question in three broad areas. First, we had plenty of lead time. This is an area over which we have been working with our health plans, as I mentioned in my opening statement, for a number of years. We had the better part of 18 months from the President's announcement to actually bring parity on line, though I would also say to you that there were plenty of indications about what we were doing even before then. So lead time is one.

Second, one of the strengths of the Federal Employees Health Benefits Program is the fact that it is not just one big monolith. It is 250 health plans who design their benefit programs and their means of delivery of those benefits in a variety of ways and then compete on the basis of their success in that for individual enroll

ees.

We have seen the introduction of a variety of techniques to deliver parity services. We have seen a number of plans contract with managed behavioral health care organizations and to provide that benefits through those organizations. We have seen health plans. contract with a managed behavioral health care organization, but use the plan's existing networks of providers, and then we have seen plans develop and expand on their own networks.

So I think the second point that I would make is that there are a variety of ways in which to deliver this benefit, all of which are in place in one way or another in the Federal Employees Health Benefits Program. That is not to say, however, that there are not areas of the country where access is an issue. You mentioned your own State of Washington. Typically, in the Western States, particularly in rural areas, that will be an issue.

One of the things that plans can do and one of the things that plans do, not just in the mental health area but also in the sort of general area of physical benefits where there are not large numbers of network providers and access for those that are in the network oftentimes involves traveling great distances, and so on and so forth, plans have the administrative discretion and will then sometimes get into a situation, and I will mention an extreme situation where they will take all of the providers in a six-county area and simply make them part of their network at their existing reimbursement rates, without having to engage in a contractual negotiation over reimbursement levels for specific services, in an effort to provide the participants with access to the care they need and as a way of attracting participants to that plan.

So, again, there are a whole series of things that I think in an evolutionary way address access. I would not want to leave you this morning or any other members of the committee with the idea that we have solved this completely. We need to keep working on it.

I tend to think that everything in health care evolves, and this is another area that evolves. Particularly, managed behavioral health care organizations are a relatively new introduction in health care today and I suspect there will be evolution there as well. We need to keep working on access. I think we have largely done that, but we can't stop.

Senator MURRAY. Did the shortage of providers impact costs at all from what you saw?

Mr. FLYNN. Well, in a general sense, a shortage of providers under a network can impact costs, and it can impact costs not just in mental health areas but in physical medicine areas as well.

I know all of you know we have seen in the Federal Employees Health Benefits Program over the last 4 years premium increases on average that are well above the overall rate of inflation. And there are a lot of reasons for that, one of which is the need to have adequate networks and the negotiations that go on between health plans and network providers and the reimbursement levels that are associated with that. So, clearly, adequacy of networks will impact costs, but that is no different from any other aspect of care. Senator MURRAY. Mr. Chairman, I have one other area I just want to ask about, and that is I am very worried about the economic gap for women in health care costs in general. Women pay more than 60 percent more out of pocket than men do for health care costs. Often, it is because health care packages don't include reproductive health care benefits or discriminate against contraceptives. But I think that the lack of mental health benefits really has an impact on women. We know that 70 percent of those diagnosed with depression are women.

From your experience with FEHBP plans in bringing in mental health, did that help to close some of that economic gap for women? Mr. FLYNN. Senator Murray, I would have to give you an intuitive answer because we don't have a lot of claims experience just yet. I think clearly that is the case. I would also say that I think the Federal Employees Health Benefits Program is a particularly strong program in terms of benefits for women generally, whether that be coverage of contraceptive devices, many aspects of women's specialty health care, access to ob/gyn specialists and things like that.

I think just as we have worked over the years to improve mental health coverage, we have also worked over the years to make sure we pay special attention to women's health needs in general.

Senator MURRAY. Thank you very much, Mr. Flynn. Thank you, Mr. Chairman.

The CHAIRMAN. Thank you very much.

Thank you, Mr. Flynn. We appreciate it.

Mr. FLYNN. Thank you, Mr. Chairman.

[The prepared statement of Mr. Flynn may be found in additional material.]

The CHAIRMAN. On panel three, I would like to welcome Lisa Cohen. Lisa has personally experienced the difficulty in obtaining quality mental health services. Her testimony will highlight for the committee the need for the important legislation on mental health parity.

We also will have Henry Harbin, who is the CEO of Magellan Health Services International. Magellan is the largest managed behavioral health care organization in the country. As both a psychiatrist and chairman of managed care, Dr. Harbin is uniquely qualified to testify about the benefits of mental health parity.

Dr. Regier is from the American Psychiatric Institute for Research and Education, a national leader in treating mental health disorders. He will speak to us about the low cost of implementing parity.

Lisa, we welcome you. We know it is never easy to share these kinds of personal experiences. We understand that, so we particularly appreciate your willingness to talk with us about it. I think the best way we can thank you is to commit to you to do our very best to make sure that we are going to achieve something worthwhile so these circumstances don't happen to another Lisa Cohen. So we thank you very much for being here.

STATEMENTS OF LISA COHEN, BORDENTOWN, NJ; DR. HENRY HARBIN, CHAIRMAN AND CHIEF EXECUTIVE OFFICER, MAGELLAN HEALTH SERVICES, COLUMBIA, MD; AND DR. DARREL A. REGIER, EXECUTIVE DIRECTOR, AMERICAN PSYCHIATRIC INSTITUTE FOR RESEARCH AND EDUCATION, WASHINGTON, DC

Ms. COHEN. Good morning. My name is Lisa Cohen and I am here today because I am lucky. I am certainly not lucky to have a mental illness, nor am I lucky to have a physical illness. I am, however, extremely lucky that I have been able to receive the treatment I need, despite the roadblocks of unequal insurance coverage and stigma that I have had to cross in the process of learning to live successfully with chronic illness since 1988.

The insurance industry's discriminatory practice of providing far less coverage of mental than of physical illnesses has made my struggle to live a healthy and productive life much more difficult. And it makes no sense, since the costs to society of untreated mental illness are greater than the costs of providing treatment.

Thirteen years ago, I dropped out of college in Ohio and returned home to Philadelphia in a cloud of severe depression. At the time, I didn't know what I was suffering from or why. All I knew was that I could no longer function, and all I felt was futility, failure and hopelessness.

With the support of my family, I was soon in the care of a psychiatrist. The diagnosis of clinical depression, and later bipolar illness or manic depression, was a blessing and a curse. Finally, I knew that I had an actual illness with available treatment and the possible to return to a normal life. What I didn't realize at the time was that along with this diagnosis came the need for long-term treatment, expensive and uncovered care and, of course, the stigma of having a mental disorder.

A few months later, in October of 1988, I was diagnosed with a rare blood disorder called idiopathic thrombocythemia. In simple terms, this means that I have too many platelets in my blood. The result of such a condition is the high risk of clotting diseases such as strokes and heart attacks.

Just as my mental illness does, this disease demanded immediate treatment as well as continued medical attention. I would like to add that the cause of this condition is unknown. This included bone narrow testing, frequent blood tests, monitoring of side effects and numerous doctor visits.

For three very long years, I struggled to maintain a semblance of order in my life as I went from psychiatrist to hematologist, from therapy to medication, and eventually numerous hospitalizations. To me, the two illnesses I have don't seem to be that different. One affects my blood, the other my brain chemistry. Untreated, either