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HRD-80-79 1 (1980-07-29)

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REPORT BY THE                   RELEASED


Comptroller General


OF THE UNITED STATES





OPM Should Promote Medical

Necessity Programs For Federal

Employees' Health Insurance



This is GAO's third report calling for the
Office of Personnel Management to pay more
attention to the medical necessity provisions
of its Federal Employees Health Benefits pro-
gram contracts. OPM has been slow to encour-
age health insurance plans to use medical ne
cessity programs which are designed to help
hold down medical costs and to' encourage
good medical practice.

Promoted by many health insurers and ap-
proved by numerous medical specialty so-
cieties, the proorams have been avdilable since
1977, Until recently, however, OPM provided
virtually no (juidance to participating health
insurance plans ibout medical necessity pro-
grams. Plans' awareness and use of them var
ied greatly. OPM should monitor the pro-
grams, evaluate their benefits, and require
  health insurance plans to use their beneficial
  aspects.






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                         ItP                                    JULY 29,1980
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