National Association of State Mental Health Program Directors 

66 Canal Center Plaza, Suite 302, Alexandria, VA 22314 (703) 739-9333 Fax (703) 548-9517 

OPERATING UNDER A COOPERATIVE AGREEMENT WITH THE NATIONAL GOVERNORS’ ASSOCIATION 

NASMHPD 

 Board of Directors 

Virginia Trotter Betts, M.S.N., J.D., 

R.N., F.A.A.N. 

 President

 Tennessee 

James S. Reinhard, M.D. 

 Vice President 

Virginia 

 

Lorrie Rickman Jones, Ph.D. 

 Treasurer 

Illinois 

Brian Hepburn, M.D. 

Secretary 

Maryland 

Vacant 

At-Large Member 

Kevin Martone 

North-Eastern Regional 

Representative 

New Jersey 

Linda Roebuck 

Western Regional 

Representative 

New Mexico 

Terri White 

Mid-Western Regional 

Representative 

Oklahoma 

Katharine Lyon, Ph.D. 

Southern Regional 

Representative 

Florida 

Robert W. Glover, Ph.D. 

Executive Director 

NASMHPD 

May 28, 2009 

Internal Revenue Service 

U.S. Department of Treasury 

Employee Benefits Security Administration 

U.S. Department of Labor 

Centers for Medicare & Medicaid Services 

U.S. Department of Health and Human Services 

VIA EMAIL: E-OHPSCA.EBSA@dol.gov

RE: Request for Information Regarding the Paul Wellstone and Pete 

Domenici Mental Health Parity and Addiction Equity Act of 2008 

(published in 74 Fed. Reg.19155 et seq.) 

To Federal Agencies: 

On behalf of the members of the National Association of State Mental 

Health Program Directors (NASMHPD), we appreciate the opportunity to 

submit comments to the three Federal agencies as part of the rule making 

process for the Paul Wellstone and Pete Domenici Mental Health Parity and 

Addiction Equity Act signed into law on October 3, 2008. 

Under the new law, employers with over 50 employees that offer mental 

health coverage are required to offer benefits that are on par with medicalsurgical benefits. Financial requirements (deductibles, co-payments, 

coinsurance and out-of-pocket expenses) and treatment limitations (number 

of visits, scope and duration of treatment) cannot be more restrictive for 

mental health or substance abuse benefits. However, several issues related 

to the law are not completely straightforward and as requested in the Federal 

Register Notice of April 28, NASMHPD welcomes the opportunity to 

highlight areas of concern surrounding several key issues. In consultation 

with our members in the states, several questions have emerged that need to 

be addressed: 

• What is the scope of services covered under parity? Is it limited to 

inpatient hospitalization, office visits or clinic services, partial 

hospitalization, and prescription drugs or does it include services that are 
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May 28, 2008 

Dr. Robert W. Glover, Ph.D. 

more specific to treatment of mental illness such as case management, day treatment, rehabilitation services, 

assertive community treatment, and supports to remain in independent housing? Standards should be 

established that require plans to include all clinically necessary services provided by practitioners of the 

healing arts licensed under state law. A narrow medical necessity screen would not provide wellness and 

recovery-oriented services that are cost-effective and lead to improved health outcomes. 

• What are the behavioral health equivalents of vaccinations and inoculations, PSA and PAP tests, and 

cholesterol lowering drugs and anti-hypertensives? The regulations should assure access to a basic level of 

wellness and prevention services. Managed behavioral health plans sometimes use a Global Assessment of 

Functioning (GAF) scale to make medical necessity determinations for services ranging from high intensity 

inpatient services to no services indicated. The use of this type of scale should not exclude the use of 

effective “inoculations” for mental health conditions. 

• Are there adequate standards for the network? If credentialed networks are inadequate or do not 

include needed subspecialties such as child psychiatry, the option to go “out of network” is only available to 

those with the ability to pay higher copays and deductibles. Networks must include sufficient numbers of 

both primary and specialty providers to assure access to services. 

• Some health plans have lower copayments for primary care doctors (including Ob/Gyn, pediatricians, 

and internists) than for other specialists. Will the lower co-pays that often apply to primary care services 

also apply to those provided by psychologists, social workers, and drug and alcoholism counselors? It 

violates the spirit of parity that an individual participating in substance abuse counseling two or three times a 

week would have to pay copayments set at the highest rate for medical subspecialties. 

• Because the new parity law does not mandate coverage for mental health and addiction services, 

some employers could choose to terminate behavioral health coverage altogether and provide expanded 

employee assistance plan (EAP) services instead. Regulations should draw a bright line defining what 

services EAP can include and what can only be provided through a health insurance policy. Inpatient care, 

psychiatric visits, and medications should be on the insurance side of that line. 

Thank you for the opportunity to raise concerns in this initial stage of the regulatory process. If you have 

any questions regarding these comments please feel free to contact me or Elizabeth Prewitt, Director of 

Government Relations at 703-682-5196. 

Sincerely yours, 

Robert W. Glover, Ph.D. 

Executive Director