Docket: IRS-2009-0008 

Request for Information for Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 

2008 

Comment On: IRS-2009-0008-0001 

Request for Information Regarding the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 

Equity Act of 2008 

Document: IRS-2009-0008-0012 

Comment on FR Doc # E9-09629 

Submitter Information 

Name: Martha M Grout, MD, MD(H) 

Address: 

Scottsdale, AZ, 

Organization: Arizona Center for Advanced Medicine 

Government Agency Type: Local 

General Comment 

Comments regarding Regulatory Guidance USCG-2007-27022 

page 19157, II B specific areas 1 and 4 

I am a physician who provides HEG biofeedback treatment to individuals with 

Attention Deficit Hyperactivity Disorder and Mood Disorders. HEG biofeedback is 

an empirically validated and widely recognized effective non medication treatment 

for ADHD, as well as other conditions. There are over 50 studies evaluating the 

effectiveness of EEG biofeedback in the treatment of ADHD, Substance Use 

disorders and Autism. A recent review of this literature concluded “EEG 

biofeedback meets the American Academy of Child and Adolescent Psychiatry 

criteria for” Clinical Guidelines “for treatment of ADHD.” This means that EEG 

biofeedback meets the same criteria as to medication for treating ADHD, and that 

EEG biofeedback “should always be considered as an intervention for this disorder 

by the clinician”. 

This service has been denied by Georgia Medicaid, Aetna, United Behavioral 

Health, Blue Cross, Cigna, and Amerigroup. 

This is significant limitation of an effective and validated treatment for a mental 

health problem. The reasons given by the insurance companies for this denial fell 

into two categories: 1) our company does not cover biofeedback for Mental Health 

PUBLIC SUBMISSION 

As of: May 28, 2009 

Tracking No. 809acd98 

Comments Due: May 28, 2009
problems or 2) there is not yet sufficient evidence for the efficacy of EEG 

biofeedback. As such, they are using evidence-based criteria that are far more 

restrictive for mental health services than the criteria which are used for 

medical/surgical services. There are many routine medical and surgical 

procedures which have far fewer controlled studies about their efficacy than does 

EEG biofeedback. These medical and surgical procedures are generally not 

limited because of concerns about how many controlled studies have been 

performed about them. 

We believe that the parity regulations, based on legal reviews of the parity 

statue should require that employers and plans pay for the same range and 

scope of services for Behavioral Treatments as they do for Medical and Surgical 

benefits and that a plan cannot be more restrictive in their managed care criteria 

and reviews for MH and SA disorders when compared to Med Surg. Today’s plans 

are being more restrictive in how they review evidenced based Mental Health and 

Substance Abuse Treatments when compared to Med Surg treatments. This 

violates both the intent and letter of the parity statute and we hope that the 

regulations will clarify this issue. 

Thank you for your attention. 

Martha M Grout, MD, MD(H) 

Scottsdale, AZ