RECEIVED 

e 

u) Holyoke Medical Center MY - 5 zusu 

Q A Member of &[ley Health Systems, Inc. 

575 Beech Street 

THE CENTER FOR BEHAVIORAL HEALTH Holyoke, Massachusetts 0 1040-2296 

www.holyokehealth.com 

Telephone 4 13 534-2500 

April 28,2010 

Centers for Medicare and Medicaid Services 

Department of Health and Human Services 

Room 445-G, Hubert H. Humphrey Building 

200 Independence Ave., SW 

Washington, D. C. 20201 

Re: File Code: CMS-4140-IFC 

Dear Sirs: 

On behalf of the Center for Behavioral Health at Holyoke Medical Center, I am offering 

comments relative to File Code CMS-4140-IFC; Interim Final Rules Under the Paul Wellstone 

and Pete Domenici Mental Health and Addiction Equity Act of 2008. Holyoke Medical Center's 

Behavioral Health Services include a 20-bed locked adult inpatient unit; a 20-seat psychiatric 

and dual diagnosis PHP and IOP; hospital-based outpatient services; and an affiliation with River 

Valley Counseling Center, a community mental health center with offices in Holyoke, Chicopee 

and Springfield, Massachusetts. 

I think these regulations are extremely important and hope they are officially promulgated. In 

Massachusetts, we have extensive experience with Parity Laws, having passed the first Parity 

Law in 2000; and then more recently an expansion of that law in 2008. The passage of these laws 

has helped equalize the insurance treatment for behavioral health, primarily be removing 

arbitrary day and dollar benefit limitations for certain conditions. However, these laws have done 

little to nothing towards reducing the inordinate micro-management and oversight by Carve-Out 

firms. There is heavy utilization of Carve-Out firms in Massachusetts, both in the public and 

private sectors. The oversight is far more rigorous for behavioral health than it is for 

medical/surgical services in the areas of Pre-Admission Screenings; Concurrent Reviews; and 

the application of Medical Necessity Standards. Hospitals and clinicians continually struggle to 

get Carve-Out firms to approve services that the attending clinicians believe are medically 

necessary. Evidence of the difficulties our patients and clinicians experience in this regard is 

demonstrated by the fact that consistently behavioral health is the most appealed health service to 

our Massachusetts Office of Patient Protection, usually at least double the next highest appealed 

condition; see www.mass.~ov/dph/op~, Providers are constantly questioned and micro-managed 

by Carve-Out reviewers as to the medical necessity of a given behavioral health service. In 

Massachusetts, we believe the scrutiny for physical health is no where near the level of scrutiny 

for behavioral health. Indeed, the MABHS has filed legislation, S. 482 and H.1079, which would 

balance the application of medical necessity determinations by providing more authority for the 

attending clinician, verses the Carve-Out reviewer. 

An Afi-liate of UMass Memorial Health Care 
Given the above situation I believe the proposed federal regulations, particularly in the area of 

"non quantitative" treatment limits, are vitally important and must be maintained in the final 

rewlations. My understanding of the non quantitative proposed rule is that treatment limitations 

can be no more stringent for mental health or substance abuse than they can be for 

medical/surgical benefits. The experience of Massachusetts providers would lead us to believe 

this provision is critical towards implementing true Parity-because we have seen through nearly 

ten years of Parity Laws that removal of day and dollar limits essentially does not lead to Parity 

if the behavioral health services are going to be more rigorously managed, scrutinized and denied 

by Carve-Out firms. Parity with medical/surgical benefit management would be a maior step 

forward in providing better access to needed services for the patients we serve and in essence 

would help lead towards true Parity. which we believe the Congress intended. I hope that the 

federal agencies adhere to this language in the final regulations; for without such a provision it is 

difficult, if not impossible to achieve true Parity for mental health and substance abuse services. 

I also request that there be clarification in the final regulations that the plans provide all levels of 

essential behavioral health services, including PHP, IOP, Psychiatric Day Treatment, and 

Outpatient Counseling, just as they do for medical/surgical services. In order to have Parity, the 

scope of services should be comparable for behavioral health and medical surgical services. 

I appreciate the opportunity to offer these comments and stand ready to answer any questions or 

provide any hrther details you may need. 

'hatthew-~aas, L~S W, LADC-I 

Director of Behavioral Health Services, 

Holyoke Medical Center 

Executive Director, 

River Valley Counseling Center, Inc.