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MAY 4 REG-120692- 05

LEGAL PROCESSING DIVISION
PUBLICATION & REGULATIONS As of: May 04, 2010
BRANCH Received: May 03, 2010

Status: Posted
PUBLIC SUBMISSION breetes: eyo, 2010,
Comments Due: May 03, 2010)
[Submission Type: Web

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-2009-0008-0119
Regulations Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
Equity Act of 2008

Document: IRS-2009-0008-0151
Comment on FR Doc # 2010-02166

Submitter Information

Name: David Matteodo
Address:

115 Mill St

Belmont, MA,
Email: DMatteodo@aol.com
Phone: 617-855-3520
Submitter's Representative: David Matteodo
Organization: Massachusetts Association of Behavioral Health Systems, Inc.

— —— — ———

General Comment

See attached file(s)

Attachments

IRS-2009-0008-0151.1: Comment on FR Doc # 2010-02166

https://fdms.erulemaking .net/fdms-web-agency/component/submitterInfoCoverPage?Call=P... 5/4/2010


Massachusetts
Association of
Behavioral
Health
Systems, Inc.

115 Mill Street
3elmont, MA 02478
hone: 617-855-3520

Nasir Khan, MD
President

david Matteodo
Executive Director

embers:

\dCare Hospital
\rbour Hospital
\rbour-Fuller Hospital
\rbour-HRI Hospital
3ournewood Hospital
AcLean Hospital
2embroke Hospital
Vestwood Lodge

\ssociate Members:

\nna Jaques Hospital
3ayridge Hospital

Jaystate Health

erkshire Health Systems
3eth Israel Deaconess
3rockton Hospital

Zambridge Health Alliance
2ape Cod Hospital

Jaritas Carney Hospital
Jaritas Good Samaritan
Jaritas Holy Family Hospital
Jaritas Norwood Health System
Jaritas St. Elizabeth's
Shildren's Hospital

Dooley Dickinson Hospital
Emerson Hospital

‘aulkner Hospital

‘ranciscan Hosp. for Children
3osnold Treatment Center
Jallmark Health System
Jarrington Memorial Hospital
denry Heywood Hospital

tigh Point Treatment Center
tolyoke Medical Center
Aarlborough Hospital

dass General Hospital

Aetro West Medical Center
Aorton Hospital

Aount Auburn Hospital
ewton Wellesley Hospital
{oble Hospital

{orth Adams Regional Hospital
orth Shore Medical Center
Quincy Medical Center
*rovidence Behavioral Health
3t. Luke's Hospital

3t. Vincent Hospital

“ufts Medical Center

J Mass Memorial Health Care

May 3, 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 Massachusetts Association of Behavioral Health Systems (MABHS),
Iam 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.
The MABHS represents 47 inpatient mental health and substance abuse facilities, which
collectively admit over 45,000 patients on an annual basis and provide the vast majority
of acute inpatient behavioral health services in Massachusetts

We 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 lirnitations 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.gov/dph/opp. 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.

Given the above situation we believe the proposed federal regulations, particularly in the

area of “non quantitative” treatment limits, are vitally important and must be maintained
in the final regulations. Our understanding of the non quantitative proposed rule is that


treatment limitations can be no more stringerit for mental health or substance abuse than
they can be for medical/surgical benefits. Our Massachusetts experiences 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 major 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. We 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.

We also request that there be clarification in the final regulations that the plans provide
all levels of essential behavioral health services, 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.

We appreciate the opportunity to offer these comments and stand ready to answer any
questions or provide any further details you may need.

Sincerely,

David Matteodo
Executive Director

DMatteodo@aol.com
(617) 855-3520