Docket: CMS-2009-0040 

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 

Comment On: CMS-2009-0040-0048 

Interim Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and 

Addiction Equity Act of 2008 

Document: CMS-2009-0040-DRAFT-0072 

TN 

Submitter Information 

Address: 

Nashville, TN, 37243 

Organization: TN Department of Mental Health & Developmental Disabilities 

General Comment 

See attached file(s) 

Attachments 

PUBLIC SUBMISSION 

As of: April 28, 2010 

Received: April 27, 2010 

Status: Draft 

Category: Government - State

Tracking No. 80ae179c 

Comments Due: May 03, 2010

Submission Type: Web

CMS-2009-0040-DRAFT-0072.1: TN

Page 1 of 1

file://C:\Documents and Settings\gelman.beth\Local Settings\Temporary Internet Files\OL... 4/28/2010
TN Dept. of Mental Health & Developmental Disabilities 

MH/SA Parity Comments 

4/15/2010 Page 1 

Scope of service/continuum of care: 

The regulations state that the criteria for decision-making shall be the same for MH/SA 

conditions as it is for medical-surgical conditions. If a health plan does opt to cover a 

specific mental health condition, then the regulations should require that treatment for 

that condition conform to established standards for treatment, which preferably include 

evidence-based practices. 

We would like to see the regulations specify the inclusion of evidence-based recovery 

and rehabilitative services: for example, practices such as assertive community treatment, 

illness self-management and recovery, supported housing and employment, and cognitive 

behavioral therapy. These are all services that have shown promise for leading to better 

outcomes for persons with serious mental illnesses and addictions. 

Medical management and medical necessity: 

The regulations state that the same criteria for medical management techniques, such as 

pre-authorization or utilization review, shall be applied in the case of MH/SA as in 

medical-surgical benefits. It would be helpful if the regulations could give some 

examples as to how criteria should be selected and used by health plans for both medicalsurgical and MH/SA treatment services. 
TN Dept. of Mental Health & Developmental Disabilities 

MH/SA Parity Comments 

4/15/2010 Page 2 

In addition to “medical necessity,” we would like to see services included based on 

“clinical necessity,” which are often services necessary for the longer-term rehabilitation 

of those with serious mental illnesses/addictions or those well known for mental health 

promotion, substance abuse prevention, and early intervention. 

 

Provider networks: 

The regulations state that provider networks for MH/SA and medical-surgical benefits 

shall be comparable. In Tennessee, some health plan MH/SA provider networks are 

inadequate due to a shortage of mental health professionals and psychiatric hospitals 

willing to accept the rates offered by health plans. Inadequate provider networks limit 

access to care. Federal regulations should address network adequacy requirements that 

would help ensure the MH/SA network is as robust as the medical-surgical network and 

facilitate credentialing/billing/coding mechanisms that provide enhanced access. 

Formulary design: 

The regulations permit formularies with different financial tiers if the tiers are based on 

reasonable factors (such as cost, efficacy, generic vs. brand, mail-order vs. retail) without 

regard to whether the drug is prescribed for medical-surgical or MH/SA benefits. 

Supplemental rebates from drug manufacturers often determine whether a brand name 

drug receives “preferred” (lower copay) or “non-preferred” (higher copay) status. There 

is some indication that people are more able to access brands on the medical-surgical side 
TN Dept. of Mental Health & Developmental Disabilities 

MH/SA Parity Comments 

4/15/2010 Page 3 

and more often forced into generics on the MH/SA side because the MH/SA brands tend 

to be more expensive. We would like to see the regulations specify that brand drugs for 

MH/SA conditions without a comparable generic be available and not excluded based 

solely on cost, if this is the case on the medical-surgical side. 

General Comment: 

 

We are concerned that health plans may choose to restrict medical-surgical benefits to 

bring them in line with their pre-parity MH/SA benefits rather than expand the MH/SA 

benefits to achieve parity. Likewise, we are concerned that some employers or health 

plans may drop their MH/SA benefits entirely rather than be required to comply with the 

new regulations. Although the authors of the regulations state their belief that this will 

not be the case, it would be helpful if some research could be done in this area. 

We would also like the regulations to include incentives that encourage parity by 

maintaining and/or expanding MH/SA benefits—better aligning them with medicalsurgical benefits. We believe that reimbursement incentives will be necessary in ensuring 

access to and quality of care, particularly in relation to appropriateness of providers and 

the application of integrated models to achieve better health and mental health outcomes. 

We applaud the passage of federal health reform with its requirement for inclusion of 

MH/SA benefits in the basic benefit package for all health plans in the individual and 

small group markets.