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-0077 

DC 

Submitter Information 

Name: Ron Manderscheid 

Address: 

Washington, DC, 20001 

Organization: National Association of County Behavioral Health and DEvelopmental Disability 

Directors 

General Comment 

The National Association of County Behavioral Health and Developmental Disability Directors 

strongly endorses and supports the Interim Final Regulations on Parity for mental health and 

addiction services. In addition, we offer the following comments. 

These regulations represent an essential plateau for the mental health and substance use care 

fields. Together, the Wellstone-Domenici Act and the associated regulations are intended to make 

it precisely clear that these fields are to be treated no differently than medical/surgical care. For 

both quantitative factors, e.g., number of visits, and qualitative factors, e.g., management of 

benefits, health plans are required to offer benefits for these fields that are no different than those 

offered for medical/surgical care. 

Because they address qualitative factors such as management of benefits, the regulations are 

designed to improve equality of access between medical/surgical care and mental health or 

substance use care. However, since they do not specify common standards of medical necessity, 

the degree of access is very likely to continue to vary dramatically across health insurance plans. 

This means that two people in two different health plans with the same problem and same severity 

will very likely not have the same degree of access to care. Hence, the regulations should provide 

a common national definition of medical necessity.

PUBLIC SUBMISSION 

As of: April 30, 2010 

Received: April 29, 2010 

Status: Draft 

Category: Association - Other

Tracking No. 80ae369b 

Comments Due: May 03, 2010

Submission Type: Web

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Beyond the useful 6-tiered stratification, the regulations do not address scope or quality of 

services. Clearly, scope of services is important, since failure to receive a needed service can 

result in a less desirable outcome. Similarly, receiving a needed service in a low quality manner 

can also lead to a less desirable outcome. As we continue to move ahead, it will be extremely 

important for the regulations to address both of these factors. It is not unreasonable to ask that 

scope and quality of care be at parity with medical/surgical services. 

The penultimate goal is to receive effective care that makes a difference in one’s life. Hence, why 

should we be willing to accept any lesser outcomes for behavioral healthcare than for primary 

care? The parity regulations should address this very important issue. 

Thank you for the opportunity to provide these formal comments. 

Ron Manderscheid, PhD 

Executive Director, NACBHDD 

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