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April 29, 2010

Office of Health Plan Standards and Compliance Assistance

Employee Benefits Security Administration, Room N-5653

U.S. Department of Labor

Attention RIN 1210-AB30

200 Constitution Avenue, NW

Washington, D.C. 20210

Centers for Medicare & Medicaid Services

U.S. Department of Health and Human Services

Attention CMS-4140-IFC

P.O. Box 8016

Baltimore, MD 2124401850

CC:PA:LPD:PR (REG-120692-09), Room 5205

Internal Revenue Services

P.O. Box 7604

Ben Franklin Station

Washington, D.C. 20044

Re: Interim Final Rules under the Paul Wellstone and Pete Domenici Mental

Health Parity and Addiction Equity Act of 2008 (published in 75 Fed. Reg. 5410

et seq.)

VIA EMAIL: E-OHPSCA.EBSA@dol.gov

To ‘The Departments’:

The Texas Council of Community MHMR Centers, Inc. is an association that represents the

thirty-nine (39) public Community Mental Health Centers that serve all 254 counties of Texas.

On behalf of our members, we appreciate the opportunity to submit the following comments on

the interim final rules (“IFR”) for the Paul Wellstone and Pete Domenici Mental Health Parity

and Addiction Equity Act of 2008 (“MHPAEA”), as published in the February 2, 2010 Federal

Register:

1. We support the parity standard as proposed by the Departments in the IFR. The

standard sets the stage for implementation of the statutory requirement in MHPAEA

and ensures mental health and substance use benefits are properly included in health

plan benefit design.
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2. The IFR reflects the MHPAEA requirement that a group health plan that provides both

medical/surgical and mental health/substance use disorder benefits must ensure that

the financial requirements and treatment limitations applicable to these benefits are no

more restrictive than those requirements or limitations placed on medical/surgical

benefits.

3. We support the retention of the parity standard (effective since 1998) related to annual

and lifetime dollar limits.

4. We support application of the predominant standard, as described in the IFR, relative to

financial requirements and treatment limitations for mental health and substance use

disorder services.

5. We recommend clarification that non-quantitative treatment requirements are subject

to the Predominant and Substantially all Standard and the Comparable and No More

Stringently Standards and ensure that exceptions to these standards are based on

independent and objective clinical policies and standards.

6. We recommend adding a requirement that plans disclose the reason for a benefit claim

denial within a specific timeframe.

7. We agree with the determination of six discrete classifications of benefits in which

parity is applied (inpatient/in-network, inpatient/out-of-network, outpatient/innetwork, outpatient/out-of-network, emergency care and prescription drug coverage)

and recommend clarification that all medical/surgical and mental health/substance

abuse disorder benefits must be included within the six classifications.

8. We support the specific provision in the IFR that applies the MHPAEA to out-of-network

benefits, reflecting clear Congressional intent.

9. We agree with the determination that the MHPAEA prohibits health plans from applying

separate deductibles, out-of-pocket maximums or other cumulative financial

requirements or mental health/substance use disorder benefits, reflecting clear

Congressional intent.

10. We agree with the Departments that a “shift in source of treatment from primary care

physicians to mental health professionals could lead to more appropriate care, and thus,

better health outcomes”.

11. We agree with the Departments commentary to the rule that mental health and

substance use disorder providers should not be classified as “specialists” for the

purpose of applying higher copayments and recommend inclusion of this statement in

the rule.

Thank you for considering our comments.

Sincerely,

Danette Castle, CEO

Texas Council of Community MHMR Centers