PUBLIC SUBMISSION 

Docket: IRS-20.09-UUU8 

Request for Infbmatjorl for Paul Wellstone and Pete Dommici Mcntal Hcaltl~ Parity and 

Addiction Equity Act of 2008 

Commcnt On: I liS,2.009-OI)O8-~!OO 1 

Request for Tn formatinn Regarding the Paul Wcllstonc and Pete nolnenici Mental I iealth Parity 

arid Add tction Equity Act of 2008 

Document : IKS-200'2-0008,0~44 

Comment on FR Doc # E9-09h29 

Submitter Information 

Name: William F, Coby 

Address: 

Lafayette, CA. 

Submitter's Representative: George Miller 

Organization: Clinical & Consulting Psycholngy 

General Comment 

1'111 excited abnut the beginning oi' pari ty for mcr~tal heal tl~ conditions and 

scientifically established procedures that I believe provide the best treatment. 

See my attacllcd letter. 

Attachments 

IR S-21)N-I)008-0044.1 Comment on FR Doc # E9-09629 
Comments regarding Regulatory Guidancc USCG-2007-27022 

page 19157,II B specific areas 1 and 4 

I an a clinical psychologist who has studidthe efTects of LEG biofeedback treatment to 

individuals with Attention Deiici t Hypcract ivity Disorder and Mood Disorders tior 20 

years. EEG biofcd back is an empirically validated and widely rccognizeci effective nanme4 ication treatment fbr AD1 ID, as well as othcr conditions. There are over 50 studies 

evaluating the effect ivcncss of EEG biofeedback in the trcdtment of ADHD, 

Substance Ll se disorders and Autism. A rexnt review of this literature mncluded "EEG 

biofeedback meets the American Acade~ly of Child and Adolescent Psychiatry critcria 

fivr" Clinical Guidelines "fnr treatment of ADHD." This mcans that EEG hi0 feedback 

meets the same c~itmia as medication for treating ADHD, and that E EG biufecdback 

"shu uld always bc co~lsidered as an intervention tor this disordcr by the clinician". 

This service has been denied by Gcorgia Medicaid, Aetna, United Behavioral Health, 

Blue Cruss, Cigna, and Amerigroup. 

?'his is limitation of an effective and validated treatment for a mental health problem Tllc 

reasons given by the insurarlcc companies for this denial fell into two catcgorics: 1) outcompany do~ rwt cover biofeedback lbr Mental Hcaith pro hlems or 2) there is not yet 

sufficient evidence tor the efficacy of EEG biofeedback. As such, they art: using 

evidencc-bascd criteria that are far more restrictive fir rncr~tal health services than the 

criteria which are used for mdicallsurgical senrices. There are many routine medical and 

surgical proccdurcs which have fhr fewer contrulled studies about their efficacy than does 

EEG biofeerlbnck. These medical and surgical procedures are generally not limited 

because of cvncerns about how many cnntrolled studies have been pcrfbnlled about them. 

We believe that the parity regulations, based on legal reviews of the parity statute sl~nuld 

require that emp1oyer.s and plans pay for the same range and scope of services for 

Behavioral Treatments as they do tbr Md SUI-g benefits and that a plan cannot bc more 

restrictive in ilicir ~narlaged care criteria and reviews 6r MH and SA d isorderc when 

cornpared to Med Surg. Today phns arc being more restrictive in how they review 

evidenced-based Mental Hcalt h and Suhst ance Abuse Treatments whcn compared to Med 

Surg treatments. This violates both the inten1 and lctter oft he parity statute and we hope 

that the regulations will ~larify that this can't continue. 
Comments regarding Regulatory Guidance USCG-2007-27022 

page 19157, II B specific areas 1 and 4 

I am a clinical psychologist who has studiedthe effects of EEG biofeedback treatment to 

individuals with Attention Deficit Hyperactivity Disorder and Mood Disorders for 20 

years. EEG biofeedback is an empirically validated and widely recognized effective nonmedication treatment for ADHD, as well as other conditions. There are over 50 studies 

evaluating the effectiveness of EEG biofeedback in the treatment of ADHD, 

Substance Use disorders and Autism. A recent review of this literature concluded “EEG 

biofeedback meets the American Academy of Child and Adolescent Psychiatry criteria 

for” Clinical Guidelines “for treatment of ADHD.” This means that EEG biofeedback 

meets the same criteria as medication for treating ADHD, and that EEG biofeedback 

“should always be considered as an intervention for this disorder by the clinician”. 

This service has been denied by Georgia Medicaid, Aetna, United Behavioral Health, 

Blue Cross, Cigna, and Amerigroup. 

This is limitation of an effective and validated treatment for a mental health problem. The 

reasons given by the insurance companies for this denial fell into two categories: 1) our 

company does not cover biofeedback for Mental Health problems or 2) there is not yet 

sufficient evidence for the efficacy of EEG biofeedback. As such, they are using 

evidence-based criteria that are far more restrictive for mental health services than the 

criteria which are used for medical/surgical services. There are many routine medical and 

surgical procedures which have far fewer controlled studies about their efficacy than does 

EEG biofeedback. These medical and surgical procedures are generally not limited 

because of concerns about how many controlled studies have been performed about them. 

 We believe that the parity regulations, based on legal reviews of the parity statute should 

require that employers and plans pay for the same range and scope of services for 

Behavioral Treatments as they do for Med Surg benefits and that a plan cannot be more 

restrictive in their managed care criteria and reviews for MH and SA disorders when 

compared to Med Surg. Today plans are being more restrictive in how they review 

evidenced-based Mental Health and Substance Abuse Treatments when compared to Med 

Surg treatments. This violates both the intent and letter of the parity statute and we hope 

that the regulations will clarify that this can't continue.