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PUBLIC SUBMISSION 

As of: May 28,2009 

Tracking No. 809aeSff 

Docket: IRS-2009-0008 

Request fir In i'urmation for Paul W el lstone and Pete Domenici MenVal Idealth Parity and 

Addiction Equity Act of 2008 

Cnmn~cnt On: I_RS_-20F)-001)8-I)OO I 

Request for Information Regarding the Paul Wellstonc aild Pete Oornenici Mental Health Parily 

and Addiction Equity Act of 2008 

Document: 1K 5-21109-0008-003.4 

Comnlcnt on FR Doc # E9-09629 

Submitter Information 

Namc: MERLYN 1 IURD PHD 

Address: 

NEW YORK, NY, 

Submitter's Representative: MR. CHARLES SCHUMAN 

Government Agency Type: Fedmal 

Government Agcncy : I IHS 

General Comment 

Dcar sirs, 

1 am submitting commmts re: parity using ncurofeedback and biofeedback. 

Sincerely, 

Merlyn Hurd PhD 

- 

Attachments 

IRS-200C)-O008-0034-l Ccrmn~ent on FR Doc # E9-09629 
Co~mne~lts rcgard irlg Regulatory Guidance USCG-2007-27022 

page 1 9 1 57,lI B specific arcas 1 and 4 

I am a devclomcntal psy~hulogist who provides BEG biofeedback treattnent to 

individuals with Attention Deficit Hyperactivity Disorder and Mood Disorders. EEG 

hiu feedback is an cmpirically validated and widely recognized effective non medicat ion 

treattnent for ADHD, as well as other conditions. There art: over 50 studies evaluating 

the cfi'cctiveness of EEG biofeedback in the treatment of ADHD, Substance Use 

disorders and Autism. . A recent rcvicw of this literature concluded 'BEG biofeedback 

mccts the American Academy of Child and Adolescent Psychiatry criteria for" Clinical 

Guideli~les "for treat tnlctlt of ADHD." This mwns that EEG biofeedback meets the same 

criteria as to medication for treating ADHD, and that EEG biofeedback "should always 

be co~lsidered as an intcrvcntion for this disorder by the clinician". 

This service has been denied by Gmrgia Medicaid, Aet~la, Vnitcd Behaviclrril Health, 

Bluc Cross, Cigna, and Ammigroup. 

This is limitation of an effective a11d validatcd trcatmenl fir a mental health problem. 

The reasons given by the insurance cnmpanies for this denial fell mto two catcgorics: 1 1 

our company does not covcr bioficdback for Mental Health problems or 2) there is not 

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

evidence-bascd criteria that arc: far more restrictive for mental health sewices than the 

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

surgical produrrs which have far fewer contmHed studies about their efficacy than docs 

EEG biofeedback. ~l'hcsc rncd ical and surgical procedures are generally not limited 

because oKwncerns about how many controlled studies have been performed about them. 

We believe that the parity regulations, based on legal revicws of tllc paril y slal ut: 

4muld requirc that employers and plans pay for the same range and scope of sentices for 

Behavioral Treatments as they do for Med Surg heticfits and that a plan carnut be more 

restrict jve in their managed care criteria and reviews for MH and S A disorders whcn 

compmed to Med Surg. Today plans arc bcing more restric3ivt: in how they review 

evidenced basd Mehtal Health and Substance Abuse Treatments whcti cornpard to Md 

Surg treatments. 'This violata both the intent and letter ofthe parity statute and we hope 

that the regulations will clarify that this cm't wntinuc. 

Merlyn Hurd PhD;BCIAC/EEG Fellow 

Editor of ISNR's ncwslcttcr NcuroConne~tiuns 
Comments regarding Regulatory Guidance USCG-2007-27022 

page 19157, II B specific areas 1 and 4

I am a develomental psychologist who provides EEG biofeedback treatment to 

individuals with Attention Deficit Hyperactivity Disorder and Mood Disorders. EEG 

biofeedback is an empirically validated and widely recognized effective non medication 

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 to 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 statue 

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. 

Sincerely, 

Merlyn Hurd PhD;BCIAC/EEG Fellow 

Editor of ISNR’s newsletter NeuroConnections