From: DRKMS@aol.com [mailto:DRKMS@aol.com] 

Sent: Thursday, May 28, 2009 5:33 PM 

To: EBSA, E-OHPSCA - EBSA 

Subject: Comments re: Wellstone and Domenici Mental Health Parity and Addiction Equity Act of 

2008 (MHPAEA).located in the main lobby of the health coverage laws, including the 

nondiscrimination protections, may call

Comments regarding Regulatory Guidance USCG-2007-27022 

page 19157, II B specific areas 1 and 4 

 I am a licensed clinical social worker who provides EEG biofeedback treatment to individuals 

with Attention Deficit Hyperactivity Disorder and Mood Disorders as well as TBI’s (traumatic brain 

disorders), learning weakenesses/disabilities, autism, and substance abuse. 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”. 

Whereas the effects of medication do not last when the medication is removed, the improvements 

from neurofeedback DO last. Also, unlike medication, there are no negative side effects. 

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

Cross, Cigna, and Amerigroup, as well as Colorado Medicaid and Medicare and other insurance 

providers. 

This is limitation of an effective and validated treatment for mental health problems. 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 Medical Surgical benefits, provide equal payment coverage and that a 

plan cannot be more restrictive in their managed care criteria and reviews for Mental Health and 

Substance Abuse disorders when compared to Medical Surgical. Today plans are being more 

restrictive in how they review evidenced based Mental Health and Substance Abuse Treatments 

when compared to Medical Surgical treatments. This violates both the intent and letter of the 

parity statue and we hope that the regulations will clarify that this can't continue 

 Thank you for your attention to this matter. 

 Kay Sheehan

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