MASSACHUSETTS 

PSYCHIATRIC 

SOCIETY 

 

40 Washington Street, Suite 201 

Wellesley Hills MA 02481-1802 

(781) 237-8100 FAX (781) 237-7625 

email: mps@psychiatry-mps.org

EXECUTIVE COMMITTEE 

Theo Manschreck, M.D. 

President 

Marie H. Hobart, M.D. 

President-Elect 

Donald B. Condie, M.D.

Secretary 

 

Mark J. Hauser, M.D. 

Treasurer 

Todd Holzman, M.D. 

Immediate Past President 

Robert L. Pyles, MD 

Sr. APA Representative 



Beverly Sheehan 

Executive Director 

Mayuri Patel 

Executive Office and 

Membership Administrator 

Julie Kealey 

Continuing Medical Education 

Coordinator

_________________________________ 

www.psychiatry-mps.org

May 3, 2010 

Centers for Medicare and Medicaid Services 

Department of Health and Human Services 

Room 445-G, Hubert H. Humphrey Building 

200 Independence Ave., SW 

Washington, D. C. 20201 

Re: File Code: CMS-4140-IFC 

Dear Sirs: 

The Massachusetts Psychiatric Society (MPS), the medical specialty 

society representing more than 1,600 psychiatric physicians in 

Massachusetts, appreciates the opportunity to submit these comments 

on the Departments of Labor, Health and Human Services, and the 

Treasury (The Departments) interim final rule (IFR) on the Paul Wellstone 

and Pete Domenici Mental Health Parity and Addiction Equity Act of 

2008 (Sections 511 and 512 of PL 110-343, October 3, 2008) 

(MHPAEA). 

As a District Branch of the American Psychiatric Association (APA), we 

strongly support the comments submitted by APA regarding the Interim 

Draft Regulations. We would like to offer comments from the 

perspective of a professional organization serving the public in 

Massachusetts, a state with strong parity legislation, high managed care 

penetration for almost 20 years, nearly universal insurance, with 

extensive experience with mental health carve out organizations (also 

known as Managed Behavioral Health Organizations) and which is at the 

forefront in the process of payment reform.

In our experience, the state parity legislation has been a significant step 

in improving access to psychiatric care, particularly with local insurers 

and with insurers who do not carve out mental health and substance 

abuse services. Insurers covered by the state parity law are no longer, 

for many conditions, able to limit care based on diagnosis alone and 

impose arbitrary limits on care. However, particularly for insurers who 

are exempt from parity (self-insured plans and plans written out of state) 

and for insurers who use national carve out organizations, significant 

limitations continue to exist. Many citizens are not aware of their mental 

health benefit until the very time that they need to access them. Many 

do not know that their insurer has carved out mental health services to 

a for profit national carve out organization which imposes an entirely 

different set of conditions for mental health and substance abuse 

treatment than is the case for the rest of medical care. The proposed 

regulations would insure that medical necessity criteria are readily 

available and would allow for greater transparency in the delivery of 

care. The inclusion of substance abuse treatment in the regulations is 

critical, given the pervasiveness of substance use disorders and the 

human and economic toll that they take on our citizens. 
As such, regulation in the area of "non quantitative" treatment limits is critical. As practiced currently, 

mental health treatment is doled out in sessions or days and is often more stringently limited than is 

medical care by means of overly aggressive micromanagement by insurers and carve outs. Mental 

health conditions, like medical conditions, vary in symptomatology, length of illness and severity. Care 

for all conditions must be delivered based on the nature of the condition, not on arbitrary annual or 

lifetime limits. As an example, bipolar disorder and schizophrenia, like diabetes, are lifelong 

conditions. Using up annual or lifetime limits for psychiatric conditions makes as little sense as would 

be the case for diabetes or heart disease. Given the well known toll that conditions such as depression 

take on citizens, families and their employers, it is in the interest of all that effective treatment is made 

available for this and other major psychiatric conditions. Insurers will often suggest that parity 

legislation opens the floodgates of indefinite psychiatric treatment for relatively non-severe condition. 

 If psychiatric conditions, as proposed in these regulations, are treated with greater parity, then 

treatment would be authorized for psychiatric conditions not in an unlimited way, but in a way that is 

consistent with medical conditions. 

 

An essential part of parity is the inclusion of multiple levels of care, such as day treatment and other 

rehabilitative services. Here again the principle of parity would dictate the provision of these services 

in a way analogous to rehabilitation admissions and physical therapy are common for medical/surgical 

conditions. 

We strongly support the single combined deductible as proposed in the regulations. Separate 

deductibles, by definition, treat mental health conditions differently from other conditions and have 

been used to shift further costs to persons in need of mental health services. Separate deductibles 

also encourage the use of another layer of bureaucracy to manage them, most often for profit, national 

carve out companies. We are confident that health insurers are as capable of providing and managing 

mental health care as they are for medical/surgical care. 

Finally, in Massachusetts, discussions are underway to consider global payments for medical services. 

 In our view, the integration of mental health treatment in any proposed global payment system is 

critical to provide comprehensive medical care to the public. We believe that the proposed regulations 

will further this integration and that such integration is consistent with the overall goal of parity for 

mental health and substance abuse services. 

We thank you for the opportunity to present our comments and perspective and would welcome the 

opportunity to discuss further details of these comments. 

Sincerely, 

Eugene J. Fierman, MD 

Chair, Legislative Committee 

Theo C. Manschreck, MD 

President 

Massachusetts Psychiatric Society