From: Alan Johnson [mailto:ajohnson@hinamauka.org] 

Sent: Friday, May 15, 2009 4:54 PM 

To: EBSA, E-OHPSCA - EBSA 

Subject: Comments in response to the "Request for Information Regarding the Paul Wellstone 

and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008."

Comments in response to the “Request for Information Regarding the Paul 

Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 

2008.” 

DEPARTMENT OF THE TREASURY, Internal Revenue Service, 26 CFR Part 54, RIN 1545-BI70, 

DEPARTMENT OF LABOR, Employee Benefits Security Administration,29 CFR Part 2590, RIN 1210-

AB30, DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid 

Services, 45 CFR Parts 144 and 146, [CMS-4140-NC]RIN 0938-AP65 

The Hawaii Substance Abuse Coalition, a group of substance abuse and mental health 

providers throughout the state of Hawaii, provide the following comments and 

recommendations. 

We commend government for enacting The Paul Wellstone and Pete Domenici 

Mental Health Parity and Addiction Equity Act of 2008 that there is improved 

treatment for these illnesses leading to wellness in recovery as positive community 

members: 

• Having the same co-pays, cost-sharing percentages and rules for out-of-pocket 

expenses as for other medical benefits will end a major access to treatment 

problem as well as communicate to families and communities that there is hope 

because these illnesses are treatable as are other medical conditions. 

• Ending treatment limitations for restricting the number of visits or number of days 

for inpatient or outpatient treatment, especially annual and lifetime maximums, 

will ensure proper treatment is provided according to individual need, which 

means more individuals and families will find recovery and wellness. 

Furthermore, this will help reduce stigma and encourage others to seek recovery 

and wellness throughout each community. 

We offer recommendations to address potential shortfalls for any future revisions or 

new laws:

• Mandate that plans cover mental health or substance use disorders because this is 

a prevalent medical condition with proven treatment methods for a brain disease. 

Any epidemic or prevalent medical condition that impacts the social and 

biological condition of so many members of community must be addressed with 

proper medical treatment. 

• Define with standard language what the definition is with respect to “medically 

necessary” determinants for mental health or substance abuse services in order to 

remove any possible limitations that would prevent proper medical treatment. 
• Regulate that plans must properly disclose any defining criteria for what is 

determined as medically necessary in enrollment materials and plan information 

documents as a means that community may be properly informed. 

• Regulate that all mental health benefits or substance abuse benefits be defined as 

opposed to the rather vague language that states as “defined under the terms of the 

plan and in accordance with applicable Federal and State law.” The concern is 

that plans may use this provision to limit coverage i.e. coverage may apply to 

these substances but not this substance, etc. 

• Include regulations that government plans have no such restriction with respect to 

limiting the number of visits or number of days for inpatient or outpatient 

treatment. 

• Establish a plan period where small employers will eventually have to comply 

with parity. The concern is that the need for proper medical treatment is 

paramount for the individual regardless of who might be the employer. 

Aloha, 

Alan Johnson, Chairperson, Hawaii Substance Abuse Coalition