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PUBLIC SUBMISSION 

As of: May 28, 2009 

Tracking No. 809adl b3 

Docket: IRS-20094008 

Request for Information for Paul Wellstone and Pctc Dommici Mental Health Parity and 

Addiction Equity Act of 2008 

Comment On: I K S-20119-QN!S-OO_O_J. 

Request for Znformativn Regarding the Paul Wellstone and Pete Dotnenici Mental Hcalth Parity 

and Addiction Equity Ad of 2008 

Document: !RS:2.009:0008-00!3 

Comment on FR Doc # E9-09629 

Submitter Information 

Name: Dr-Ron Lcchnyr, Ph.D. 

Address: 

Eugene, OR 

Submitter's Rcprcsentative: Peter UeFasio 

Organization: Clinical Psychologist 

Government Agency Type: Federal 

Government Agency: HHS 

General Comment 

Comments regarding Regulatory Guidance USCG-2007-27022 

page 1 91 57, 11 B specific areas 1 and 4 

1 am a clinical psychologist who provides B io fccdback treatment to individuals with 

Chronic Pain and Complex Health Carc problems. Biof lxlback is an empirically 

vnlidated and widely rewgnizd ef'ftctive non-medication treabnent of a variety of 

cllallcnging rndical problems which frustrate physicians and lead to medical ovcrutilization . There are over 30 years of various studies evalwt ing thc cffcxtiv~mas 

of Biofeedback in the treatilletit of Cl~ronic Pain, Headaches, Cardiac, ADHD, 

Substance IJse disorde~s and Autism. A rcccnt review uC this literature 

concluded "EEG biofeedback meets the American Academy of Child and 

Adolcsccnt Psychiatry miteria for" Clinical Guidelines "for treatment of ADHI)." 

This tneans, for examnplc, that EEG biof'kedback meets the same criteria as 

medication for trcaling ADHD, and that EEG biofeedback "should always be 

considered as an ultcrvcntion ibr this disurder by the clinician". This helps to 

furtl~er focus paticmi care only on taking of medications-from pain medications to 

stimulant ~lledicatiutls for Attention Deficit Hyperactive Disorders which is only a 

partial treatment fnr such d isordcrs. 
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This service has been denied by Georgia Medicaid, Actna, United Behavioral 

Health, Blue Cross, Cigna, Amerigroup and most othw health insurers. 

This is ljmitation of an effective and validated treatmmt fbr a mental health 

pmblem. The reasons givcrl by the insurance wrnpanies for this denial fell illto 

two categories: 1) our company does not cover biofeedback for Mcntal Health 

problems or 2) there is not yet sufficient evidence for ttlc efficacy of EEG or EMG 

and other biofeedback tremtments--denying to acknowledge the 30 plus years of 

such research and hnving this modaIily available and utilized in most medical 

schools, ccntms, and clinics. 

As such: they are using evidence-based criteria that arc far more restri~tive for 

mental health services than the criteria which are used fur medicallsurgical 

services. There are Inany routine medical and surgical procedures which have far 

fewer co~~trolled studics about their efficacy than does EMG and EEG 

Biofeedbak. These medical and surgical procedwcs arc generally not limited 

beause of concerns about how many controlld studies have been performed 

about them. No othcr procdure has had to wait so many years for acceptance 

when t tic there is scientilic evidenced based research studies backhg thatti. 

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

should require that employers and plans pay ibr the same range and scope of 

services for Behavioral Tredtments as they do for Med Surg benefits and that a 

plan cannot be more restrictive in their managed care critcria and reviews fir MH 

and SA disorders when compared to Md Surg. Today plans *art: being more 

restrictive in how they revicw cvidalced-based Mental 1 Iealth and Substance 

A huse Treatments whcn cornpard to Med Surg treatments. Though parity exists 

for several years in many states, including Oregon, ijlsurers still over-ch~k md 

push ibr providers to stop treatment before fbl l results havc been achieved. They 

push for medication as it is a quick fix at a tiinc whcn we art: quttstioning the use 

of too many prescript ions. This violates both the intent and letter of the parity 

statutc and we hope that the regulations will clarify that this can't wr~tinuc. 

Dr. Ron Lechnyr, Ph.D. 

CAinical Medical Psychologist 

Diplomate, American Academy of Pain Management 

Pain Management & Behavioral Medicine Clinic 

Willarnette MedicaI Center, Suite 103 

P.O. Box 40668 

Eugene, Orcgon 97404-0 18 1