From: Randall R. Lyle, Ph.D. [mailto:rlyle@randallrlylephd.com] 

Sent: Monday, May 25, 2009 2:28 PM 

To: EBSA, E-OHPSCA - EBSA 

Subject: Request for Information Regarding the

To whom it may concern:

Attached is a letter in response to the RFI for the Wellstone parity law.

Sincerely,

Dr. Randall Lyle

Randall R. Lyle, Ph.D.

4230 Gardendale St.  

Suite 502

San Antonio, TX 78229‐3699

210‐593‐9725 ext. 12

210‐593‐9714 Fax

www.randallrlylephd.com

www.brainwisetherapy.com

rlyle@randallrlylephd.com
Comments regarding Regulatory Guidance USCG-2007-27022 

page 19157, II B specific areas 1 and 4

I am a marriage and family therapist who provides EEG biofeedback treatment to 

individuals with Attention Deficit Hyperactivity Disorder and Mood Disorders and 

Traumatic Brain Injury (TBI). 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 treatment of ADHD.” This means that EEG 

biofeedback meets the same criteria as 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, 

United Healthcare, 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. 

In addition there is no regulation or demand for controlled studies for the so called “offlabel” prescription of medications. 

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

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.