Docket: EBSA-2009-0010 

Request for Information Regarding the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 

Equity Act of 2008 

Comment On: EBSA-2009-0010-0001 

Request for Information Regarding the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 

Equity Act of 2008 

Document: EBSA-2009-0010-DRAFT-0232 

Comment on FR Doc # E9-9629 

Submitter Information 

Name: Daniel A Coffman 

Address: 

Auburn, CA, 

Organization: Auburn Pain Rehabilitation Medical Clinic 

General Comment 

Comments regarding CMS-4140-NC 

I am a licensed psychologist who provides behavioral medicine services for 

treatment of a variety of disorders. I work in a medical clinic providing 

services for patients with intractable pain, and have a private practice. 

I regularly utilize biofeedback as part of the behavioral medicine treatments 

for chronic pain, anxiety and mood disorders, sleep disorders, and attention 

disorders. There is a substantial body of support for use of biofeedback in 

these areas, and it is now recommended as a primary treatment for anxiety and 

pain disorders by the American Academy of Family Physicians, a primary treatment 

for insomnia by the American Academy of Sleep Medicine, as an essential and 

effective component of chronic pain functional restoration programs according to 

the American Pain Society, and as a primary treatment for attention disorders by 

the American Academy of Child and Adolescent Psychiatry. 

When providing treatment I combine cognitive-behavioral therapy with biofeedback 

using a combination of muscle tension (sEMG), skin conductance (EDR), peripheral 

skin temperature (Temp), heart rate variability (HRV), or brain wave (EEG)

PUBLIC SUBMISSION 

As of: May 28, 2009 

Received: May 28, 2009 

Status: DoNotPost 

Tracking No. 809bbbfe 

Comments Due: May 28, 2009

Submission Type: Web
feedback to facilitate skill development in self-management of pain, anxiety, 

mood, or insomnia. This typically results in symptom resolution or reduction 

with reduced need for medications and decreased utilization of medical services 

over time. 

Many insurance providers deny biofeedback services, even when directly provided 

by a licensed psychologist or physician. This is limitation of an effective and 

validated treatment for a mental/behavioral health problem, or a physical 

problem with mental/behavioral health component. The reasons given by insurance 

companies for denial generally fall into two categories: 1) our company does not 

cover biofeedback for Mental/Behavioral Health problems or 2) there is not yet 

sufficient evidence for the efficacy of biofeedback. As such, they are using 

evidence-based criteria that are far more restrictive for behavioral health 

services than criteria used for medical-pharmacological or surgical services. 

Many routine medical-pharmacological therapies and most surgical procedures have 

far fewer controlled studies about their efficacy than does biofeedback. These 

medical treatments and surgical procedures are generally not limited because of 

concerns about how many controlled studies have been performed about them. 

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-Pharmacological and Surgical 

benefits and that a plan cannot be more restrictive in their managed care 

criteria and reviews for Mental/Behavioral Health and Substance Abuse disorders 

when compared to Medical-Pharmacological and Surgical disorders. Today plans are 

being more restrictive in how they review evidenced based Mental Health and 

Substance Abuse Treatments when compared to Medical-Pharmacological and Surgical 

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. 

Thank you for your time and attention.