________________________________________________________________________ 

Vermont Department of Banking, Insurance, Securities and Health Care Administration 

89 Main Street, Drawer 20 

Montpelier, VT 05620-3101 

802-828-3301 

To: U.S. Department of Labor 

 U.S. Department of Health and Human Services 

 U.S. internal Revenue Service 

From: Herbert W. Olson, General Counsel 

 Vermont Department of Banking, Insurance, Securities and Health Care Administration 

Date: May 28, 2009 

Re: Request for Information Regarding the Paul Wellstone and Pete Domenici Mental Health 

Parity and Addiction Equity Act of 2008 

As a long-standing leader in mental health and substance abuse parity, the Vermont Department 

of Banking, Insurance, Securities and Health Care Administration (“BISHCA”) offers the 

following comments in response to the federal agencies Request for Information published in the 

Federal Register on April 28, 2009. 

1. With respect to the exemption for extraordinary premium increases attributable to parity, 

clarification would be useful concerning the actuarial standards that should be used in the 

case of a state such as Vermont, which enacted a strong health parity law in 1997. It is 

difficult to see how the exemption could be applicable in a state with a long-standing 

parity law. 

2. Again with respect to the cost exemption, the federal statute requires notice to states if a 

plan intends to make an election pursuant to the exemption. Vermont suggests the rules 

require that a plan must provide 90 days prior notice to the federal agencies and to the 

states where the exemption would take effect, and that the federal agencies give careful 

consideration to the comments and recommendations of the effected states concerning the 

proposed exemption before making a determination of whether to approve the exemption 

election. 

3. Vermont is in the process of developing standards of care and insurance coverage for the 

appropriate and cost-effective management and treatment of chronic conditions, known 

in Vermont by its program name the “Blueprint for Health”. These standards are 

designed to offer better and less-costly care for individuals with chronic conditions: for 

example, diabetes, cardiovascular disease, asthma, alcoholism, and depression. The 

program will be phased in over time, and program criteria, financial cost-sharing 

requirements, and treatment protocols for various chronic conditions may differ. 

Vermont suggests that the federal rules be drafted so as to preserve the ability of states to 

implement chronic care management programs such as the Blueprint for Health. 

Vermont . . . 

Department of Banking, Insurance, Securities 

and Health Care Administration 
Vermont comments on mental health and substance abuse parity RFI 5-28-09 Page 2

4. The federal parity law requires that cost sharing be “no more restrictive than the 

predominant financial requirements applied to substantially all medical and surgical 

benefits covered under the plan”. Vermont parity regulatory standards permit plans to 

impose higher cost sharing for specialty care than for primary care and preventive care. 

Vermont recommends that the federal rules permit states to continue to allow plans to 

design benefit plans in a similar cost-effective and medically appropriate manner. 

Vermont appreciates this opportunity to share information with the federal agencies. Please 

do not hesitate to contact BISHCA is there are additional questions or need for information 

concerning the implementation of mental health and substance abuse parity in Vermont and 

the nation. 

Cc: Paulette J. Thabault, Commissioner 

 Christine Oliver, Deputy Commissioner