1025 Connecticut Avenue, NW, Suite 1012 • Washington, DC 20036-3536 • (202) 857-9735 phone • (202) 362-5145 fax • www.nacbh.org 

May 27, 2009 

Centers for Medicare and Medicaid Services 

Department of Health and Human Services 

Hubert H. Humphrey Building, Room 445-G 

200 Independence Avenue, SW 

Washington, DC 20201 

Re: CMS-4140-NC 

Dear Gentlepersons: 

The National Association for Children’s Behavioral Health (NACBH) appreciates the opportunity 

to comment on the development of regulations for the Paul Wellstone and Pete Domenici Mental 

Health Parity and Addiction Equity Act of 2008. 

NACBH represents multi-service treatment agencies providing a wide array of behavioral health and 

related services. Services provided by NACBH members include assessment, crisis intervention, 

residential treatment, therapeutic group homes, in-home services, therapeutic foster care, independent 

living, alternative educational services, respite, day treatment, outpatient counseling and myriad 

community outreach programs. Providers serve clients from the mental health, social service, juvenile 

justice and educational systems. 

Nearly one hundred percent of the clients served by NACBH members are publicly funded, many due to 

disability or family income, but many as a result of inadequate mental health benefits under their families’ 

private health insurance. We are hopeful that Congress’ intent to close the loopholes of the 1996 parity 

law will improve families’ ability to access timely and appropriate mental and addiction treatment 

services as well as reduce cost-shifting from the private to the public sector. 

In addition to the Mental Health Liaison Group’s comments, to which we signed on, there is another area 

of clarification that could minimize the potential for continued under-insurance of children and youth. In 

defining “treatment limitations,” we encourage the Department to consider more than number of inpatient 

days and outpatient visits. For example, if a health plan does not explicitly include or exclude physical 

health diagnoses or treatment settings, parity would dictate the same for mental or addiction diagnoses 

and treatment settings. Medical necessity and utilization review criteria, which would continue to be 

defined by the health plans, would avert unnecessary use of services. 

We refer the Department to the National Business Group on Health’s recent Employer’s Guide to Child 

and Adolescent Mental Health for an excellent review of the current – and recommended – state of the art 

in developmentally appropriate dependent coverage. It details the direct and indirect costs to businesses 

of employees’ children’s behavioral health disorders, outlines the types, prevalence and age of onset of 

disorders in children and youth, and discusses related treatment and cost trends. We believe it would be 

useful in conducting both the fiscal impact analysis required by the Regulatory Flexibility Act and a 

determination of whether and how family well-being would be affected as required by Section 654 of the 

Treasury and General Government Appropriations Act of 1999.
Centers for Medicare and Medicaid Services 

May 27, 2009 

CMS-4140-NC 

We appreciate the opportunity to comment and offer the resources of this Association as you 

consider the unique needs of children and youth in crafting the new parity regulations. 

Sincerely, 

Joy Midman 

Executive Director