May 3, 2010 

VIA ELECTRONIC SUBMISSION

Office of Health Plan Standards and Compliance Assistance 

Employee Benefits Security Administration 

Room N-5653 

U.S. Department of Labor 

200 Constitution Avenue, NW 

Washington, D.C. 202010 

Attention: RIN 1210-AB30 

Re: Interim Final Rules under the Paul Wellstone and Pete 

Domenici Mental Health and Addiction Equity Act of 

2008 

To Whom It May Concern: 

The New Jersey Association of Mental Health and Addiction 

Agencies (NJAMHAA) appreciates the opportunity to comment on 

the interim final rules (the “Interim Final Rules”) related to the Paul 

Wellstone and Pete Domenici Mental Health and Addiction Equity 

Act of 2008 (“MHPAEA” or “Act”), which were published in the 

February 2, 2010 issue of the Federal Register. NJAMHAA is 

grateful for the efforts put forth by the Departments of Labor, Health 

and Senior Services and the Treasury and commends the Departments 

for their work and analysis to ensure the Act is implemented 

consistent with the intent of Congress. 

NJAMHAA supports the comments submitted by the National 

Council for Community Behavioral Healthcare, Mental Health 

America, the National Alliance on Mental Illness and the other 

members of the Parity Implementation Coalition. The comments that 

follow build upon those submitted by the Parity Implementation 

Coalition and represent NJAMHAA’s priority recommendations. 

The MHPAEA requires parity with respect to scope of services and 

makes clear that the parity requirements apply both quantitative and 

non-quantitative treatment limitations. The Interim Final Rules state 

that the “regulations do not address the scope of services issue,” and 

request comment “on whether and to what extent MHPAEA addresses 

the scope of services or continuum of care provided by a group health 

plan or health insurance coverage.” NJAMHAA believes that the 

clear language of the MHPAEA requires that the scope of mental 

health and substance use disorder (MH/SUD) services be no more 

restrictive than the scope of services for medical and surgical services. 
In addition, the MHPAEA permits an exception to the mental health 

parity requirements for plans that experience a cost increase of over one 

percent as a result of the Act. The Act is clear that actual costs incurred, 

not actuarial cost projections, must form the basis of a cost exemption 

application. Such an interpretation is consistent with the implementation 

of prior mental heath parity laws. NJAMHAA respectfully requests that 

the Departments reject any argument to allow plans to use actuarial cost 

projections to establish an exception to the Act. 

Moreover, many states, including New Jersey, have already implemented 

their own mental health parity laws. Many of the existing state laws 

impose restrictions on the same subjects and requirements included in the 

MHPAEA. NJAMHAA strongly supports the Interim Final Rules’ 

interpretation that state parity laws with stronger protections than those 

contained in the MHPAEA will not ordinarily be preempted by the Act. 

Finally, a timeline for the completion and publication of Final Rules 

related to the MHPAEA is unclear. Health insurance plans have already 

begun to implement the Act, often with differing interpretations of 

various provisions. In order to ensure that the Act is implemented 

effectively for the tens of millions of children and adults with mental 

health and addictions disorders, the Departments should issue formal 

guidance related to the issues currently contained in the regulations. Such 

guidance is especially important because of the very inequities that the 

MHPAEA was enacted to remedy continue to be pervasive. Specifically, 

the financial restrictions and treatment limitations on access to mental 

health and substance abuse treatment services continues to be greater than 

those imposed on medical and surgical conditions. 

On behalf of NJAMHAA and our 150 member organizations, I thank you 

for the opportunity to comment on the Interim Final Rules. NJAMHAA 

appreciates the work completed thus far by the Departments in 

developing the Interim Final Rules and we look forward to working with 

the Departments to ensure that the final rules appropriately reflect 

Congressional intent related to the enactment of the MHPAEA Thank you 

for your consideration of our views. I may be reached at (609) 838-5488, 

ext. 292, if you require additional information. 

Sincerely, 

Debra L. Wentz, Ph.D. 

Chief Executive Officer