SPAN 

35 Halsey Street 

4th Floor 

Newark, NJ 07102 

(973) 642-8100 

(973) 642-8080 – Fax 

E-Mail address: span@spannj.org Website: www.spannj.org 

Statewide Parent Advocacy Network, Inc.

Our Mission: To empower families and inform and involve professionals and other individuals interested in the healthy development and 

educational rights of children, to enable all children to become fully participating and contributing members of our communities and society. 

 May 28, 2009 

The U.S. Department of Health and Human Services 

Centers for Medicare & Medicaid Services 

Department of Health and Human Services 

Attention: CMS-4137-NC 

P.O. Box 8017 

Baltimore, MD 21244-8010 

To Whom it May Concern: 

Thank you for the opportunity to comment on issues surrounding the Paul Wellstone and Pete 

Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The attached 

document represents the comments from the Statewide Parent Advocacy Network of New 

Jersey, New Jersey’s Parent Training and Information Center, Family to Family Health 

Information Center, Statewide Parent to Parent, and Federation of Families for Children’s 

Mental Health Chapter. 

In the document, we have addressed many of the specific areas for which comments were 

solicited. We hope you will take our recommendations under careful consideration as 

regulations are developed. 

Thank you again for this opportunity to comment. 

Sincerely, 

Diana MTK Autin, Esq. 

Executive Co-Director 
Response to Request for Information: 

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction 

Equity Act of 2008 

Submitted by the Statewide Parent Advocacy Network of New Jersey (SPAN) 

The Statewide Parent Advocacy Network of New Jersey (SPAN) is New Jersey’s Parent 

Training and Information Center for families of infants, toddlers, children and youth with 

disabilities; the Family to Family Health Information Center for families of children with special 

healthcare needs; and houses Family Voices-NJ, NJ Statewide Parent to Parent, and a chapter of 

the Federation of Families for Children’s Mental Health. We provide information, training, 

technical assistance, advocacy and support for families of children birth to 26 on all of the issues 

that impact their children, including access to quality, family-centered, mental health services for 

their children and youth. We speak to thousands of parents each year whose children suffer due 

to the lack of true mental health parity in New Jersey and in our nation. Thus, we have long 

endorsed, and continue to strongly support, treating mental health coverage and care as a health 

issue, including requiring true mental health parity by public and private insurers. 

Our comments are based both on our own experiences working with families, and on the 

comments of the Bazelon Center for Mental Health Law. 

A. Comments Regarding Economic Analysis, Paperwork Reduction Act and Regulatory 

Flexibility Act 

1. Do plans currently impose other types of financial requirements or treatment limitations on 

benefits? How do plans currently apply financial requirements or treatment limitations to (1) 

medical and surgical benefits and (2) mental health and substance use disorder benefits? Are 

these requirements or limitations applied differently to both classes of benefits? Do plans 

currently vary coverage levels within each class of benefits?

The primary goals of parity legislation are to prohibit discriminatory insurance practices and 

affirm that mental health and substance use disorder treatments are appropriate and required 

components of comprehensive health care. Thus, SPAN supports one single, inclusive 

deductible for physical health care and mental health services. “Separate but equal” deductibles 

for these services would continue the illogical and inappropriate distinction between physical and 

mental health care services and likely lead to continued discrimination. 

2. Are there unique costs and benefits for small entities subject to MHPAEA (that is, employers 

with greater than 50 employees that maintain plans with fewer than 100 participants)? What 

special consideration, if any, is needed for these employers or plans? What costs and benefits 

have issuers and small employers experienced in implementing parity under State insurance laws 

or otherwise?

SPAN strongly believes that the law should not permit “special considerations” for small entities 

that have greater than 50 employees that maintain plans with fewer than 100 participants. 
3. Are there additional paperwork burdens related to MHPAEA compared to those related to 

MHPA 1996, and, if so, what estimated hours and costs are associated with those additional 

burdens?

SPAN agrees that MHPAEA may create additional paperwork hours and costs; however, we 

oppose any consideration being given to any additional burden on plans associated with the costs 

of making a request to the federal government for exclusion from the parity requirements. 

B. Comments Regarding Regulatory Guidance 

2. What terms or provisions require additional clarification to facilitate compliance? What 

specific clarifications would be helpful?

Although there is statutory language and references in Medicaid to the 1996 Parity Act, there is a 

need for clarification regarding the application of the parity law to Medicaid managed care plans 

and affirmation that parity applies to SCHIP plans. We also agree with the Bazelon Center for 

Mental Health Law that “clear explanations indicating how to compare mental health to health 

with regard to limits on a benefit package and cost-sharing requirements are also necessary.” 

There needs to be explanation of provisions such as Section 512(a)(3)(A)(i) which states that 

financial requirements for mental health benefits “should be no more restrictive than the 

predominant financial requirements applied to substantially all medical and surgical benefits 

covered by the plan.” The regulations must provide clarity and guidance to ensure that any 

limits on mental health services are appropriate given the overall coverage (including limits and 

financial obligations of the insured) in a particular plan. 

Further, “no more restrictive than” must also be interpreted to mean that coverage and cost 

sharing are equal even when a mental health services is not strictly identification to a medicalsurgical services. In addition, intensive outpatient mental health treatment should be compared 

with a standard medical-surgical visit for purposes of out-of-pocket costs or limits on number of 

visits, while the residential treatment service should be considered analogous to inpatient 

hospitalizations. 

The regulations should allow for plan provisions that encourage individuals to participate in 

needed mental health treatment, such as those that may waive cost-sharing for the first few visits 

or those that provide residential treatment with lower cost-sharing than hospital care. 

Finally, SPAN supports clarification and examples that illustrate how states may maintain 

broader mandates to cover mental health services that may not be required under the federal law, 

while ensuring that the federal law would pre-empt any inappropriate limits on those services. 

Additionally, statements that explain how a mandated minimum benefit becomes a parity benefit 

and how mandated coverage of serious mental illness remains in effect and becomes mandate for 

parity for serious mental illness are necessary. 

4. What information, if any, regarding the reasons for any denial under the plan (or coverage) of 

reimbursement or payment for services with respect to mental health or substance use disorder 

benefits is currently made available by the plan? To whom is this information currently made 
available and how is it made available? Are there industry standards or best practices with 

respect to this information and communication of this information?

SPAN’s Family to Family Health Information Center helps thousands of families understand 

their children’s public and/or private health insurance plans, as well as critical terms such as 

“medical necessity.” Based on our experience, we strongly support regulations that would 

require that parents be provided with more information than is now typically received when a 

service is denied based upon “medical necessity.” The regulations must require the use of plain 

language explaining why a particular service is not appropriate at this particular time for their 

child or family – and in the language of the family if it is not English. 

6. Which aspects of the increased cost exemption, if any, require additional guidance? Would 

model notices be helpful to facilitate disclosure to Federal agencies, State agencies, and 

participants and beneficiaries regarding a plan’s or issuer’s election to implement the cost 

exemption?

SPAN supports restrictions on the use of the exemption for a plan based on their documentation 

of increased costs, and urge the adoption of language identical to the regulation on the 1996 law. 

We also recommend the use of model notices, developed with input from consumers including 

parents and particularly parents of children with special healthcare needs, which will assist with 

disclosure to participants and beneficiaries regarding a plan’s or issuer’s election to implement 

the cost exemption. 

Conclusion 

SPAN and Family Voices of NJ welcome mental health parity legislation and urge the adoption 

of regulations that ensure that such legislation’s full benefits are realized for children and youth, 

particularly children and youth with special mental health needs, and their families. Thank you 

for this opportunity to submit comments for your consideration.