PROTECTION
8r ADVOCACY

100 Fair Oaks Lane, Third Floor Telephone: (502) 564-2967 TTY: (800) 372-2988
Frankfort, Kentucky 40601 Toll Free: (800) 372-2988 Fax: (502) 564-0848
May 3, 2010

The U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-4140-IFC

P.O. Box 8016

Baltimore, MD 21244-1850

RE: Interim Final Rules implementing the MHPAEA
To Whom it May Concern:
Kentucky Protection and oes (P&A) is an independent state agency that

Is with disabilities in the state of Kentucky.
jonse to the Interim Final Rule Request for

Comments S Regarding the Pai
Parity and Addiction Equity A
Register on February 2,.2010.

‘orf example, a plan can impose a $250 deductible on all
fits and a separate annual $250 deductible: on nall ‘mental

B. Nonquantitative Treatment Limitations (§146.136(c)(4))

Kentucky P&A’s request for information comments asked that the parity rules
apply to nonquantitative treatment limitations as well as quantitative limits. The
interim final tule. provides an illustrative list of nonquantitative treatment
‘lirnitati ke medical management standards limiting or excluding benefits
ical necessity, prescription drug formularies, and fail first policies.

P&Ais a federally mandated program that receives funding from the U.S. Department of Health and Human Services,
the U.S. Department of Education and the Social Security Administration.


We welcome this inclusion, but remain concerned that the regulation does not
make it clear that health plans may not impose such limitations unless the
processes used in applying the nonquantitative limitation to mental health or
substance use disorder benefits are comparable to and no more stringently
applied than those involving medical surgical benefits.

By allowing plans to use processes and standards differently “to the extent that
recognized clinically appropriate standards or care may permit a difference”
leaves the door open for health plans to utilize disparate processes and
standards. We would suggest that the Departments narrow that exception by
offering an exhaustive list of exceptions in which plans may apply different
processes and standards.

C. Availability of Plan Information (§146.136(d))

The interim final rule requires plans to provide the criteria for medical necessity
determinations and the reason for a denial. In our request comments, Kentucky
P&A asked that plans be required to provide more information than is now
typically received when a service is denied based upon medical necessity. We
asked that a plain language explanation of why this particular service was not
considered appropriate at this time for this person should be required.

We recommended that the regulations should specify that consumers may
request at no charge copies of the documentation the plan used to make the
coverage determination at issue; set timeframes for disclosure of reasons for
claims denials; and outline the process for appealing the determinations,
including time frames and enforcement mechanisms. Similar requirements are
found in Medicaid’s fair hearing regulations—42 C.F.R 431, subpart E. Fair
Hearings for Applicants and Recipients—and we encourage the Departments to
take a similar approach with the MHPAEA.

D. General Applicability Provisions (§146.136(e))

Many advocacy groups were concerned that plans would carve-out mental health
benefit packages if the parity requirement were applied separately to each
package. We applaud the decision that “[t]he rule is that all medical care benefits
provided by an employer or employee organization constitute a single group
health plan.”

E. Small Entities (Supplementary Information)

We were pleased to find that the interim final rule does not permit special
consideration for small entities and that small entities are required to comply in
the same manner as other plans subject to MHPAEA.

We appreciate the opportunity to provide these comments.


fam $ an
Staff Attorney Supervisor