Center for Medicare and Medicaid Services 

Department of Health & Human Services 

Room 445, Hubert H. Humphrey Building 

200 Independence Ave. SW 

Washington, D.C. 20201 

Re: File Code: CMS – 4140-IFC 

Dear Sirs: 

On behalf of Northeast Hospital Corp., Behavioral Health Services Division, I am writing 

to comment on File Code CMS-4140-IFC: Interim Final Rules under the Paul Wellstone 

and Peter Domenici, Mental Health and Addiction Equity Act of 2008. Northeast 

Hospital Corp. operates ninety-two (92) acute inpatient psychiatric beds, as well as, an 

extensive outpatient behavioral health network of services. 

We believe the above regulations are critically important and look forward to their final 

promulgation. In Massachusetts, we have extensive experience with Parity Laws, having 

passed the first Parity Law in 2000; and more recently an expansion of that law in 2008. 

The passage of these laws has helped equalize the insurance treatment for behavioral 

health, primarily by removing arbitrary day and dollar benefit limitations for certain 

conditions. However, these laws have done very little towards reducing the inordinate 

micro-management and oversight by Carve-Out firms. There is heavy utilization of 

Carve-Out firms in Massachusetts, both in public and private sectors. The oversight is far 

move rigorous for behavioral health than it is for medical/surgical services in the areas of 

Pre-Admission Screenings: Concurrent Reviews: and the application of Medical 

Necessity Standards. Hospitals and clinicians continually struggle to get Carve-Out firms 

to approve services that the attending clinicians believe are medically necessary. 

Evidence of the difficulties our patients and clinicians experience in this regard is 

demonstrated by the fact that behavioral health is the most appealed service to our 

Massachusetts Office of Patient Protection, usually at least double the next highest 

appealed condition: see www.mass.gov/dph/opp. Providers are constantly questioned 

and micro-managed by Carve-Out reviewers as to the medical necessity of a given 

behavioral health service. In Massachusetts, we believe the scrutiny for physical health is 

no where near the level of scrutiny for behavioral health. Indeed, the MABHS has filed 

legislations, S. 482 and H. 1709, which would balance the application of medical 

necessity determinations by providing more authority for the attending clinician, verses 

the Carve-Out reviewer. 

Given the above situation we believe the proposed federal regulations, particularly in the 

area of “non-quantitative” treatment limits, are vitally important and must be maintained 

in the final regulations. Our understanding of the non quantitative proposed rule is that 
treatment limitations can be no more stringent for mental health or substance abuse than 

they can be for medical/surgical benefits. Our Massachusetts experiences would lead us 

to believe this provision is critical towards implementing true Parity. We have seen over 

ten (10) year of Parity Laws that the removal of day and dollar limits essentially does not 

lead to Parity if the behavioral health services are going to be more rigorously managed, 

scrutinized and denied by Carve-Out firms. Parity with medical/ surgical benefit 

management would be a major step forward in providing better access to needed services 

for the patients we serve and in essence would help lead towards true Parity, which we 

believe the Congress intended. We hope that the federal agencies adhere to this language 

in the final regulations; for without such a provision it is difficult, if not impossible to 

achieve true Parity for mental health and substance abuse services. 

We also request that there be clarification in the final regulations that the plans provide 

all levels of essential behavioral health services, just as they do for medical/surgical 

services. In order to have Parity, the scope of services should be comparable for the 

behavioral health and medical surgical service. 

Thank you for your review and consideration of these comments and I would be happy to 

respond to any questions you might have. 

Sincerely, 

James Q. Purdy 

Vice President, Inpatient Behavioral Health 

Northeast Hospital Corp.