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understanding of
the profession of
marriage and
family therapy as
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and a science, to
maintaining high
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professional
ethics and
qualifications,
and to expanding
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California Association
of Marriage and
Family Therapists

7901 Raytheon Road
San Diego, CA 92111
P: (858) 292-2638

F: (858) 292-2666
www.camftorg

Office of ne Medicare

OmbuXsman
MAY 29 th

May 18, 2009

Department of Health and Human Services
7500 Security Boulevard
Baltimore, MD 21244-1850

RE: Paul Wellstone & Pete Domenici Mental Health Parity & Addiction
Equality Act of 2008 (Public Law 110-343)

To Whom It May Concern:
On behalf of the nearly 30,000 members of the California Association of Marriage and
Family Therapists (““CAMFT”) we thank you for allowing public comment on the
rulemaking and regulations surrounding the Paul Wellstone & Pete Domenici Mental
Health Parity & Addiction Equality Act of 2008 (the “Act”).

1. Mental Health AND Substance Abuse Parity

Regulation must clarify ‘that the: purpose .of: the Act is to servé both those: suffering
from mental ‘health’ illnesses and-substance:abuse disorders. . All three amendment
sections: (a)-ERISA, (b)-Public Health Service Act, and (c)-IRS Code at sub-section
(3) state:

(3) Financial Requirements and Treatment Limitations.
(A) IN GENERAL.—In the case of a group health plan (or health
insurance coverage offered in connection with such a plan) that
provides both medical and surgical benefits and mental _health or
substance use disorder benefits, such plan or coverage shall ensure
- that—
(i) the financial requirements applicable to such mental health or
substance use disorder benefits are no more restrictive than the
predominant financial requirements applied to substantially all
medical and surgical benefits covered by the plan (or coverage) and
there are no separate cost sharing requirements that are applicable
only with respect to mental health or substance use disorder benefits;
and,
- (ii) the: treatment limitations applicable to such .mental .health: or. . .-:
“substance use. disorder: benefits are no more-restrictive than.thess.. 17)
* s-predominant treatment limitations applied'to substantially all. medical :.::
and surgical benefits covered by the plan (or coverage) and there are
no separate treatment limitations that are applicable only with respect
to mental health or substance use disorder benefits.



Although the legislative intent behind the bill is to serve both those suffering from mental illness
and substance abuse disorders, the way the language is currently written is open to interpretation
by health care plans and insurers, as well as each individual state. Our recommendation is to
clarify, through regulation, that Public Law 110-343 is to cover both mental health illness and
substance abuse disorders, not either.

2. Denial of Reimbursement or Payment

Providing to the patient, and the health care practitioner, the reasoning behind a denial of
reimbursement or payment is essential in protecting a patient’s right to treatment. Throughout the
California Health & Safety Code and Insurance Code, language is utilized to mandate clear
reasoning behind plan or insurer decision making. We would suggest mimicking this language in

— —— .- regulation, such as: Jf, reimbursement or. payment_is, denied by_the_health care plan/insurer, the. _
decision shall be in writing, and shall include a clear and concise explanation of the reasons for
the decision.

3. Out-of-Network Coverage

Allowing the patient to receive services out-of-network is often necessary based on exigent
circumstances. Putting into regulation the following concepts protects the patient, while not
creating undue hardship on the health care plan or insurer:

¢ For continuity of care purposes, if the patient’s plan/insurance changes, allow patient to
continue with their existing health care practitioner, provided that practitioner is willing to
accept the new health care plan/insurer’s rate of reimbursement;

e Ifan in-network provider is not available to a patient within their geographic area within a
reasonable amount of time, the plan/insurer shall reimburse the out-of-network
practitioner; and,

e Plan/insurer to reimburse for any reasonable costs associated with urgent care or
emergency services, or other extraordinary and compelling health care services, when the
patient’s decision to secure those services outside of the plan network was reasonable
under the urgent or emergency circumstances.

Thank you for your attention to this matter and please let us know if we can provide you any
additional information.

Sincerely,
Catherine L. Atkins Mary Riemersma
Staff Counsel Executive Director

cc: Capitol Associates, Inc.