ABHW

Association for Behavioral
Health and Wellness

Advancing benefits and services
in mental health, substance use
and behavior change.

August 16, 2010
Submitted via the Federal eRulemaking Portal: http://www regulations.gov

Office of Consumer Information and Insurance Oversight; Department of Health and Human Services
Attention: OCIIO-9991-IFC
P.O. Box 8016, Baltimore, MD 21244-1850

Re: Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan
Under the Patient Protection and Affordable Care Act

Dear Sir or Madam:

The Association for Behavioral Health and Wellness (ABHW) is writing to offer comments in response to the interim final rule ("IFR")
under the Patient Protection and Affordable Care Act for Group Health Plans and Health Insurance Coverage Relating to Status as a
Grandfathered Health Plan.

ABHW is an association of the nation's leading behavioral health and wellness companies. These companies provide an array of
services related to mental health, substance use, employee assistance, disease management, and other health and wellness programs to
over 147 million people in both the public and private sectors. ABHW and its member companies use their behavioral health expertise to
improve health care outcomes for individuals and families across the health care spectrum. In particular, ABHW members are all involved
in management of behavioral health benefits under group health plans as managed behavioral health organizations (MBHOs).

ABHW recognizes that the Mental Health Parity and Addiction Equity Act (MHPAEA) provisions continue to apply to those
grandfathered plans that are regulated by MHPABA. It is our understanding that plan changes that are made in order to comply with the
MHPAEA IFR will not cause a plan to lose its grandfather status. We want to ensure that this is true for all changes that are made in order
to comply with MHPAEA. For example, if a plan currently has separate deductibles for behavioral health and medical/surgical benefits,
MHPAEA requires the plan to establish one deductible. In order to comply with this provision and create a combined behavioral health
and medical/surgical deductible, a plan may need to increase a lower medical/surgical or behavioral health deductible more than the
allowable amount under the Grandfathered Health Plan IFR. Because the plan is increasing the deductible to comply with the MHPAEA
unified deductible requirement, the plan should not lose its grandfather status.

Another example is in relation to copayments. When a plan performs the “substantially all” and “predominant” tests set forth in the
MHPAEA IFR, the parity calculation may lead to establishing a copayment for behavioral health that requires a larger increase than that

allowed under the Grandfathered Health Plan IFR. Because the plan followed the calculation required by the MHPAEA IFR, the
grandfather status should remain intact.

ABHW is pleased to have had the opportunity to provide the above comments on the IFR. Thank you for this opportunity and your
consideration of our concerns. Please feel free to contact me at greenberg@abhw.org or (202) 756-7726 if you have any questions.

Respectfully submitted,
amela Greenberg, MPP
President and CEO {

N01 Pennsylvania Avenue, NW, Sixth Floor, Washington

Fax 202.756.7308 | www.abhw.org