The Employee Benefits Security Administration has posted 402 comments regarding implementation of the Mental Health Parity and Addiction Equity Act of 2008.

EBSA, an arm of the U.S. Department of Labor, is posting the comments here.

Many commenters have asked EBSA to tell them what certain of the provisions of the MHPAEA mean and how exactly they will be implemented.

The American Benefits Council, Washington, and the U.S. Chamber of Commerce, continue to ask regulators to apply the condition classification provisions in the act as flexibly as possible.

The regulations implementing the act “should confirm that the classification of a mental health or substance use disorder is a matter of plan design as determined by the plan sponsor,” Kathryn Wilber of the ABC and Randel Johnson of the chamber write in a joint comment.

“Early versions of the act would have required that group health plans use the DSM-IV to define mental health and substance use disorders,” Wilber and Johnson write. “Congress, however, ultimately rejected that approach and provided that mental health and substance use disorder benefits are defined as benefits with respect to services for mental health or substance use disorder conditions (as applicable) as defined under the terms of the plan and in accordance with applicable federal and state law…. This reflects Congress’ clear intent that plan sponsors (and insurers) have the flexibility to classify disorders as either medical or mental health conditions in their plan documents, so long as there is scientific or medical support for the classification and the classifications are not designed to circumvent the parity requirements.”

The National Association of Manufacturers, Washington, has submitted a similar plea for flexibility when it comes to condition classification.

“The MHPAEA clearly indicates that group health plans and group health insurers may determine what conditions, treatments, services, or settings of care are covered under the terms and conditions of the plan or insurance policy,” Jeri Kubicki, a NAM vice president, writes. “Any proposed guidance should clarify that the MHPAEA requirements do not impose any obligation on a group health plan or group health insurer to cover any specific mental health conditions or substance use disorders, services or treatments, or settings of care.”

Helen Darling, president of the National Business Group on Health, Washington, asks that regulators not make autism spectrum disorders subject to the parity requirement.

“If parity were required, many employers would be forced to discontinue these very valuable benefits,” Darling writes. “Given the uniqueness of the treatment protocols and the intensity of early intervention required (25-35 hours per week for 2 to 3 years), providing parity would simply be too cost-prohibitive for employers to continue to sponsor these programs.”

America’s Health Insurance Plans, Washington, has submitted a 98-page analysis of how each state handles mental health and substance abuse benefits requirements.

The Blue Cross and Blue Shield Association, Chicago, says EBSA should permit the use of a full-time employee equivalency rule and defer to state law when determining whether employers are small enough to be exempt from the parity requirements.

“It would be far too onerous to require small employers to perform one calculation of employees for purposes of determining whether COBRA applies, and a second, different calculation of employees for purposes of determining whether the parity requirements apply,” writes Justine Handelman, the executive director of the association.

“We are also concerned there are states where different approaches are used for counting employees,” Handelman writes. “It would be inequitable to require an employer that may have 60 employees, but is considered a small group under state law because only 45 employees are eligible, to be subject to small group community rating and then force the same plan to comply with the parity requirements, which are likely to be quite costly.”