From mseereiter at mhanys.org Mon Oct 16 15:29:29 2006 From: mseereiter at mhanys.org (Michael Seereiter) Date: Mon, 16 Oct 2006 15:29:29 -0400 Subject: [Timothy's Team] Timothy's Team Action Alert In-Reply-To: <010d01c6e19d$1aee2e90$4001a8c0@MHA> Message-ID: <035601c6f159$66fdf2e0$4401a8c0@MHA> Timothy's Law Action Alert October 2006 Last month, the New York State Senate unanimously passed "Timothy's Law," (S.8482/A.12080) to provide parity in insurance coverage for mental illnesses. The legislation, which has been sent to the Assembly, would require insurance companies to cover most mental illnesses and would require coverage for a broad range of mental illnesses and conditions specifically related to children. This legislation also equalizes co-payments and deductibles for treatment for mental illness with co-pays and deductibles for other physical ailments. The Assembly is expected to return to Albany sometime before the end of the year to pass the legislation. It is not clear whether or not the Governor will sign the bill into law. While it is not everything we fought for (including the lack of addiction services), this version of Timothy's Law will improve access to needed mental health care for adults and children. If the Governor vetoes the bill, New Yorkers will continue to face arbitrary restrictions on mental health care and be forced to pay more for mental health care than they do for other physical ailments. Your help is needed NOW to urge Governor Pataki to sign S.8482/A.12080 into law once it reaches his desk. Tell the Governor New Yorkers can't afford to go without mental health care anymore. You can contact the Governor by: * Calling (518) 474-1041. Leave a message asking the Governor to sign Timothy's Law. * Writing: Governor George E. Pataki State Capitol Albany, NY 12224 * Emailing: Go to www.timothyslaw.org, click on the "Get Involved" tab and follow the instructions from there. Summary of Legislation: COVERAGE FOR TREATMENT OF MENTAL ILLNESSES This legislation requires that all insurance companies cover 30 inpatient days of treatment and 20 outpatient days of treatment for all mental illnesses (30/20 benefit) and requires that co-pays and deductibles for treatment for mental illness be equal to co-pays and deductibles for other physical ailments. The cost to employers of 50 or less employees for the minimum 30/20 benefit will be subsidized in full by the state, in accordance with a methodology to be developed and implemented by the Superintendent of Insurance. Policies and contracts for employers of more than fifty employees must also include full parity coverage for the treatment of "biologically based" mental illness; defined as schizophrenia/psychotic disorders, major depression, bipolar disorder, delusional disorders, panic disorder, obsessive compulsive disorder, bulimia, and anorexia. The broader parity benefit mandated for large employer plans will be also be made available as an option for small employers wishing to purchase such coverage. COVERAGE FOR CHILDREN WITH MENTAL ILLNESS In addition, the agreed upon legislation requires insurance coverage for children under age 18 with attention deficit disorder, disruptive behavior disorders or pervasive development disorders where there are serious suicidal symptoms or other life-threatening self-destructive behavior; significant psychotic symptoms (hallucinations, delusion, bizarre behaviors); behavior caused by emotional disturbances that placed the child at risk of causing personal injury or significant property damage; or behavior caused by emotional disturbances that placed the child at substantial risk of removal from the household. The state Insurance Department and the Office of Mental Health are also required to conduct a two year study to determine the effectiveness and impact of mental health parity legislation in New York and other states. When enacted, the legislation will take effect January 1, 2007 and sunset on December 31, 2009, to provide for an opportunity to amend the law based on the findings. IN THE NEWS: Timothy's Law: Senate Deal a Good Start, Old Prejudices Die Hard. Editorial The Ithaca Journal, September 27, 2006 That is why the sound of such inherited barriers to reason getting ready to crumble should ring as a cause for celebration. So it is with the recent special session of the state Senate and the passage of a compromise version of Timothy's Law. For those who have lost track of the many legislative initiatives named after victims, the law is named after 12-year-old Timothy O'Clair, a Schenectady boy who committed suicide after his parents fought for years to get him adequate mental health care. The family's insurance coverage was limited, and the last-minute desperate attempt get Timothy care by relinquishing custody to the state proved too late. No family, no one, should find themselves in such a position or have to make such a choice. But years of negative stereotypes about mental illness still cling to us, and insurance companies less than eager to weaken profits have been reluctant to alter that norm. If a person is diagnosed with a heart ailment rooted in a physical imperfection in that organ, treatment is generally undertaken and continues until full recovery or a long-term maintenance plan is set. Insurance companies follow all the way along. If someone is diagnosed with bipolar disorder, an ailment rooted in a physical imperfection in the brain, treatment is too often refused or limited, regardless of the health impact of that policy. Old notions that mental health issues are a defect in character, rather than a flaw in brain function, have long buried that health care disparity under a cloak of shame. With its passage of Timothy's Law, the Senate has helped change that. The law sets minimum outpatient and inpatient visit insurance standards for everyone. In addition to assisting small businesses meet any potential added costs, it broadens the scope of coverage large employers must provide to adults and at-risk children - including health issues such as major depression and panic disorders, illnesses long dismissed as an indulgence to the weak willed. It is far from a perfect package. Too little is done to address addictive disorders such as alcoholism and substance abuse - diseases with deep physical roots also long dismissed as indulgences of the weak willed. An earlier Assembly-backed version of the bill included this coverage, but this compromise version does not. The bill also has a three-year sunset built in, ostensibly to give state lawmakers time to get feedback on cost. While that's a smart precaution, proponents of the bill, including several business organizations, have argued that recovering the lost worker productivity due to untreated mental health issues will more than offset a modest rise in insurance cost. Still, this Timothy's Law is an important first step, and the Assembly should return before year's end to approve it in that house. Breaking down this barrier is essential, and long overdue, and experience will no doubt allay fears and allow for careful expansion to include the lost provisions. Likewise, outgoing Gov. George Pataki should get his pen ready for this final legislative gesture. While Pataki has proven himself no ready champion of mental health issues, it would be his greater political ambitions that would suffer the long-term disability - an inhumane shadow cast over his final days in Albany that the would-be president might find voters unwilling to treat. Mental Health Insurance Law Passes. By Patrick L. Fanelli. The Jamestown Post-Journal, October 4, 2006 ALBANY - New York health insurance companies have always drawn a line between physical and mental disorders, covering fewer expenses for patients suffering from severe depression, schizophrenia and other mental illnesses. That began to change when Timothy O'Clair, a resident of Schenectady, committed suicide only seven weeks before his 13th birthday. Now, with ''Timothy's Law'' having passed the state Senate two weeks ago, many health insurance providers will soon be forbidden to make that distinction again. ''Mental illness is a brain disorder. The brain is an organ of the body,'' said Jeff Keller, National Alliance on Mental Illness state deputy director. ''However, it's ironic that it's an organ that we all use to work, but in employee health plans it's the only one that is arbitrarily limited.'' Timothy's Law will require health insurance providers and HMOs to cover treatment for mental health disorders the same way physical disorders are covered, according to Keller. ''If you have severe depression, the way it goes now is for most health insurance companies, the industry standard is 20 outpatient days and 30 inpatient days (a year),'' Keller said. ''If you have a severe illness, the problem is if you run out of visits, you're done. There is nothing you can do.'' On the other hand, if a patient suffers from a kidney disorder, ''you don't get 20 dialysis treatments a year. You get what you need,'' Keller explained. An estimated 1,100 Chautauqua County residents suffer from severe and persistent mental illness. Timothy O'Clair, who suffered from a very severe emotional disorder, was only 12 when he hung himself in his bedroom closet. Timothy's parents struggled to pay for the treatment Timothy needed for years, even though his father - who worked for the state Thruway Authority - was covered through both the MVP and Capital District Physicians health care plans. ''The problem is people run out of their benefits,'' Keller said. ''He was so severely depressed that at one point the parents had to literally give him up to the state, so as a ward of the state, he could go on getting treatments. It was the only way they could do it.'' Tom and Donna O'Clair, Timothy's parents, began fighting to end discrimination against mentally ill patients by the health insurance industry. In fact, Mr. O'Clair became chairman of the Timothy's Law Coalition. ''Today is a landmark day for New Yorkers suffering with mental illness and disorders. It's a wonderful testament to what the Legislature can accomplish when they work together, and a heartfelt tribute to Timothy,'' Mr. O'Clair told reporters shortly after the state Senate announced they had passed Timothy's Law. The law still needs to pass the state Assembly, which has approved it numerous times before just to have it die in the Senate. Keller explained the Senate's version is a compromise - once the Assembly agreed to drop a provision requiring alcohol and drug treatment coverage, the Senate agreed to pass it. ''The next time we are in session, we will effectuate that agreement, whether it's the end of the year or the beginning of next year,'' Assembly Speaker Sheldon Silver, D-Manhattan, told reporters last week. ''The Assembly is going to pass it. The majority leader has promised it. And the way it works in Albany, if the majority leader says it will pass, it will pass,'' Keller said. ''Our worry is the governor will veto it.'' However, New York state will likely have a new governor by the time the Assembly passes Timothy's Law. Even if it is vetoed, the Legislature would likely have the votes to override. Timothy's Law applies to employee health insurance plans, according to Keller - though exemptions are offered to employers with less than 50 employees. Assemblyman Bill Parment, D-Harmony, was out of the country and could not be reached for comment - though he voted in favor of Timothy's Law the last time it came before the Assembly. N.Y. Advocates Encouraged by Senate Passage of MH Parity Mental Health Weekly, October 9, 2006 Following several years of intense advocacy, New York mental health advocates may be getting one step closer to achieving parity in insurance coverage for mental illnesses, after last month's unanimous Senate passage of the parity bill known as Timothy's Law. The New York bill reflects an agreement with the state Assembly that was reached at the end of the regular legislative session in June. The Assembly has pledged its commitment to pass the legislation when it returns after the fall elections. If Gov. George Pataki signs the bill, New York would join about 37 states with some form of mental health parity, according to advocates. Advocates say their only disappointment is that the legislation does not expand coverage for chemical dependency treatment; however, they vow to continue the fight for that in the future. On the federal side, discussion of the need for comprehensive mental health parity is heating up again, as some leading supporters in Congress filed a petition last week to demand a vote on their mental health/substance-use parity bill (see story on page 4). The New York legislation is named for 12-year-old Timothy O'Clair, who committed suicide in 2001, seven weeks before his 13th birthday. The legislation requires that adults and children with biologically based mental illnesses - including schizophrenia/psychotic disorders, major depression, bipolar disorder, panic disorder, obsessive-compulsive disorder and other conditions - receive the same health care coverage benefits as those provided for any other physical ailments. Insurance companies would be required to cover 30 inpatient days of treatment and 20 outpatient days of treatment for all mental illnesses per year. The parity bill would also require the state insurance department and the state Office of Mental Health (OMH) to conduct a two-year study to determine the effectiveness and impact of mental health parity legislation in New York and other states. The legislation would require insurance coverage for children under age 18 with attention-deficit disorder, disruptive behavior disorders or pervasive development disorders where there are serious suicidal symptoms or other life-threatening self-destructive behavior; significant psychotic symptoms; or behavior caused by emotional disturbances that place the child at risk of causing personal injury or significant property damage. "I support parity," Sharon E. Carpinello, RN, Ph.D., Commissioner of OMH, told MHW. "I am especially concerned about children. Children should not suffer because of disparities in health insurance coverage." Mental health advocates remain optimistic that Pataki will sign the bill into law once the state Assembly approves it. "We're on the cusp of having it done," Shelly Nortz, deputy executive director for policy with the Coalition for the Homeless in New York, told MHW. "It's a long-fought battle. It's a good package; it's not everything we want - it does not include unlimited coverage for addiction." Nortz added, "A compromise in negotiations greatly disappointed all parties in our campaign." The legislation will help reduce Medicaid costs and increase worker productivity rates dramatically, said Nortz. "That's why large corporations offer a parity benefit to their employees," she said. "It helps the bottom line. They do it automatically." Timothy O'Clair's father, Tom O'Clair, said he is encouraged by the Senate passage. "The Senate passing the bill unanimously was a huge relief," O'Clair told MHW. "I'm thrilled, because [the Senate] has been a stumbling block for so many years in moving us forward," he said. "It's a pared-down version; however, it is still a huge stepping stone toward moving it forward." O'Clair said he is confident that the Assembly will pass the bill and that Pataki will subsequently sign it. "I have been given the promise of the Assembly Speaker [Sheldon Silver]. That holds a lot of weight with me." O'Clair added, "I would hate to think that a governor who has built his reputation on child treatment issues would not want to sign it." "All eyes are looking to New York for what the governor will do," Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, told MHW. "We have another month before we find out." Push for chemical dependency treatment The Assembly's version of Timothy's Law originally included substance abuse coverage; however, in negotiations with the Senate, lawmakers dropped that provision, Michael Polenberg, director of policy and advocacy for the Coalition of Voluntary Mental Health Agencies in New York, told MHW. "It's been a long battle," Polenberg said. "We also view it as incomplete; it excludes coverage for substance abuse treatment, which we think is important. We're going to work in the year ahead for people battling addiction disorders." Phillip A. Saperia, executive director of the Coalition of Voluntary Mental Health Agencies in New York, told MHW that he was also disappointed over the lack of coverage for addiction and substance use. "Chemical dependency should be covered in full as every other physical illness is covered," said Saperia. "We will be in Albany this year for addiction issues." Saperia added, "It is an incredibly wonderful first step. We have this legislation. Let's move on to the next step and make sure we cover people with chemical dependency as well." HAVE A FRIEND WHO YOU THINK MIGHT WANT TO JOIN TIMOTHY'S TEAM? Refer A Friend Friend's Name: Friend's Email: Your Name: Your Email: -------------- next part -------------- An HTML attachment was scrubbed... URL: