[Timothy's Team] Timothy's Team Action Alert

Mon Oct 16 15:29:29 EDT 2006

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  <http://www.timothyslaw.org/> 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: <http://kilakwa.net/pipermail/timothysteam_kilakwa.net/attachments/20061016/d271da9e/attachment.html>