[Timothy's Team] Timothy's Team Update - SENATE RETURNING TO ALBANY TO TAKE UP TIMOTHY'S LAW!

[Michael Seereiter]

IT'S OFFICIAL - NYS SENATE TO RETURN TO ALBANY THIS FRIDAY TO TAKE UP
TIMOTHY'S LAW!

JOIN FELLOW TIMOTHY'S LAW SUPPORTERS IN ALBANY FOR THE VOTE!

 

As had been rumored for several weeks, the NYS Senate has officially
announced that it will be returning to Albany this Friday, September 15th,
to address, among other issues, Timothy's Law.

 

Following up on the agreement reached between the Senate and Assembly at the
end of the Regular Legislative Session in June, the Senate will be
considering passage of S.8482.  Specifically, the bill will require
employers of all sizes that offer health insurance to provide at least 30
inpatient days and 20 outpatient visits of mental health care.  In addition,
such coverage will be accompanied by co-payments that are no longer far in
excess of the co-payments charged for accessing other health services
covered by an insurer.  In order to address the Senate's concerns with
regard to small businesses, this bill will hold employers with fewer than 50
employees harmless from any potential cost increases.  For employers with 50
or more employees, they will be required to provide coverage that eliminates
all arbitrary limits on mental health coverage for a specific list of
"biologically based mental illnesses."  This bill, while not ideal,
represents a good first step toward eradicating discrimination in health
insurance for people living with mental health needs.

 

The Senate has officially announced that they will resume "in Session" at
2:30 on Friday.  Timothy's Law advocates from all over the state are
expected to join in this momentous occasion to watch from the gallery as the
Senate debates and votes on Timothy's Law.

 

Tom O'Clair invites all Timothy's Law supporters to join him in Albany, in
the Senate lobby on the 3rd floor of the NYS Capitol, at 1:30 on Friday to
show support and watch as the NYS Senate takes up (and hopefully passes)
Timothy's Law!


  


 


IN THE NEWS: 

 

Timothy's Law -er, Agreement

The Journal News Editorial, July 9, 2006

By Laurie Nikolski

 

They won. Sort of. I think.

We're well into July, and most state lawmakers have long since scattered to
the winds, or at least dryer climates. For people with mental illness and
emotional disabilities, and their advocates, the Albany crowd left behind
hope. And bewilderment.

It was high drama to which only a few were privy. At the 13th hour of the
legislative session late in June, state legislators came to agreement on
probably the top health-rights issue in New York: insurance parity for
mental illness. After years of resistance and bowing to business interests,
the GOP-dominate state Senate agreed with the Democratic-led Assembly that
medical coverage and treatment for people with mental disorders should be on
a par with physical ailments. Sort of. I think.

News stories, and rumors, had see-sawed until the bitter end: Compromise,
maybe. Nope, dead bill. No, flicker of hope. Wait - could it be? Compromise
bill. Just not in time for real passage. The session ended, but not to
worry, lawmakers assured us: They'll be back later this year, sure to pass
Timothy's Law Light. Outgoing Gov. George Pataki may, just may, sign it.

Lawmakers' pride ran deep. Advocates - who had run a stubborn grass-roots
campaign to convince them that securing mental-health coverage was both the
practical and moral thing to do - cheered the deal as major progress.
Majority Leader Joseph L. Bruno, who had stood in the way for so long,
crowed in his official Senate press release: "Mental illness can result in
tragedy if it is not properly treated, however many families do not have
access to the proper treatment. This agreement would provide parity in
coverage and would help people get the treatment they need.''

Um. Sort of.

Thomas O'Clair went home to Schenectady exhausted. Timothy's Law is named
after his son, a 12-year-old boy who took his life in 2001. His parents had
used up their insurance benefits to try to get him help, eventually giving
up custody of the boy to the state so he could get better treatment via
Medicaid. Even that desperate tactic didn't save his life. So ever since,
Thomas O'Clair has been fighting alongside groups like the Mental Health
Association in New York State for a parity law. This year, they turned up
the heat under state senators, all of whom are up for re-election this fall.

What, exactly, was won? After all, as Gannett News Service reported in the
waning days of the session, "Business groups and insurance companies have
mounted strong opposition to Timothy's Law. The Conference of Blue Cross and
Blue Shield Plans has said passage of the bill could mean long-term,
possibly lifelong, unlimited treatment.''

Did those gosh-darn scheming mentally ill people actually get long-term,
unlimited treatment? No. If you can make heads or tales of the bill that
didn't officially pass yet, it seems they may get out of insurance policies

 

. Hospitalization for mental illness for up to 30 days a year;

. Up to 20 visits annually with a psychotherapist;

. Lower copays for some treatments.

 

Not to worry: The powerful business sector won, too. After all, The Business
Council of New York State had warned legislators on its Web site of dire
consequences if Timothy's Law passed as envisioned. "The Business Council
respectfully opposes (its) enactment . . . because increasing the cost of
insurance benefits is not healthy for businesses or families.''

More ominously, the council's legislative memo concludes with a nudge in
lawmakers' ribs: "This legislation will be included as one of the scoring
measurements . . . (in the) Council's annual assessment of legislators'
action on key issues of concern to the state's business community.''

In other words, our business people vote more than your mentally ill ones.
And don't you forget it.

So the Senate got clever. The bill - sorry, make that agreement - calls for
the state to cover any extra cost for businesses in New York that have 50 or
fewer employees. The estimate for that coverage: around $50 million a year.

Yet the creativity didn't stop there. For a while lawmakers tossed around
the idea of letting insurance companies decide what types of mental illness
was covered. This is like letting teens decide which chores they would like
to do.

Then legislators took the matter in hand. They - not doctors, not
therapists, not researchers - defined what Timothy's Agreement would cover:
"biologically based mental illness,'' Bruno's office wrote, including
"Schizophrenia/physchotic (sic) disorders, Major Depression, Bipolar
Disorder, Delusional Disorders, Panic Disorder, Obsessive Compulsive
Disorder, Bulimia, Anorexia and Binge Eating.''

Not covered, the press release failed to point out: treatment for
addictions. Elected officials apparently are sure that binge eating is
"biologically based,'' but drug and alcohol addictions are not? Never mind
that the federal government estimates that there are more than 10 million
Americans who have "co-occurring'' mental illness and substance-abuse
disorders. And some of them may live in New York. It will be entertaining to
see how treatment providers bill those patients.

Finally, lest anyone think they went too far, the legislators built in extra
protections The would-be law will sunset after two years, during which time
two state departments, Insurance and Mental Health, will study the
"effectiveness and impact'' of mental-health parity here and elsewhere.

Rest assured, though: State lawmakers did not cave on one compromise that
had floated through the chambers: not covering children. See, if they had
done that, then they would have to rename Timothy's Law after a grown-up. Or
themselves.

 

 

It's Timothy's Time
Syracuse Post Standard Editorial, August 18, 2006

 

Rewind the clock five years. Timothy O'Clair, a 12-year-old tormented way
beyond normal adolescent angst and anxiety, gets the mental health care he
so desperately needs. 

His parents don't have to frantically search for treatment for the boy -
beyond the 20 outpatient visits allowed by insurance. They don't have to pay
co-payments that are higher than those required for physical illnesses. They
don't have to try to pay for his care when the insurance runs out. They
don't have to relinquish custody of Timothy to the state, in hopes of
getting him better medical treatment.

Timothy gets help, and instead of hanging himself just a few weeks before
his 13th birthday, he enters his teen years hopeful about his future,
eventually graduating with the class of 2006.

That scenario would only have been possible if a law had existed ensuring
parity between mental health and physical health coverage. But finally,
after a relentless, five-year fight by Tom O'Clair on behalf of his son's
memory, the Legislature and Gov. George Pataki could make Timothy's Law a
reality. 

It was a worthy battle waged by O'Clair, who visited Syracuse last week. For
too long, as if stuck in a medieval mindset, the state has sanctioned two
sets of standards for illness - mental and physical. It has allowed
insurance companies to dicker over mental health benefits - restricting or
denying coverage - or requiring more out-of-pocket costs.

Perhaps most ashamedly, the debate has focused on costs - as if patients who
suffered from mental illnesses were less worthy of coverage than those who
had a broken leg. Certainly, health costs are astronomical all around - and
many businesses are feeling the strain. But the answer isn't to deny
much-needed mental health services. 

Indeed, the advocacy organization www.timothyslaw.org argues that the nation
already pays nearly $80 billion a year in costs related to not covering
mental illness. 

Among the bill's provisions: coverage for 30 inpatient days and 20
outpatient days; co-payments equal to those for physical illnesses, and full
coverage for children for certain mental health illnesses, including the
disruptive behavior disorders that affected Timothy. 

The bill isn't perfect. Its provisions may temper a hostile campaign against
the bill by the Business Council by covering added costs of businesses with
50 or fewer employees. But legislators have stepped into
a murky area by excluding addictions (including eating disorders) in the
provision. The bill does have a sunset clause that allows reviewing and
revision after three years. 

The Senate is expected to vote on the bill in September, and the Assembly,
which has always supported the law, later in the year. The bill deserves
universal support - on behalf of all the Timothys who need help, not
hassles.

 

 

A chance for change

State Senate has opportunity now to act

Long Island's Newsday Editorial        September 12, 2006 

 

                 State senators are running hard to avoid being swept away
this fall in what some fear will be a Democratic tidal wave. But the
Republican majority can impress voters - after a lackluster spring session -
by not squandering a chance this week to take care of some important
unfinished business.

GOP senators, including the nine-member Long Island delegation, should act
on Assembly bills that would improve budget making, environmental
protections, and access to mental health care and prescription drugs. And
they should be careful about approving appointments by fellow Republican
Gov. George Pataki that are aimed at making it harder for a new, potentially
Democratic governor to clean house.

On budgeting, Albany must make the process less secretive and less
controlled by majority leaders. Reforms include greater disclosure of
pork-barrel spending, more use of public conference committees, a later
budget deadline, and an independent office - not one controlled by the
lawmakers - to certify revenue and spending estimates.

On health care, legislators are close to approving the long-sought Timothy's
Law, which would require similar insurance coverage for mental and physical
ailments. Currently, people seeking treatment for depression or substance
abuse often have higher premiums and co-pays - if they can get coverage at
all. Fairness aside, businesses in other states have found that the nominal
increase in premiums is more than offset by improvements in worker
productivity.

To reduce costs for the state and consumers, the Senate should mandate bulk
purchasing of drugs for all public health programs, as well as the
disclosure by physicians of gifts greater than $75 from drug-company sales
representatives. This will save money and strengthen consumer confidence
that doctors are prescribing the best and cheapest drugs.

To improve the landscape and water quality, the Senate can green its record
by approving a bottle bill that covers noncarbonated beverage containers and
extending the reach of the state's wetlands protection to smaller parcels.

If your senator doesn't do these this week, ask him why when he asks for
your vote.

 

 

New Law Could Help Depression Sufferers Get Health Care They Need

NY1                  September 11, 2006

 

Nearly 20 million American suffer from depression, but for many roadblocks
to insurance coverage can make getting the right treatment virtually
impossible. That seems to be the case for some patients seeking a device
that treats patients for a form of depression once deemed un-treatable. NY1
Health and Fitness reporter Kafi Drexel filed the following report. 

 

Thirty-year-old Andrea Taylor has struggled with treatment-resistant
depression for years, something nearly four million Americans suffer from.
So when a new, implantable device that might help was approved by the FDA
just over a year ago, she thought she'd finally found a solution. 

"I needed something. My choices were running low, so I needed something to
work," says Taylor. 

Taylor who'd been hospitalized and suicidal, looks at the Vagus Nerve
Stimulator, or VNS Therapy as a potential lifesaver. The battery-powered
generator sends signals to the brain to alleviate depression. But on her
first three attempts to get coverage she was denied. 

"There's no way I would have been able to afford it," says Taylor. "Even
before it was approved I was considering going to Canada, because my best
friend and brother live there and it has been approved in Canada. But
economically, I mean I have some savings, but I don't have $25,000 to spend
on this." 

With the help of the maker of the device, Cyberonics, Taylor was finally
able to win approval from Empire Blue Cross/Blue Shield based on an external
review process. But according to Cyberonics, Taylor is only one in a handful
of patients who've been able to get coverage. 

Dr. Sarah Lisanby of the New York State Psychiatric Institute at Columbia
University says she has waiting lists of patients trying to get VNS Therapy,
mostly due to issues with access to coverage. 

"In my practice, I do have patients who have exhausted all the conventional
therapies and still have treatment resistant depression," says Lisanby. "For
them we'd like to have access to something that's now been approved for that
condition. 

Part of the problem in New York State: currently private insurance companies
aren't required to provide coverage from mental health treatment issues,
even with FDA approved treatments like VNS. 

"Anything that they can classify as experimental or not medically necessary,
they do have the power under current law to deny," says New York State
Insurance Department superintendent Howard Mills. "This situation has given
rise to Timothy's Law, which is legislation the Senate is expected to pass,
and if Governor Pataki signs it, will require that private insurers will
provide mental health coverage on par with all other health insurance
coverage that they provide." 

In the meantime, Taylor says finally getting covered has given her something
she didn't have before: hope. 

"There's the opportunity that this is something the medicine hasn't been
able to do for me, that psychotherapy hasn't been able to do for me. Right
now I just merely exist and I'm hoping to live," says Taylor.

 

- Kafi Drexel

 

 

Timothy's Law Would Help Prevent Suicide. Letter to the Editor
Schenectady Daily Gazette

 

I would like to respond to the letter July 30 [by Nancy Sheltra and Joanne
Cleveland], regarding the death of their sister by suicide. I was struck by
the statement, "She was hopeful about getting into Ellis Hospital's day
program, but the program was held up for her because her husband's insurance
wouldn't cover it." 

Our state legislators have had the opportunity to correct such a grave
situation from happening With a mental health parity bill, commonly known as
Timothy's Law. Parity means that mental health services would be treated the
same as any other medical services. Medicaid would have paid for the
program.

Here lies the problem: In order to be Medicaid-eligible, one has to spend
down resources to poverty level. Therefore, without medical insurance
coverage, this woman, along with many others in the middle class, cannot
afford such treatment.

Once again the bill passed the Assembly this year. The Senate has an
opportunity when it returns in the fall to pass this bill. I encourage
people to contact their senators and urge them to pass Timothy's Law.

Mental health parity will prevent unnecessary loss of life.

 

KAREN GAROFALLOU 

Troy

The writer is director of programs and services at the Independent Living
Center of the Hudson Valley.

 

 

Law Would Help Pay Insurance 
Auburn Citizen, August 8, 2006

by Amanda Derby

 

While we can't celebrate it as a law yet, Timothy's Law may just become
that, after an agreement was reached in Albany between the Senate and
Assembly in late June. Timothy's Law is a bill that would provide parity in
insurance coverage for mental illnesses. This agreement is expected to be
acted on officially once the Legislature reconvenes.

"After four and a half years, it is gratifying to see the Legislature coming
together and recognizing the difficulties confronting families who need
mental health insurance coverage. I look forward to the day when Timothy's
Law is the law, and I urge this bill to be finalized as soon as possible,"
said Thomas O'Clair, Timothy's father after the agreement was reached.

Timothy's Law was named after Timothy O'Clair, who hung himself in March of
2001 at the age of 12. His parents spent nearly five years trying to seek
the necessary supports and services for his emotional disorder without
success. The O'Clair's had health insurance through Thomas O'Clair's job
with the New York State Thruway Authority.

Their policy only allowed 20 outpatient visits per year for the psychiatrist
and psychologist combined. Initially their physical health and mental health
insurance co-payments were $10 per visit; however mental health visits
became $35 each after just a few visits. As the family used up their
coverage, they had to begin to pay for all appointments. Additionally, they
found themselves having to pay for his extended hospitalization stays.

The Timothy's Law Campaign announced the agreement. "The agreement requires
health insurance policies sold in New York state, not exempt under Federal
law, to provide at least 30 inpatient days and 20 outpatient visits for
mental health treatment. Perhaps more importantly, co-payments for accessing
such services will be equalized with other co-payments for physical health
needs included in a policy. This will bring to an end the exorbitant
co-payments, often in excess of $50 per visit, commonly required to access
mental health services. Affected insurance plans will have to cover
conditions in a manner comparable to the insurance state employees and state
legislators have access to under the Empire Plan. Small employers of 50 or
fewer employees will be held harmless from any potential premium increases,"
the Web site reported.

The agreement would also require insurance companies to fully cover
treatment of biologically based mental illnesses including bipolar disorder,
major depression, panic disorder, obsessive-compulsive disorder, anorexia,
bulimia, schizophrenia/psychotic disorders, attentiondeficit/ hyperactivity
disorders, disruptive behavioral disorders and pervasive developmental
disorders. Small employers would have the option to purchase this same
coverage.

It should be noted that when Assembly bill 2312-A went up for a vote in the
Assembly this past March, 134 Assembly members voted for it, nine voted
against it. Of our Assembly members, only Assemblyman Gary Finch voted in
the affirmative. Both Assemblymen Brian Kolb and Bob Oaks voted against it.

This is only an agreement, so celebration for healthcare parity might be
premature. We'll let you know once the Legislature reconvenes if this
agreement becomes official and Timothy's Law is voted on and then signed by
the governor.   

 

Amanda Derby is the housing advocate for Options for Independence

 

 

 
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/20060913/990a7457/attachment.html>