Mental Health Association in New York State, Inc.
(Publication Archives)

Friday Fax from Albany

Timothy’s Law Debate Shifts from Cost to Savings: Stoked by the endless commitment of Assembly sponsor Paul Tonko, the fire to pass Timothy’s Law continues to grow. Joined by nearly 60 of his Assembly majority colleagues, Assemblyman Tonko has asked Speaker Sheldon Silver to embrace Timothy’s Law as part of this year’s budget.

Focusing on the cost of unnecessary custody relinquishment, Assemblymembers from around the state wrote, “New York State taxpayers are shouldering the burden of massive amounts of otherwise unnecessary social services expenses because of the limits that health insurers place on coverage for mental illness and chemical dependency.” The text of the letter and the signatories follows.

MHANYS believes that this is a major step in pursuit of Timothy’s Law. As stated in a previous edition of the Friday Fax from Albany, MHANYS joins with the Assembly in calling for recognition of the savings that can be achieved by the passage of Timothy’s Law. Although there is not an exact figure as to what the savings would be (we believe many millions of dollars), identifying such savings as part of the budget is feasible.

“It is indeed a rare day when we can help enhance the quality of life for those who struggle with mental illness, save lives, and save money at the same time,” the Assemblymembers wrote, as they asked the Speaker to present this request to the Ways & Means Committee, the entity responsible for drafting the Assembly’s budget.

With leaders in Albany already admitting that this year’s budget will likely be late, MHANYS believes we have sufficient time to act, and intends to place great emphasis on the life – and cost saving aspects of Timothy’s Law, urging its inclusion in the budget.

Neither Rain nor Snow…: Several hundred Timothy’s Law supporters rallied in Albany Tuesday, braving bad weather to memorialize Timothy O’Clair on the third anniversary of his tragic death, and call for passage of the law that bears his name. Energy and volume was provided by about 150 students, most of them classmates of Timothy, and his brother Christopher, who is now a senior.

Waving signs and chanting in the cold and blowing snow, these teens provided a heartfelt reminder of why we pursue this law – the love we have for our families, our children and our friends. The enthusiasm grew with direct encouragement from three of MHANYS dearest friends: Board members Jessica Lynch and Tom O’Clair and surprise guest Assm. Paul Tonko – the successful survivor, the valiant father, and the legislator leading the fight to fix the system.

Many thanks to those who helped organize the event, Assemblymembers Tonko, Rivera and Brennan, and especially to those who braved such bad weather to be there. Keep up the good fight!

March, 2004

Speaker Sheldon Silver
932 Legislative Office Building
Albany, New York 12248

Dear Speaker Silver:

We are writing to thank you for your efforts and commitment to the passage of Timothy’s Law. In addition, we are requesting your further support by embracing comprehensive mental health and chemical dependency/substance abuse parity as part of this year’s budget. While much attention has been paid to the plight of families living with mental illness in the debate over Timothy’s Law, little attention has been paid to the fact that continued discrimination in insurance coverage results in significant cost to the state.

Through the process of custody relinquishment, some families have given up custody of children with mental illness, solely for the purpose of accessing the unrestricted mental health services afforded to Medicaid recipients. As you are certainly aware, when a parent relinquishes custody of a child to the municipality, all of the needs of that child, including other health care, education and housing needs, become the government’s responsibility. Whereas, if the families could get the mental health services children need to remain at home, our state and local governments would not be forced to cover these costs because families, not government, would be raising the child, and presumable, private insurance would cover their health care needs.

New York State taxpayers are shouldering the burden of massive amounts of otherwise unnecessary social services expenses because of the limits that health insurers place on coverage for mental illness and chemical dependency. With passage of Timothy’s Law, we believe that significant savings would accrue for New York’s taxpayers, while at the same time our constituents would be provided better health care.

It is indeed a rare day when we can help enhance the quality of life for those who struggle with mental illness, save lives, and save money at the same time. In that regard, we hope that our Ways and Means Committee can examine this issue to determine the exact amount of Medicaid and other social service program savings that would be realized through passage of Timothy’s Law. That exercise would allow the Assembly Majority to propose a solution to reduce the impact to State and local government without denying access to care and services.

Sincerely,

Paul Tonko Peter Rivera Ron Canestrari Rhoda Jacobs Luis Diaz Michele Titus Vivian Cook Richard Smith Barbara Lifton John Lavelle Sandra Galef Steven Englebright James Brennan Kevin Cahill Richard Brodsky Steve Sanders Steven Cymbrowitz Amy Paulin RoAnn Destito Jeffrey Klein Darryl Towns Harvey Weisenberg Jeffrion Aubry Sam Hoyt David Koon Sandra Galef Pete Grannis Carl Heastie Felix Ortiz Adam Clayton Powell Joan Christensen Brian McLaughlin

William Magnarelli Barbara Clark Jose Rivera Bob Sweeney Tom DiNapoli Michael Benjamin Earlene Hooper Diane Gordon Stephen Kaufman Daniel O’Donnell Adam Bradley Joseph Lentol Peter Abbate Jose Peralta Jack McEneny Dick Gottfried Darryl Aubertine Adriano Espaillat Jeff Dinowitz Deborah Glick Ann M. Carrozza Jose Peralta Michael Cusick Ivan LaFayette Harvey Weisenberg Barry Grodenchik John McEneny Audrey Pheffer John Lavelle Ron Tocci Patricia Eddington Joan Millman

MHANYS and Samaritans Suicide Prevention Center
2004 Legislative Conference

Date: Monday, March 22, 2004

Location: Room 711-A, Legislative Office Building, Albany, NY

Time: 8:30 – 12:00 Noon, individual meetings afterward

Mental Health Association in New York State and
Samaritans Suicide Prevention Center
Legislative Conference

March 22, 2004
Room 711-A
Legislative Office Building

REGISTRATION FORM

Name ____________________________________________________________

Organization ______________________________________________________

Address __________________________________________________________

City ______________________________ State _________ Zip _____________

Phone _____________________________Fax ___________________________

E-Mail___________________________________________________________

Number of Attendees: ____________

Names of Attendees:

__________________________ ___________________________

__________________________ ___________________________

__________________________ ___________________________

__________________________ ___________________________

FAX OR E-MAIL TO:
Michael Seereiter, Director of Public Policy
MHANYS
194 Washington Avenue, Suite 415
Albany, NY 12210
FAX: (518) 427-8676
mseereiter@mhanys.org

In the News:

Advocates push for ‘Timothy’s Law’. By Shirin Parsavand
The Schenectady Daily Gazette, March 17, 2004

Mental health insurance parity proposal too costly as written, Bruno says

ALBANY — Senate Majority Leader Joseph Bruno said Tuesday he wants a law ensuring adequate mental health coverage for New Yorkers, but the mental health parity bill passed by the Assembly would cost too much.

"We want to do Timothy’s Law and hopefully the Assembly will be realistic" and agree to changes in the version it has approved repeatedly, Bruno said.

But advocates said Tuesday they are focused on getting the original measure through the Senate. They note that most of the Senate’s Republican majority has signed on as co-sponsors of the bill.

Several hundred people rallied on the steps of the Capitol on Tuesday to urge the Senate to adopt the bill, named after a Rotterdam boy who committed suicide at the age of 12. The rally marked the third anniversary of Timothy O’Clair’s death.

"The people we elect to represent us, mental health parity is not an issue with them. They get mental health parity in their health insurance, and they work for us," Tom O’Clair, Timothy’s father, told the crowd, which included three busloads of students from Mohonasen High School. Timothy would now be a 10th-grader at the school, and his brother Chris is in 12th grade there.

Depending on the insurance plan they select, both legislators and other state employees have access to unlimited mental health services, when deemed medically necessary.

Timothy O’Clair went through severe bouts of depression and anger, and his parents have said limitations in their insurance plan prevented him from getting the level of care he needed.

Supporters of the mental health parity bill argue it would have only a small effect on health insurance premiums. Business and health insurance groups argue that supporters are understating the bill’s cost, and it would increase the number of people without any health insurance.

Bruno, R-Brunswick, implied the senators who signed onto the bill did not want to say no to the advocates, and instead were letting him play the heavy by refusing to bring the bill to the Senate floor. "They say, ‘I want to, and I will, and I support Timothy’s Law. Bruno doesn’t,’ " he said.

Assembly Speaker Sheldon Silver, D-Manhattan, said the Senate should pass its own version of Timothy’s Law so the Assembly and Senate can hash out the differences in a public conference committee.

"It is always very easy to say maybe we can do this and maybe we can do that. Whatever they’re going to do, let them do it out in public," Silver said.

Bruno said he "absolutely" would agree to a conference committee if the Senate passes its own version of the bill.

Mental health insurance bill still in doubt. By Erik Kriss
Syracuse Post-Standard, March 17, 2004

Both houses of the Legislature say they want to pass a mental health insurance parity bill this year.

But whether they can compromise, and how comprehensive the resulting legislation would be, is uncertain.

One thing's for sure: The process is instructive in how Albany works.

On March 3, the Assembly passed a sweeping bill, dubbed "Timothy's Law" after Timothy O'Clair, a 12-year-old Schenectady boy whose parents had limited insurance coverage for his mental illness and who killed himself in 2001. The bill would require health insurance policies to provide mental health coverage equal to that for physical ailments.

Assembly members Joan Christensen and William Magnarelli, both Syracuse Democrats, voted yes; other local Assembly members voted no.

With demonstrators from Central New York and elsewhere calling on the Senate to pass Timothy's Law Tuesday, Senate Majority Leader Joseph Bruno said his house would not - although he said it would eventually pass a less "expansive" version of the bill.

Echoing the concerns of health insurers who fear the law would drive up premiums, Bruno said government would "bankrupt the people of this state if we were to adopt it (Timothy's Law) in its present form."

"We don't help the public by passing irresponsible bills," Bruno, R-Brunswick, declared during a news conference.

But most of Bruno's Republican Senate colleagues - including Central New Yorkers John DeFrancisco, Nancy Larraine Hoffmann, James Wright and Michael Nozzolio - signed on as co-sponsors of the Assembly bill. Does that make them irresponsible?

"No, that is being smart," Bruno replied. "When you have the hundreds of people around here saying, 'Pass Timothy's Law,' they (Republican senators) say, 'I want to, and I will, and I support Timothy's Law, and I support all parts of it. Bruno doesn't.' "

After the laughter of the news conference died down, Bruno added: "That's why I get the big bucks."

Excellus earnings hit $161M. By Joy Davia
Democrat and Chronicle, March 12, 2004

Excellus Health Plan Inc., the state’s largest nonprofit health insurer, ended 2003 $161 million in the black, almost twice what it earned the previous year, according to filings with the state Insurance Department.

The filings, obtained through a Freedom of Information Act request, also showed that the company — parent of the local Blue Cross health plans — paid four of its executives more than $1 million each in 2003. And 200 of its employees had annual paychecks of more than $100,000.

The news comes despite a 5 percent dip in the insurer’s membership and as Excellus continues to stress a need to raise premiums.

An Excellus spokesman said the company is passing the 2003 profit increase on to members through smaller-than-expected premium increases. Spokesman Jim Redmond defended the $1 million paychecks, saying the insurer has to pay top wages to attract and retain talent.

“When you look at the compensation of these executives, they require an extensive skill set,” he said.

For example, The Lifetime Healthcare Cos. President and Chief Executive David Klein, who was paid $1.27 million, manages a $4.3 billion company with employees in 30 locations in upstate New York, Redmond said.

Also on the list: Howard Berman, who stepped down in April from his post as Lifetime chief executive. Berman, who was paid $1.6 million in 2003, is now vice chairman, advising Klein on a “regular basis” and representing Excellus on a variety of national organizations.

Berman “has a wealth of knowledge and experience to draw upon,” Redmond said. “We want to ensure that another company will not end up with our most important asset.”

Dr. Arthur Goshin, who made $1.08 million, lost his job as president of Buffalo’s Univera Healthcare when it was taken over by Lifetime in 2001. He’s now “adviser to the CEO,” according to the state filings, and is using his knowledge and contacts in Buffalo to advise senior managers, who are trying to boost membership there, among other initiatives, Redmond said.

Not everyone is buying Excellus’ arguments. Those million-dollar salaries are being paid with money that should be used for people’s health care, said Joseph Glazer, president of the Mental Health Association of New York State.

The association co-sponsored a report in 2003 that said high salaries for health insurance executives are contributing to rising health premiums. But that report was challenged by the health insurance industry for a variety of reasons, including inclusion of a life insurance company in its calculations.

CEOs in New York generally made about $300,000 in 2002 — which was less than the salaries of about 20 Excellus officials that year, Glazer said. “If people are paying $1,500 a year for an individual policy, to make that million-dollar salary is taking the premium of about 1,000 people.”

That money could bolster reimbursements to physicians, whose income is about 11 percent below the national average, an issue blamed for problems in recruiting and retaining doctors here, said Nancy Adams, executive director of the Monroe County Medical Society.

Still, the Excellus salaries are lower than the total compensation for executives at similarly sized insurance companies, who are mainly executives at for-profit entities who also have stock options, said R. Lawrence VanHorn, associate professor of economics at the University of Rochester’s William E. Simon Graduate School of Business Administration.

Plus, Excellus’ board of directors — not the executives — set the salaries, which is based on the market, he said.

Excellus Health Plan’s profit was about 4 percent of its annual revenue of $3.79 billion. Excellus Health Plan typically represents more than 90 percent of the revenue for Lifetime.

Excellus also took in 4.6 percent more money in premium revenue than it paid out in medical claims and operational costs.

The larger than expected underwriting gains caused the big jump in profit, Redmond said.

That is why Excellus BlueCross BlueShield, Rochester Region, raised 2004 rates by 7.99 percent — less than the double-digit growth expected nationally and below the premium in-creases of other Rochester insurers. This is the smallest premium increase in six years for the area’s largest insurer, although it was preceded by years of double-digit increases.

Excellus includes Blue Cross plans in Rochester, Syracuse and Utica-Watertown, plus Univera Healthcare in Buffalo.

Putnam group seeks mental health parity. By Cara Matthews
The Journal News, March 15, 2004

MAHOPAC — The oldest of Sarah Montgomery's three sons was classified as a difficult child from a very young age. When he got into kindergarten and first grade, he was labeled as a student who had trouble paying attention. Now 10, he has been hospitalized four times, takes three medications to keep him stable and has to be watched closely to make sure he doesn't harm himself.

Although her son is too young for an official diagnosis, the 10-year-old is exhibiting signs of schizophrenia and bipolar disorder, marking what could become for him a lifelong battle against mental illnesses, she said.

"He never did anything seriously to hurt himself, (but) he's always escalating the attempts," said Montgomery, 42, a physical therapist.

Besides the emotional repercussions on the family, there is significant financial impact from the cost of prescription drugs and hospital and outpatient visits. The doctor that Montgomery's son sees is not a preferred provider under the family's insurance plan, so visits are covered at 70 percent and they are limited to 20 a year. Her son used up all those visits and more last year, leaving the family with an additional $3,000 in fees. Other services, such as speech therapy, from nonparticipating providers, are not limited.

"I know how fortunate we are. We have a nice house. We're OK," said Sarah Montgomery, who lives in Mahopac. "But we could lose it so fast."
Irene Soriano, director of Putnam Family Support and Advocacy, said the Montgomerys' story is not uncommon.

Her organization and others are fighting for passage of Timothy's Law in the state, which would create parity in insurance coverage for people with mental-health illness and chemical dependencies. The Putnam group sent petitions with more than 500 signatures to Albany to urge enactment of the law, she said.

Advocates plan a rally on the steps of the state Capitol tomorrow.

A push to get such legislation enacted has been going on for several years, but the campaign took on the name of Timothy O'Clair in 2001. Shortly before his 13th birthday that year, Timothy hanged himself in his bedroom closet.

According to a Web site maintained by Timothy's brother, Christopher, the care Timothy received was of a high quality, but it was limited and sporadic because of the O'Clairs' financial situation and their insurance.

The O'Clairs, who live in Schenectady, ultimately put Timothy in foster care because their insurer did not cover residential care for him.

Paige Macdonald, executive director of the parent-run Families Together in New York State, said mental-health care is often considered a "soft service" that is more of a perk than a necessity. Macdonald, who has a child with mental-health needs, said it doesn't make sense that there are limits on the number of mental health-care visits her son can get, yet the insurance company will pay for his braces.

Co-payments are $8 for his pediatrician, but $36 for mental-health visits, she said.
"It's about stigma, about not recognizing mental health as an integral part of everyone's health," she said.

Timothy's Law faces opposition from the New York Health Plan Association. The group opposes mandates in general, spokeswoman Leslie Moran said.

"We believe that mandates cause people to become uninsured and drive up the cost of health insurance," she said.

Moran, whose association represents 31 managed-care plans that cover more than 6 million New Yorkers, said there are limits to many services provided by insurers. Visits to physical therapists and chiropractors are a few examples, she said.

"The number of visits are based on studies of what utilization is and what is the most appropriate utilization for those services," she said.

As backup for its campaign, Families Together points to a PricewaterhouseCoopers study claiming parity will cost an additional $1.26 per member each month. Advocates believe that is reasonable, she said.

Moran said the report is 2 years old, which lessens its credibility, and the gross impact of mental-health parity would be $3.14 monthly for each member. PricewaterhouseCoopers reported that some people would be negatively affected because of cost-shifting, reducing benefits or eliminating coverage altogether, she said.

Timothy's Law, if passed, would not apply to large businesses that self-insure because they are exempt under federal law, Moran said, which is not fair to other businesses. A federal approach, something that has been discussed for some time, would be fairer, she said.

A Timothy's Law bill passed in the state Assembly in early March. Sen. Thomas Libous, R-Binghamton, said Friday that he plans to draft a different bill that is less broad than what the Assembly approved.

Libous, chairman of the Committee on Mental Health and Developmental Disabilities, said he supports parity. Libous said there needs to be an exemption for small businesses.

In Putnam, Montgomery said so much is riding on the legislation, and the sooner it passes, the better. Her son is a highly intelligent child who has close friends, but he has serious problems, his mother said. He has threatened to kill himself and said he wishes he were dead.

Schizoaffective disorder is an illness that includes severe mood swings like bipolar disorder and some of the psychotic symptoms of schizophrenia, such as delusions and hallucinations, the New York-Presbyterian Hospital Web site says.

"People's lives are at stake. I'm convinced that if (my son) had not had these treatments that he got, he would not be here," she said.

Kendra's Law is 'Patriot Act for Mental Patients'. By Fred Fusco
Syracuse Post Standard, March 17, 2004

If you're Attorney General Eliot Spitzer, Chief Judge Judith Kaye or a member of the New York State Court of Appeals, which Feb. 17 unanimously upheld its constitutionality, you know it as "Kendra's Law."

The state legislation passed in 1999, after the tragic death of Kendra Webdale at the hands of Andrew Goldstein, a young man with emotional problems and a psychiatric diagnosis who couldn't get the help he was desperately seeking. The legislation allows the state to make a pre-emptive strike and force outpatient psychiatric treatment on a person who might commit a violent act. Just as the reasons for war with Iraq have evolved, the current line on why some people should be denied their constitutional freedoms is to force mental health providers to be more responsive to them.

But my reason for writing is to be a uniter, not a divider. To that end I propose we find a name for this legislation all sides can agree on. My favorite is "PAMP" the Patriot Act for Mental Patients. Think about it:

What is the primal emotion that drives the federal Patriot Act? Fear. What is the main objective of that legislation? Safety.

What is society being asked to sacrifice in order to be free of fear and to feel safe? Constitutional rights.

Which sworn defender of our constitutional rights is the leading advocate of this legislation? The attorney general.

Let me elaborate. PAMP as I hope we all come to call it was born of fear and is nourished by fear. Until 9/11, the most feared population undoubtedly was mentally ill people. (When you consider how we describe terrorists - crazy, mad - and when you think of Saddam Hussein's recent elevation to the status of "madman," terrorists haven't replaced mentally ill people as the most-feared, rather the two have merged.) Because of the stigma, the perception of danger, mentally ill people already have a far more difficult time finding jobs, housing and friends. PAMP reinforces that stigma.

The person with the most challenging job in our agency is the coordinator of our community companions program. She's charged with finding volunteers to spend one hour a week in friendship with one of these "scary" mental patients. Despite the extraordinary flexibility of the program, she must disappoint countless individuals who have asked to be matched with a volunteer because too few people respond.

PAMP is intended to make us feel safe. The whole premise is that if we can coerce mentally ill people whom we have decided could commit a future violent act to "take their meds," then they won't commit the violent act.

Ironic. We know for a fact that people with mental illnesses are far more often the victims of violent acts committed by sane people. No one seems to worry about that. How about we extend the scope of PAMP to make life safer for mental patients by forcing sane people to report for their injections?

I'm not a constitutional scholar. But no matter what the ruling from the Court of Appeals, PAMP singles out one group of people, takes away their freedom to determine what is in their own best interest, and does so on the grounds that they might commit a violent act.

I have a hard time believing the framers of the Constitution had that in mind when they talked about "certain inalienable rights" including "life, liberty and the pursuit of happiness." But if I'm wrong, let's expand PAMP to include a few other groups where future violence against others is a possibility - like abusive spouses, alcohol and substance abusers, clergy and traumatized veterans. And what about you? What guarantee does the state have that you won't hurt someone in the future?

Since neitherthe attorney general nor the Court of Appeals appears inclined to protect mentally ill people from the coercive powers of the state, we must turn to the Legislature. Kendra's Law will sunset in June of 2005. Contact your representatives and ask them to commit the one future act of violence that is most needed kill the legislation.

Fred Fusco is executive director of the Mental Health Association of Onondaga County.

Until next time, we remain,
Working to ensure available and accessible
mental health services for all New Yorkers