MHANYS - Friday Fax

Senate (Dis)Parity Proposal: Yesterday morning, Senate Majority Leader Joseph Bruno and Senate Mental Health Committee Chair Tom Libous were joined by representatives from the New York State Association of Psychiatric Rehabilitation Services (NYAPRS), the National Association of Social Workers (NASW) – New York State and New York City Chapters, the New York State Psychiatric Association, the Medical Society of the State of New York (MSSNY), and the Coalition of Voluntary Mental Health Agencies to announce their intention to introduce a new version of parity legislation.

At the press conference, Senators Bruno and Libous were commended by those present for their “historic” advancement of this issue through the advancement of their legislation. Although no bill is as yet available, the materials provided indicate that this bill would give New Yorkers the weakest law in the nation – carve out for small employers, no chemical dependency coverage, and serving only 11 specific diagnoses. Effective January 1, 2005, the law would expire at the end of 2007. Also, any company that could prove a more than 2% increase in insurance premiums because of the law could opt out of parity-based health coverage.

At the press conference, Senator Bruno lauded his proposal stating, “This provides coverage for tens of thousands of people out there who are looking for parity with mental disorders…” Senator Bruno spoke the truth – Millions of New Yorkers would be covered by Timothy’s Law, and it appears the Senate proposal would only serve “tens of thousands.”

Reactions: After taking an initial look at the Senate’s proposal, but not having seen a bill yet, Tom O’Clair expressed his pleasure to see some proposal come from the Senate, but characterized their proposal as a big bump in the road. “Now, we’ve got to kick it into 4-wheel drive to get over this bump and keep the momentum for Timothy’s Law going,” Tom said.

Assembly Mental Health Chair Peter Rivera called the Senate’s bill, “a weak policy effort” and “a meager attempt to divert focus and effort on (Timothy’s Law).” Assemblyman Rivera’s press release ended with, “This is not Timothy’s Law.”

What About Timothy’s Law? The future of Timothy’s Law appears, right now, a little uncertain. Without a bill, the O’Clairs, Assemblyman Paul Tonko, MHANYS and many other colleague organizations are anxiously awaiting actual introduction of the Senate’s bill. At that point, everyone will have the opportunity to go through the bill with a fine-toothed comb and offer additional insight into the bill and the effects it would have.
Recognizing that we’re all waiting to see what the bill contains, it appears that shortly there will be a choice to make – continue to support Timothy’s Law, or try to reduce the flaws in what is likely to be a far lesser bill.

Next Steps: After introduction, the Senate is expected to act quickly to pass their bill, perhaps as early as next week. After that, it remains unclear as to what will transpire.

Senate Majority Leader Bruno has publicly agreed to Assembly Speaker Silver’s call to negotiate this issue using the conference committee process. Seldom used, conference committees are comprised of selected legislators from both the Senate and Assembly who sit down to negotiate one particular issue – in this case, parity.

At this point, all we know is that we still have a long road ahead of us if we are going to see enactment of any meaningful parity legislation in New York this year.

Chemical dependency services are excluded.
Only the following “biologically based” mental illnesses will be covered – Schizophrenia, Schizoaffective Disorder, Major Depression, Bipolar Disorder, Delusional Disorders, Paranoia, Panic Disorder, Obsessive Compulsive Disorder, Bulimia, Anorexia, Binge Eating. Additional coverage for children under 18 would be provided, which will surely be enumerated in the bill.
Employers with 50 or fewer employees would be exempt, although able to opt-in.
Any employer who can prove a 2% or more increase in premiums as a result of parity will be granted an exemption.
Includes a 2-year study to be conducted by the State Insurance Department and Office of Mental Health “to determine the effectiveness and impact of mental health parity legislation in New York and other states.”
Expires on December 31, 2007.

No reason was stated for excluding chemical dependency services. However, the Senate bill would leave the 50% of individuals with mental illness who have a co-occurring substance abuse disorder without parity-based treatment for their chemical dependency.
The “biological bas(is)” on which the determination of parity-based coverage would be made leaves many with diagnoses other than these to be excluded.
1. The Senate’s press release states that, “The Assembly’s mental health parity bill is based on a very broad diagnostic manual and would require coverage of treatment for hundreds of afflictions ranging from caffeine anxiety disorder to gender identity disorder.” Timothy’s Law would cover all of the diagnoses identified and enumerated in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Revised), published by the American Psychiatric Association.
2. It is now common knowledge that untreated illnesses, whether they be physical or mental, often lead to more serious illness. It can be expected that someone without access to treatment for an illness, such as mild depression or delusional disorder, could easily deteriorate to the point where they are later diagnosed with major depression and schizophrenia, respectively. Leaving those who are not deemed ‘sick enough’ to deserve parity-based benefits to deteriorate to the point at which they do become ‘sick enough’ to get services for a more serious mental illness is by definition “penny-wise and pound-foolish,” and does nothing to improve the lives of those with mental illness.
3. Furthermore, limiting the diagnoses that will be treated equally to other health services will likely end up in ‘diagnosis creep,’ where doctors assign patients inaccurate diagnoses so that the patient can qualify for the parity-based coverage.
4. Lastly, it is interesting to note that eating disorders have been included on the list of “biologically based” mental illnesses, yet the Academy for Eating Disorders says that, “the precise causes of eating disorders are unknown.”
The 50 or fewer employee exemption would result in a huge decrease in the number of New Yorkers who would be covered under Timothy’s Law. This would likely carve out 75 – 80% of employees, leaving only 20 – 25% of those who would be covered under Timothy’s Law with parity-based coverage for the mental illnesses on the list.
The “sunset” provision, which would cause the law to expire in 2007 would, “provide for an opportunity to amend the law based on the finding and recommendations of the study,” to be conducted by the Insurance Department and Office of Mental Health.
1. Nothing would prevent the Legislature and Governor from studying the effects or amending Timothy’s Law if it were to be enacted, even without a “sunset” provision.
2. The Senate justifies the need for the study because no experiential data exists on the cost of providing parity-based benefits in New York. However, since 2001, health insurers in New York have been providing parity-based benefits to federal employees, their families, and retirees through the Federal Employees Health Benefits (FEHB) program. The insurance companies that provide health insurance under FEHB hold the answers on exactly how much full parity-based benefits cost in New York.

Essentially, the Senate’s bill would leave people with alcoholism and substance abuse needs, co-occurring disorders, those who work for small employers, those with mild and moderate depression, PTSD and a number of other mental illnesses without full coverage.

Senate GOP Offers Own Version of Mental Health Parity Measure. By Shirin Parsavand
Schenectady Daily Gazette, May 12, 2004

Health insurance plans would have to cover treatment for most serious mental illnesses, but small businesses would be exempt, under a proposal Senate Republicans outlined Tuesday.

The proposal includes more restrictions than the mental health parity bill the Democrat led Assembly has approved.

Senate Majority Leader Joseph Bruno, R-Brunswick, said the Assembly's bill would drive health insurance costs too high, increasing the ranks of the 3 million people who are now uninsured.

The Senate proposal would cover "biologically based" mental illnesses such as schizophrenia, major depression and bipolar disorder.

Unlike the Assembly bill, the Senate proposal would not cover treatment for alcoholism and drug abuse.

Businesses with 50 or fewer employees would not have to provide the coverage. The Senate proposal also exempts any company that can show its health insurance costs went up by 2 percent or more as a result of the parity requirement.

Assemblyman Paul Tonko, who sponsored the Assembly mental health parity bill, said the Senate proposal could result in higher costs by failing to address mental illnesses before they become severe.

Tonko, D-Amsterdam, said he hopes that if the Senate passes the bill outlined Tuesday, Bruno will agree to a conference committee to air the differences between it and the Assembly bill.

Bruno said Tuesday he is "open" to a conference committee, but thinks the two bills could be reconciled more quickly without one.

The Assembly bill was named Timothy's Law for Timothy O'Clair, a Rotterdam boy who killed himself at age 12 after going through severe bouts of depression and anger. His father, Tom O'Clair, has said limitations in his insurance plan prevented Timothy from getting the level of care he needed.

O'Clair and his wife, Donna, met with Bruno and Senate Mental Health Committee chairman Thomas Libous on the Senate proposal Monday. O'Clair said he remains committed to the original Timothy's Law while he waits to see the Senate bill in writing.

"I am very encouraged they are moving forward with something that will start some kind of discussion to get this resolved," O'Clair said.

Under the Senate proposal, the state Insurance Department and Office of Mental Health would study the cost and effectiveness of the parity requirement in its first two years. The parity requirement would sunset in 2007, which Bruno said gives an opportunity to expand it if necessary.

Time for bold action. Letter to the Editor
Binghamton Press & Sun Bulletin, May 12, 2004

On May 4, Tom and Donna O'Clair held an overnight vigil in Albany to encourage the state Senate to pass Timothy's Law on May 5, the day their son Timothy would have turned 16.

The Assembly has passed Timothy's Law and encouraged our Senate counterparts to do the same. People with mental illnesses and chemical dependence should receive the same insurance coverage as those with physical illnesses. Families should not have to endure the loss of loved ones because of the lack of insurance coverage.

Sen. Thomas Libous, who sponsored Timothy's Law, now says the bill is too expensive and has promised to introduce new legislation. He claims small businesses would be hurt if required to provide additional insurance to cover mental illnesses.

Libous is aware of the many studies that have shown that expanding health insurance to cover mental illnesses and chemical dependence have not resulted in significant increases in insurance premiums.

The costs of not addressing coverage for mental illness are staggering in terms of lost lives, emotional distress, business losses due to reduced productivity and increased costs to taxpayers.

Peter M. Rivera - Chairman, Assembly Committee on Mental Health
Paul D. Tonko - Sponsor, Timothy's Law
Albany

Battle over mental health coverage causing headaches. By Chris Garifo
Watertown Daily Times, May 12, 2004

ALBANY - The north country needs mental-health parity legislation such as Timothy's Law and a bill introduced Tuesday by state Senate Republicans.

"The problem is that a lot of insurances don't cover mental health," said Dr. Muhammad U. Seleem, a psychiatrist and medical director of the mental health unit at Claxton Hepburn Medical Center, Ogdensburg.

Even when an insurer does provide mental-health coverage, it comes with several restrictions, such as covering only medication maintenance or limiting the number of days or office visits for a patient to be seen, Dr. Seleem said.

"We have a lot of difficulty getting authorization for hospitalizations," he said.

"People covered with Medicaid, there's a good support system for them. Their medications are covered. There aren't the limits there," said Stephanie A. Graf, executive director of the Mental Health Association in Jefferson County. "People with private care, working families, there is a need for Timothy's Law there."

Timothy's Law, which the Assembly approved in early March, would require health insurance companies to provide mental health and substance abuse coverage that is equal to what they provide for medical care. The legislation is named after Timothy O'Clair, who committed suicide shortly before his 13th birthday. His parents, Thomas P. and Donna S. O'Clair of Schenectady, spent years and most of their money trying to get him the mental-health care he needed, even going so far as to give up custody of their son to the state.

The legislation was sent on to the state Senate, where it remains in conference.

Senate Republicans have unveiled a slimmed-down version of the legislation, which would not include substance abuse and would provide exemptions if a business can prove that providing such coverage increased insurance premium costs 2 percent or more.

Senate Majority Leader Joseph L. Bruno, R-Brunswick, said the measure, which he promised the Senate would pass, provides for mental-health parity "in a realistic way."

"We haven't gotten there before because the major concern of everybody has to be the cost of providing coverage in the state," he said. "People can't afford coverage or work for companies that can't afford the coverage. What we have put together is a real bill."

The bill, which would take effect Jan. 1, will end Dec. 31, 2007. That period of time would be used by the state Insurance Department and the Office of Mental Health to conduct a two-year study to determine such legislation's effectiveness in New York and other states.

Such a study is needed because nobody knows just how great of a problem the state is facing, Sen. Bruno said.

"No one has specific numbers," he said. "Nobody knows how many people are insured or are not insured."

People frequently come to the Mental Health Association saying the have used up the number of office visits their health insurer covers, Ms. Graf said.

"What we get calls on more often is people needing medications when they don't have coverage for those medications," she said. "Several times a month, we're getting calls where families have exhausted their personal financial resources because health insurance only covers so much per year."

While drawing reference to Timothy's Law, the Republican legislation has not been given that name, yet.

Sen. Bruno said he and Sen. Thomas W. Libous, R-Binghamton, chairman of the Senate committee on mental health and developmental disabilities, had talked with the O'Clairs about the legislation Monday.

"At this point, there's been no legislation presented to me to support or deny," Mr. O'Clair said Tuesday. "I have not seen anything on paper."

Mr. O'Clair said he was unsure what the Republican legislation might mean for Timothy's Law.

"They haven't moved on that, so I don't know," he said. "It's a good bill, it's a strong bill and it's an important bill that all New Yorkers can benefit from."

"This is not Timothy's Law," said Assemblyman Peter M. Rivera, D-Bronx and chairman of the Assembly's standing committee on mental health, mental retardation and developmental disabilities.

Mr. Rivera pushed for passage of the Timothy's Law that the Assembly passed and which Sen. Libous introduced in the Senate.

"The Senate's mental health parity proposal is inadequate, does not cover all those in need and plays with numbers in an attempt to exempt as many employers as possible," he said.

The lack of any such legislation is forcing some mental health professionals out of private practice, said Dr. Seleem, who used to have a part-time private practice in Watertown.

"Instead of helping the patients and spending the time with them, a lot of time for mental health specialists is spent arguing with insurance providers," he said.

Even for suicidal or severely depressed patients, insurers will balk at authorizing needed hospitalizations, Dr. Seleem said.

"It's an ongoing struggle each day," he said. "We get rejections for payments often from insurance companies."

Bill would aid addicts, too. Letter to the Editor
Binghamton Press & Sun Bulletin, May 12, 2004

I read with great interest the April 30 editorial "Meth plague is spreading." Methamphetamine is the latest addiction sweeping the country, and it is thriving in rural areas such as the Southern Tier.

This highlights the reality that every community is prone to invasion from illicit, dangerous chemicals. This is why we need to act now to pass Timothy's Law, which would stem the tide of abuse at its source by treating those who use drugs and helping to end the tide of addiction.

Timothy's Law would increase access to treatment for those living with substance-abuse problems, as well as those who are living with mental illness. This is in contrast to the current system, where arbitrary health insurance limitations restrict the number of visits an individual living with chemical dependency or mental illness may receive.

Friday Fax from Albany