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March 10, 2006SEE
YOU ON MONDAY AT 9:00 A.M. IN “THE WELL” FOR UNDER LEADERSHIP OF ASSEMBLYMEMBER PAUL TONKO, ASSEMBLY PASSES TIMOTHY’S LAW 134-9: Wednesday was an exciting day at the NYS Capitol for Timothy’s Law supporters. Presenting an exceptionally strong showing of support for the bill, members of the Timothy’s Law Campaign joined Assemblymember Paul Tonko (the sponsor of Timothy’s Law in the Assembly), Assembly Insurance Committee Chair Pete Grannis, and Assembly Mental Health Committee Chair Peter Rivera at a press conference in support of the bill. Later, in the early afternoon, the Assembly took up debate on Timothy’s Law. All three Assemblymembers above spoke in support of the bill on the Assembly floor, and were joined by others, such as Assemblymember Joel Miller (R-Poughkeepsie). Debate on the bill included many aspects, but focused on the perceived impact that it would have on the ability of employers to continue to offer health insurance to their employees. Assemblymember Miller rose in his role as a small employer to support Timothy’s Law because he recognizes how this bill will help small employers reduce the hidden costs associated with absenteeism and low productivity in the workplace caused by untreated or under-treated mental health or addiction needs. The latest information about these costs is staggering: Depression, alone, costs US businesses $47 billion each year; Issues related to alcohol, alone, cost US businesses $187 billion each year. When it was all said and done, Timothy’s Law passed the Assembly by a vote of 134-9. Those who voted in opposition to the bill were: James Bacalles (R – Steuben and Yates counties), Will Barclay (R – Onondaga and Oswego counties), Clifford Crouch (R – Broome, Chenango, Delaware and Ulster counties), Michael Fitzpatrick (R – Suffolk), Stephen Hawley (R – Niagara, Orleans, Genesee and Monroe), Brian Kolb (R – Cayuga, Seneca, Cortland, Onondaga and Ontario counties), Robert Oaks (R – Cayuga, Oswego and Wayne counties), Thomas O’Mara (R – Chemung, Schuyler and Tioga), and Robin Schimminger (D – Erie and Niagara counties). If you are a constituent of any of the Assemblymembers listed above, we encourage you to contact them to express your disappointment in their vote against Timothy’s Law. Following below is the Assembly’s press release. News
Release FOR
IMMEDIATE RELEASE: ASSEMBLY.STATE.NY.US Silver,
Key Assembly Members Call For Ending Urge Senate To Join In Passing ‘Timothy’s Law’ Assembly Speaker Sheldon Silver and Assemblyman Paul Tonko today announced expected passage by the Assembly this afternoon of Timothy’s Law, a mental-health parity bill (A.2912-A) aimed at ending discrimination against mental-health care and addiction treatment by insurance companies in New York State. At a Capitol news conference, Tonko was joined by Assembly Insurance Committee Chair Alexander “Pete” Grannis and Peter Rivera, chair of the Mental Health, Mental Retardation and Developmental Disabilities Committee as well as mental-health-care advocates in urging the Senate also to approve the measure this year. The legislators hailed the bill’s goal of expanding the limited mental- health-care and addiction-treatment insurance coverage currently available to New Yorkers. The legislation is known as Timothy’s Law, for Timothy O’Clair, who took his own life before his 13th birthday. Tom O’Clair, Timothy’s father, and other members of the O’Clair family also participated in the news conference. They explained their painful loss and the suffering they continue to experience because they lacked adequate health insurance coverage required to access desperately needed treatment. “Timothy's Law is a top priority for the 2006 legislative year. This bill establishes the rights of those who need mental-health care or addiction treatment so that these individuals will no longer be second-class citizens in our health-insurance system,” said Silver. “Mental-health parity has long been a major issue for the Assembly. We urge the Senate to recognize the severity of this health-care crisis and quickly follow our lead and pass this critical piece of legislation so that it becomes law this year.” “Each year health plans continue to cut back on coverage for mental-health care and addiction treatment,” said Tonko (D-Schenectady/Montgomery counties). “Our parents, children, friends and family cannot continue to stand by and watch insurance coverage for these treatments erode from year to year. Most families can’t afford to pay out-of-pocket for expensive care, whether it be outpatient counseling, rehabilitation or inpatient care.” "It is time to end insurance discrimination against mental-health care and addiction treatment in New York. Timothy’s Law will accomplish that. We should join the 35 other states that have adopted parity laws. I am determined to see Timothy's Law enacted in 2006. Under Assemblyman Tonko's leadership, this bill will pass the Assembly and get us one step closer to ending the devastation experienced by so many New Yorkers and their families,” said Tom O’Clair, a tireless advocate of the bill. Tonko, Grannis and Rivera stressed the need to address this dire health-care situation immediately. Their urgency was confirmed by several mental-health advocates, who shared their first-hand experiences with insurance plans that failed to cover much needed mental-health care and addiction-treatment services. "The experience of the state's own Empire Plan shows that it is possible to offer a comprehensive mental-health benefit without busting the bank. It is time to end the discrimination against mental illness,” said Grannis (D-Manhattan), who noted that comprehensive parity laws in other states have not been accompanied by the often-feared increases in health-insurance premiums. "The need to extend full insurance coverage for mental-health services is very evident. Most recently, Governor Pataki has proposed screening 400,000 New York children for mental illness. Without adequate insurance coverage, such as that provided by Timothy's Law, these screenings are empty promises of help for thousands of children, adults and families throughout our state that will not be able to afford health services and treatment," said Rivera (D-Bronx). “My stepson, Chris, died last year after being denied treatment. He left behind a family who loved him and many hopes and dreams for the future, such as getting his GED and working in his father’s union. Words can’t say how much we miss him. This is discrimination in its most deadly form,” said Kim Spicciatie, who spoke of her family’s grief in the wake of losing a loved one after having difficulties obtaining care for his mental-health and substance-abuse problems. “In addition to being executive director of the National Alliance on Mental Illness of New York State, I am also a family member of a loved one who suffers from a mental illness – my wife. Last year, I spent almost $10,000 out-of-pocket for her medical care. After dealing with my HMO for many months, I finally was reimbursed about $1,700 in October. That’s 17 cents on the dollar. If she had heart disease or diabetes, almost all of her medical expenses would have been covered. It just isn’t fair. Insurers should be required to treat illnesses of the brain like illnesses of other parts of the body,” said David Seay, a member of the Timothy’s Law Campaign Executive Committee. “My family gave up our house and moved in with my mother to be able to afford the services that our son John needed. Mental health care is just that—health care. It is medical treatment that can save the life of a child. The financial sacrifices our family made were worth it because, thankfully, John is now doing great. But I do wish we could have afforded to keep our home and to take a family vacation like other families,” said Diane Lang, a mother from Long Island who told of the challenges she faced in obtaining treatment for her son. Summing up for the family members and mental-health-care consumers, Paige Pierce, executive director of Families Together in New York State and co-chair of the Timothy’s Law Campaign, called for the enactment of Timothy’s Law this year. “How many more tragedies will the families of New York have to endure? Timothy’s Law must become law in 2006,” she insisted.
Timothy’s Law is supported by more than 320 state organizations
united under the Timothy’s Law Campaign, including Alcohol
and Substance Abuse Providers of New York State; Coalition for the
Homeless; Coalition of Voluntary Mental Health Agencies; Families
Together in New York State; Mental Health Association in New York
State; National Alliance on Mental Illness in New York State; New
York Association of Psychiatric Rehabilitation Services; New York
State Coalition for Children’s Mental Health Services; New
York State Council for Community Behavioral Healthcare; New York
State Psychiatric Association; New York State Psychological Association;
New York State Rehabilitation Association; and Schuyler Center for
Analysis and Advocacy. NYAPRS E-NEWS – OMH TO TEMPORARILY HALT PROS: After discussions with the NYS Department of Health, the new office of the Medicaid Inspector General and the NYS Commission on Quality Care, the NYS Office of Mental Health (OMH) recently put a temporary halt on the roll out of the state's new Medicaid rehabilitation license program, PROS. The delay was instituted to give the state more time to tighten up PROS guidelines to ensure that NYS providers meet all of the latest federal requirements to establish the 'medical necessity' and, hence, approved Medicaid reimbursement for most of the services they deliver under PROS. Providers will need clear guidance and extensive training from OMH to make sure they know how to properly deliver, document and bill for those Medicaid reimbursable PROS services. Some services, particularly ones directly associated with employment and social activities are not reimbursable under Medicaid and will hopefully be picked up by the 'enhanced' PROS rates that have been expected to boost funding for rehabilitation providers. In this week's regular PROS teleconference, OMH staff announced that OMH was continuing a series of ‘very positive’ meetings with Medicaid Inspector General, CQC and DOH to iron out any confusion in their previous guidance on medically necessary, billable recovery services. OMH has developed new draft materials which are under review by the other 3 agencies and are apparently getting a good first response. Another meeting between the 4 groups will likely be held today. Out of all this, OMH will ultimately be distributing rewrites in chapters of their PROS handbook and additional clarification in a number of areas. Guidance will be provided that is much more ‘definitive’ and ‘prescriptive’ and will have been approved by all state parties. It appears that Orange, Erie and Suffolk Counties are those 'early adopter' counties who are lined up to go next, to be followed later this year by Schoharie, Allegany and Jefferson Counties. The first PROS program, Clinton County's Behavioral Health Services North, has developed a very impressive new lineup of services that are proving to be very popular with those being served. IN THE NEWS: Timothy’s
Law’ Revived, Easily Passes Assembly Thomas O’Clair came back to Albany on Wednesday, as the state Assembly once again passed legislation named after his dead son. It has been five years since Timothy O’Clair, who was almost 13 years old, committed suicide in his Rotterdam home. "Who knows what Tim could have grown to be?" his father asked at a Capitol news conference, echoing the words of a Kenny Chesney country song, "Who You’d Be Today." O’Clair said the song "makes me cry every time I hear it." "We couldn’t get Tim the care he needed," O’Clair said. "Timothy’s Law" is an attempt to make insurers provide that mental health coverage for other families. The "mental health parity" legislation would require insurance companies to cover mental illness and substance abuse treatment in the same way they do physical illnesses. Assemblyman Paul Tonko, D-Amsterdam, prime sponsor of the bill, said it has "languished far too long," and that its passage is a matter of "fairness, justice and who we are as a society." The bill passed the Assembly later Wednesday by a vote of 134 to 9, said Thomas Lynch, Tonko’s legislative director. It also has passed the Assembly in previous years. Before 2001, similar legislation passed with a different name. In 2004, a version of the bill passed the Senate at the end of the session, but was never referred to a conference committee. Mark Hansen, a spokesman for Senate Majority Leader Joseph Bruno, R-Brunswick, said the Senate version of the bill has an exemption for businesses with 50 or fewer workers. Without such an exemption, he said, the bill "would likely result in many businesses not offering health insurance." Matthew Maguire, communications director for The Business Council of New York State, made a similar point. He said, "The insurance industry projects a 3.5 percent increase on premiums if Timothy’s Law is enacted," meaning "health insurance could be put out of reach for some 900,000 New Yorkers." There is no requirement that employers offer health insurance. Maguire said the state does, however, have more than 40 insurance mandates, and 109 more have been proposed in the Legislature within the past year. Assemblyman Alexander "Pete" Grannis, D-Manhattan, appearing with O’Clair and Tonko at the news conference, said "tragedies have a direct and indirect cost." Many states and companies have found that providing mental health coverage can save money, he said, because "if you catch it early you avoid the cost later on." Grannis is chairman of the Insurance Committee. O’Clair also cited the lost productivity involved when families are left to fend for themselves. More than 320 organizations, including many dealing with mental health issues, have endorsed the Assembly bill. The New York State Catholic Conference is one of them. It issued a statement saying: "The case of Timothy O’Clair, for whom Timothy’s Law is named, clearly illustrates the ultimate cost that barriers to treatment can exact. Equal coverage for a patient’s illness or condition should occur whether that illness or condition is mental or physical." Hansen said the Senate leadership would consider the matter, but is now focused on the state budget. OMH
Delays PROS Rollout The New York State Office of Mental Health (OMH) has reportedly placed a temporary freeze on the rollout of its new PROS (Personalized Rehabilitation Oriented Services) licenses. Several rehabilitation programs in Suffolk, Orange and other upstate counties had been anticipating a conversion to the PROS license effective April 1st. The PROS license would allow providers to obtain reimbursement for rehabilitation services through Medicaid. The delay reportedly results from OMH's decision to review its programmatic guidelines in light of questions about the eligibility and documentation requirements necessary to obtain Medicaid reimbursement for certain rehab services. A number of providers have raised concerns based on the experiences of other states which had billing problems and recoupment issues after converting their rehabilitation programs to a Medicaid model. "Iowa had an enormous amount of money taken back by the Feds," said Philip Saperia, Executive Director of the Coalition of Voluntary Mental Health Agencies. "Medicaid requires programs to adhere to the standard of medical necessity. In the past, clubhouses and rehabilitation programs didn't have to adhere to this standard. They didn't have to document every single encounter which you must under Medicaid." "We remain fully supportive of PROS," said Harvey Rosenthal, Executive Director of the New York Association of Psychiatric Rehabilitation Services (NYAPRS). "We see the current delay as a speed bump, one that seems to be common with initiatives of this magnitude." He agrees that the concerns are real and supports the decision to reconsider the billing issues before going further. "We think OMH and DOH will be able to solve it." "We want to get this going," said Michael Stoltz, Executive Director of Clubhouse of Suffolk, who had anticipated an April 1st conversion. "It's not going to be perfect, but no new program is ever perfect." While Stoltz understands the need for caution, the delay itself is costing him money. "It is expensive," he says. "We have already made commitments to staff. We have reorganized. We have hired medical staff. It is very difficult." OMH did not respond to requests for comment. |
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