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Home >> Publications >>Mental Health Update December 28, 2006
COVERAGE OF TIMOTHY'S LAW IN THE NEWS: Ending months of uncertainty, Gov. George E. Pataki yesterday signed into law a bill requiring that commercial insurance policies pay for mental health care in much the same way they cover physical illness. The Assembly and the Senate reached agreement on the terms of the bill in June — though they did not complete passage of it until this month — but for six months the governor would not say publicly what he intended to do with it. The signing ceremony was a rare victory for the kind of emotional politics that rarely succeed in a government most often moved by large electoral blocs, moneyed interests and lobbyists. Many legislators credited passage of the bill to the family of Timothy O’Clair, a boy who committed suicide at 12, who campaigned relentlessly for the measure. Despite the widespread attention given to the O’Clair crusade, the effect of such health care mandates, which can raise insurance premiums, is narrower than it appears. Most people have health insurance through large employers or unions, plans that are usually governed by federal law, which exempts them from state laws. In addition, most commercial policies already cover mental health treatment, which the governor said had helped allay his concerns about cost, and so do government programs like Medicare and Medicaid. Business organizations — whose members pay for most health insurance — and insurance companies generally oppose these kinds of mandates. But they did not work against the mental health bill this year, after small employers were exempted and after coverage that would have mandated treatment for alcohol and drug addiction was taken out of the bill. Timothy O’Clair killed himself in 2001, after the mental health benefits provided by his parents’ insurance ran out. His parents, Tom and Donna, who live near Schenectady, set out to prevent the same thing from happening to other families, taking up a cause that advocates for the mentally ill had pursued for years. They drove countless times to the Capitol, pigeonholing lawmakers and staying through late-night sessions. In particular, Mr. O’Clair, a mechanic who has Timothy’s image tattooed on his arm, became a fixture at the Capitol, and many lawmakers say they were won over by his persistent, poignant appeals. “We, collectively, lost Timothy, not just his family and friends,” Mr. O’Clair said yesterday, standing beside Mr. Pataki in the opulent Red Room in the State Capitol. “Anybody whose life he may have affected as an adult, as a student going through college, as a father, a grandfather — we all lost Timothy.” Legislative leaders agreed on the bill in June, but by then, both houses had finished their regular session for the year. The Senate returned in September and passed the bill, but the Assembly did not return until this month. The bill passed both houses unanimously, but even after the bill was sent to the governor on Dec. 13, it was not clear what he would do. In September, when the Senate majority leader, Joseph L. Bruno, told reporters that Mr. Pataki had said he would sign it, the governor said he did not recall the conversation. Mr. Pataki, who leaves office in little more than a week, said he satisfied himself that the bill did not unduly raise health insurance costs. But he said he was concerned that employers and insurers might not have time to comply with the law, which takes effect on Jan. 1. “There does need to be time to implement it adequately, and I would hope that early next year that the Legislature will take a look to see” if businesses should be given more time, he said. The law requires that commercial insurance policies like those bought by employers provide equivalent coverage, or parity, for mental and physical illness. An employer with fewer than 50 workers could opt out, but the insurer would be required to offer a policy that covered mental illness. The law pledges that the state will develop a method to help small businesses pay for that coverage if they choose to buy it. As of early this year, 22 states had parity laws, according to a review by the National Conference of State Legislatures, and the number may have grown since then. Many of those, like New York’s, include exceptions for small businesses and substance abuse treatment. There were at least 17 other states that mandated some kind of mental health coverage, but not full parity with other health benefits.
ALBANY - Gov. Pataki yesterday signed into law a measure requiring insurance companies to provide far more coverage for mental illness. The ceremonial bill-signing follows years of tireless work by Tom and Donna O'Clair of Schenectady. Their 12-year-old son, Timothy, killed himself in 2001 after their insurance ran out and they had to give up custody of him so he could get public-funded psychiatric treatment. "This is a gift," Tom O'Clair said of Timothy's Law. "As Timothy was a gift to us, Timothy's Law is a gift to New York." The bill requires insurance companies to cover 30 inpatient and 20 outpatient days of treatment for mental illnesses. Companies must give full coverage for "biologically based" mental illnesses including major depression, schizophrenia, bipolar disorder, obsessive-compulsive disorder and anorexia. Timothy's Law would also require coverage for children with attention-deficit disorder, disruptive behavior disorders or disorders that include suicidal symptoms. The state would pay for the premium increase for companies with 50 or fewer employees. The measure is expected to increase premiums about 3 percent and no more than 10 percent, while providing a much wider array of mental-health services. "I commend the efforts of Tom and Donna O'Clair in helping to get this law enacted," Pataki said. "Sharing their experiences . . . was no doubt a difficult task, but through their tireless work and the support of numerous groups and individuals, individuals with mental illnesses will benefit."
Many New Yorkers are about to find relief from some of the stigma - and the expense - of mental illness. Responding to a grassroots lobbying effort that took several years and attracted supporters from all political parties, Gov. George Pataki Friday signed legislation requiring health insurance plans to cover treatment for mental illness ranging from anorexia to depression. Dubbed "Timothy's Law," after Timothy O'Clair, a 12-year-old upstate resident who committed suicide in 2001, the law recognizes that mental health is as important as physical health. "It's the end of legalized discrimination," said Diane Lang, of Massapequa, who attended the signing to honor her son John, 19, who has battled mental illness. They have gone public to encourage other families to come out of the shadows. Lang and others at the ceremony said insurance companies have endangered patients by limiting visits to therapists and psychiatrists. Insurance companies and businesses fought the legislation, arguing that expanding coverage would increase costs for companies and the insured. Supporters noted the law will apply to 7 million of New York's 19 million residents. Many others belong to union and corporate plans regulated by federal, not state, laws. The final version of the law says the state will pay for increased costs to businesses with 50 or fewer employees. It covers fewer services for adults than for children, and it does not require coverage for substance-abuse programs. Still, the mental health community on Long Island and across the state cheered the reform. "This is about parity," said Margo Messina of the family advocate program of the North Shore Child and Family Guidance Center. "If you have diabetes, you get whatever medication and appointments you need but if you have a mental health problem, managed care companies usually limit the number of sessions and visits to psychiatrists," she said. Kim Spicciati of East Islip, who attended the Albany ceremony with daughter Erica, talked about her 17-year-old stepson, who died after an alcohol overdose. "He had some mental health insurance, but he couldn't get all the help he needed," she said. ". . . Anybody who has to go without services, the whole family suffers with them." One of the supporters of Timothy's Law was Senate Majority Leader Joseph Bruno, a Republican who has said his granddaughter has anorexia. Lang said her son John, who has had "a long list of diagnoses," throughout the years, skipped the ceremony because he has started a job. She said, "He's walking, talking proof that recovery happens." Staff writer Melissa Mansfield contributed to this story.
There is some good news for people in New York state who use mental health services. After many years, New York has a law that will bring its citizens closer to mental health parity, with Gov. George Pataki's signing of Timothy's Law on Friday. Parity means New York insurers would provide mental health benefits on par with other medical benefits. As many of us know, unlike health insurance benefits for physical ailments, most mental health and addiction benefits often have cutoffs. They also typically have higher co-pays for treatment. As a result, many individuals with mental health issues may receive less treatment than they need. Many patients cannot afford to pay out of pocket once their mental health insurance benefits have run out for the year, and are left untreated. This has an impact on their well-being, their productivity at work or school and at home — and understandably affects their families. The New York State Psychological Association, along with numerous groups, including the New York State United Teachers and the National Alliance for the Mentally Ill, have lobbied for more than a decade to try and gain mental health parity. When passed in the Assembly and the Senate, the original bill was amended in the process and it does not afford complete mental health parity. However, it is an important step toward full mental health parity for New Yorkers. The legislation takes its name from Timothy O'Clair, a 12-year-old boy from Schenectady who committed suicide in 2001. Timothy's parents had sought mental health treatment for their son because he had attention issues and serious temper problems. When Timothy was 8, he began treatment but his family would exhaust their 20 outpatient visits per year, and would pay out of pocket to continue treatment. Timothy also had psychiatric inpatient hospitalizations. When the family could no longer carry this financial load and as a last resort, they decided to place him in foster care so he would be eligible for Medicaid benefits. His parents continued to hold shared custody and paid a significant amount of money for statutory child support. Timothy was finally placed in a residential facility. However, several weeks after his discharge, he killed himself. Since this tragedy, the O'Clair family has tirelessly advocated for mental health parity. Because
of the new law, those who receive mental health services will see
some important changes, including: • Insurers would be required to provide coverage comparable to medical coverage provided under the policy for adults and children (under 18 years old) with certain mental health issues. These include: schizophrenia/psychotic disorders, major depression, bipolar disorder, delusional disorders, panic disorder, obsessive compulsive disorder, bulimia and anorexia. •
Comparable coverage would also be provided for additional childhood-specific
mental health issues, including attention deficit disorders, disruptive
behavior disorders or pervasive developmental disorders, and where
there are one or more of the following: • The legislation may not apply to small companies, meaning those with 50 or fewer employees. However, companies may be subsidized by the state. •
Co-payments, co-insurances and deductibles for mental health treatment
would be comparable to those for physical illnesses. Lubna Somjee, Ph.D., is a clinical and health psychologist practicing psychotherapy and consulting in the mid-Hudson Valley. Her column is published on the fourth Sunday of each month. Somjee is a member of the Hudson Valley Psychological Association and can be contacted through the association at 845-452-0274. For immediate mental health assistance, contact the Dutchess County Helpline, a unit of the Dutchess County Department of Mental Hygiene, at 845-485-9700.
Gov.
George E. Pataki speaks with Tom O'Clair after signing a new mental
health law named for O'Clair's son, Timothy. But this time, the burly biker, wearing a new suit covering up the tattoo of Timothy on his biceps, smiled a bit. "This is a gift," O'Clair said of Timothy's Law, signed Friday, which will require insurance companies to offer the mental health coverage he couldn't get for his son. "As Timothy was a gift to us, Timothy's Law is a gift to New York," O'Clair said. Gov. George E. Pataki said the measure will save the lives of thousands and improve the lives of thousands more by requiring coverage of mental illness, including depression and eating disorders. Timothy killed himself in 2001 after Tom and Donna O'Clair had to give up custody of him so he could get publicly funded treatment for emotional problems. The law requires insurance companies to cover 30 inpatient days and 20 outpatient days of treatment for mental illness. Companies must fully cover "biologically based mental illnesses" including major depression, obsessive compulsive disorder, anorexia and binge eating. Timothy's Law would also require coverage for children with attention deficit disorder, disruptive behavior disorders or disorders that include suicidal symptoms. The state would pay for the premium increase for companies with 50 or fewer employees. The measure is expected to increase premiums about 3 percent and no more than 10 percent, while providing a much wider array of mental health services. "It is vital that our society take care of those in need, especially our most vulnerable children," Pataki said. "I commend the efforts of Tom and Donna O'Clair in helping to get this law enacted. Implementation of the law may take some time. The bill was supposed to have been passed by both houses in June, but the Assembly didn't pass it until this month. That left just days for the industry to adhere to its conditions, and Pataki said more time will likely be needed. The New York Health Plan Association agreed, calling a Jan. 1 start date "simply impractical." About 35 states have similar laws.
A new law will end discrimination against mentally ill patients with private insurance policies but do little to help those without insurance, Southern Tier stakeholders said Friday. After a decade-long lobbying effort by advocates, Gov. George E. Pataki signed Timothy's Law on Friday. The bill is named after 12-year-old Timothy O'Clair who committed suicide in 2001. Advocates say his death is emblematic of a need for insurance companies to provide better coverage for mental patients. The law, passed by the state Legislature earlier this month, requires insurance companies to cover at least 30 in-patient and 20 outpatient days of treatment for a range of mental illness, and to include coverage of youths with illnesses that cause risk of harm to themselves or others. "This ends decades and decades of discrimination," said Michael Seereiter, a spokesman for the Mental Health Association of New York State. "It's a long overdue change." More insurance coverage means more money for individuals and institutions to deal with mental illness, said Assemblywoman Donna A. Lupardo, D-Endwell, who sits on the Assembly's Mental Health Committee and co-sponsored the bill. But as cost barriers are lowered or eliminated for insured patients, there will likely be more demands on the Southern Tier mental health system, already being stretched to capacity, she said. Mental health services and clinics provided by United Health Services typically lose money because reimbursement rates cover only a fraction of their costs, according to administrators. Funding shortfalls have limited their development. "This (the new law) will highlight that concern," said Lupardo, who was an advocate and educator with the Southern Tier Mental Health Association before she was elected. Ultimately, more staff and resources -- including psychiatrists, social workers and clinics -- will become available to meet the demand in the Southern Tier as more money gets channeled into the system, Lupardo and Seereiter said. That assessment may be overly optimistic, said Dr. Leslie Major, head of mental health programs at Binghamton General, a UHS hospital. The largest burden on the system comes from uninsured patients or those on public programs such as Medicare, and there is nothing in the bill to address that. "A law that brought coverage to the uninsured would have much more impact. But it would cost much more money," Major said. Often, a lack of hospital beds is actually a reflection of a lack of places to discharge chronically ill patients to, Major said. Timothy's Law has merit, he added, because it will provide more help to insured individuals suffering from serious diseases such as depression, schizophrenia and bi-polar disease. "This is better than nothing, but it is not the solution," said Christina Boyd, a spokeswoman for United Health Services. The bill -- the result of compromises and negotiation over the years -- generally balances the need for benefits for mentally ill patients with the right for insurance companies to determine who qualifies, said Leslie Moran, spokeswoman for the New York Health Plan Association, a trade group. "It limits the scope to special diseases rather than opening the door to anything and everything that could be considered a mental health issue," she said. The main complaint insurance companies have now is complying with the law, effective Jan. 1. It's a time frame that is not feasible, Moran said. "It's a major, major concern," she said. "It creates an expectation of services that is simply impracticable for plans and the state to provide. ... We're asking for everybody's patience and understanding." The ceremonial bill signing follows years of work by Tom and Donna O'Clair of Schenectady. Their son Timothy killed himself after they had to give up custody of him so he could get public-funded treatment for emotional problems. The bill requires insurance companies to fully cover "biologically based mental illnesses" -- including major depression, obsessive compulsive disorder, anorexia and binge eating. Timothy's Law also would require coverage for children with attention deficit disorder, disruptive behavior disorders or disorders that include suicidal symptoms. The state would pay for the premium increase for companies with 50 or fewer employees. The measure is expected to increase premiums about 3 percent and no more than 10 percent, while providing a much wider array of mental health services. The bill has been proposed in some form for 20 years. The O'Clairs have staked out the hallway of the governor's office and lobbied legislative leaders for years, only to see political deals fall apart. This week, they held signs outside the governor's office even though Pataki was traveling and the Legislature won't return to session until January. "It is vital that our society take care of those in need, especially our most vulnerable children," Pataki said.
(A similar article also appeared in the Elmira Star-Gazette, Rochester Democrat & Chronicle) ALBANY - Gov. George Pataki signed into law yesterday a measure known as "Timothy's Law" that requires insurance companies to cover most mental illnesses as well as physical ailments. "Timothy's Law is an important step to ensure that mental-health services are accessible to all individuals and families, so that they can receive beneficial assistance and treatment for mental illnesses," Pataki said. The law's opponents have expressed concern that it will drive up insurance premiums and hurt small businesses. The law requires that insurance policies cover a minimum of 20 outpatient and 30 inpatient visits per year for the treatment of mental illness. The state will cover the cost of insurance for companies with 50 or fewer employees, but larger companies will have to pay for additional coverage for illnesses such as schizophrenia, depression and attention-deficit disorder. The legislation is named after Timothy O'Clair, a 12-year-old Schenectady boy afflicted with mental illness who took his own life in 2001. His family had limited health coverage and had to give up custody of Timothy so he could qualify for state-funded treatment. "To lose a life because we couldn't get treatment to an individual is more than motivation" for the law, said Assemblyman Paul Tonko, D-Amsterdam, who sponsored the bill. Tonko said he knew Timothy before he died. Tom O'Clair, Timothy's father, has been pushing the measure for years and has been a fixture in the Capitol. For the past week he has been holding a vigil outside the Capitol urging Pataki to sign the bill. "Anybody who knew Timothy knew how huge his heart was, and this law is a fitting tribute," O'Clair said. "As Timothy was a gift to us, Timothy's Law is a gift to New York." Timothy's Law will take effect Jan. 1 and last for three years. The Legislature will make a decision about continuing the law in 2009. State Sen. Thomas Morahan, R- New City, was the bill's second sponsor. Morahan is the chairman of the state's Mental Health and Developmental Disabilities Committee. After more than three years in the making, he said, he was relieved it was signed. "It's really a great day for the mental-health clients in the state of New York," he said. Though the bill technically starts Jan. 1, Morahan said lawmakers wanted to give businesses and insurance companies a little extra time to adjust their policies. Some business groups expressed disappointment that Pataki signed the bill, citing increased premiums and a vague explanation of how the state will fund the program. "The bill fails on three counts," said Chris Koetzle of Support Services Alliance, a small-business group. "It doesn't define the true cost of parity. It doesn't clearly tell us who is going to pay this unknown cost. It doesn't tell us how it's going to get paid." The
Business Council of New York opposed to earlier drafts, but declined
to take a position when the Legislature reached a compromise.
It was a day Timothy O'Clair's family has fought for for more than five years. "This is a very fitting tribute to Timothy," said Timothy's father, Tom O'Clair. Governor Pataki signed Timothy's Law, legislation that bears the name of Timothy O'Clair, a 12-year-old Schenectady boy who committed suicide in 2001 after suffering from mental illness. His parents' insurance company didn't provide coverage for his treatment, but Timothy's Law requires large employers to provide mental health coverage to adults and children. "I can't help but think at this moment that perhaps this is why he lived. So that we can provide policy that will address people's issues of affordability and accessibility," said Assemblyman Paul Tonko. Timothy's Law isn't without controversy. Small business owners said they can't afford to provide mental health care for their employees, but Timothy's father said they'll be proven wrong. "Just the savings in productivity that they will realize will be an eye-opening experience for them," said O'Clair with tears in his eyes. The state will provide financial assistance to small businesses who struggle with footing the bill. Legislators and employers have debated this bill for years, one O'Clair calls a no-brainer. But, he said he and his family now have the chance to help other New Yorkers struggling under the burden of mental illness. "The only thing positive that can come from that is that others suffering can stop," said O'Clair. The bill takes effect January 1st, but the legislature will take a look at how much time employers need to comply in the new year.
Gov. George Pataki invited Tom O'Clair and Donna O'Clair to a state Capitol ceremony Friday to sign a health care mandate bill named after their son, Timothy. The O'Clair family has fought for years to add a mandate that treatment for mental and emotional illnesses be included in health insurance policies written in New York state. "Timothy's Law," also known as the mental health parity bill, provides for that coverage. Conditions that will be covered include eating disorders by workers or their dependents. The state Senate surprised many by approving the bill earlier this year after resisting it because of cost concerns for more than a decade. The Assembly, which has long supported the measure, approved it during a one-day special section on Dec. 13. In order to win Senate approval, provisions in the bill mandating coverage for post traumatic stress disorder and for drug and alcohol dependencies were removed from the legislation. Sponsors promised to restore those cuts in subsequent years. Timothy O'Clair of Schenectady was 12 when he killed himself in 2001. In order to receive affordable treatments for their son, the O'Clairs had to relinquish custody of him to the state. Sponsors of the bill say they will provide more than $50 million in subsidies to small businesses to meet the cost of the new health care coverage mandate. The legislation calls for the state's insurance superintendent to figure out the best way of providing that relief to businesses.
Gov. George Pataki, after remaining mostly mum or noncommittal on whether he would sign the so-called mental-health parity bill into law, did just that yesterday, providing welcome relief to so many beleaguered New York families. Under the measure, insurers have to provide coverage for a host of mental-health conditions, and allow a minimum of 20 outpatient visits and 30 inpatient treatment days a year. Copayments and deductibles would have to be comparable to those for physical aliments. The state would pay the extra cost for premiums - estimates have varied - for employers with fewer than 50 workers. The bill signing in Rockland County capped a 20-year battle by mental health advocates. The legislation is named in honor of the late Timothy O'Clair of Schenectady, who committed suicide in 2001 as his family struggled to provide him mental-health treatment. He was 12. Timothy's Law also requires coverage for children with attention deficit disorder, disruptive behavior disorders or disorders that include suicidal symptoms. Someday, the law must be amended to serve more patients, and conditions. Someday, prejudice and ignorance against mental illness will give way to wider compassion. For today, New Yorkers should be thankful that their state had come this far.
Governor George Pataki has signed off on a bill known as “Timothy’s Law” that could change how much New York families pays for health care. The measure will require greater health coverage for mental illnesses, including depression and eating disorders. It is named in honor of a 12-year-old boy from Albany who killed himself in 2001 after failing to get the care he needed. Timothy's Law mandates mental health parity, which means mental illnesses will be covered by insurance, just like physical illnesses. For years, Debbie Bartlett worked for a service referring other people to mental health counseling. That was before her own son, Randy, was diagnosed with Bi-Polar Disorder. Suddenly Debbie was the one looking for help. "We thought all you had to do was make a phone call and you'd get an appointment and everything works great,” Bartlett said. “(It) didn't quite work that way.” Bartlett became a crusader for better mental health care and sought to end insurance plans that fail to cover mental illnesses. The bill forces companies with more than 50 employees to offer mental health insurance. Smaller companies do have the option to offer health insurance, too. So far, 40 states have Timothy’s Law in place. Bartlett said the 39 other states with similar laws haven't found that medical costs have skyrocketed, and she feels businesses could benefit from covering medical illnesses. "People who are severely depressed or people with children who have severe mental illnesses lose all kinds of productivity. They lose days from work. They lose focus at the office. Who can concentrate when you're wondering if your child is at home suicidal?” Bartlett said. Timothy's Law takes effect January 1, but it only covers biologically based mental illnesses and not ones related to substance abuse.
In New York, insurance companies will now be required to include coverage for treatment of most mental illnesses in their policies under a new law signed by Gov. George Pataki on Friday. New York Gov. George Pataki on Friday signed "Timothy's Law," in one of the final official acts of his administration. The measure mandates that insurance companies provide coverage for most mental illnesses. Under the law, insurance companies must cover at least 20 outpatient visits and 30 inpatient visits per year for treatment of mental illnesses such as schizophrenia, depression, attention-deficit disorder and eating disorders. It will not, however, require coverage for treatment of post traumatic stress disorder, or for drug and alcohol dependencies -- a concession that was necessary to win sufficient support to pass the bill. Its sponsors have vowed to add those disorders to the list covered by the new law in future years. Opponents have argued that "Timothy's Law" will result in a rise in insurance premiums and place a burden on small businesses, but those with fewer than 50 employees won't have to pay for the additional coverage -- the state will subsidize the cost. However, larger firms will be required to foot the bill. The law is named for Timothy O'Clair, who took his own life in 2001 at the age of 12. Because his family's health insurance did not cover Timothy's mental illness, his parents, Tom and Donna O'Clair, were forced to give up custody of him so that he could qualify for treatment state-funded treatment. Timothy's parents struggled for years to win support for a legal requirement that insurance policies include coverage for treatment of mental as well as physical ailments. The two were present at the state Capitol when the governor signed the bill into law. |
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