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January 11, 2007SPITZER ANNOUNCES FORMER OHIO MENTAL HEALTH COMMISSIONER MICHAEL HOGAN AS COMMISSIONER OF NYS OFFICE OF MENTAL HEALTH: MHANYS joins in welcoming Michael Hogan as the new Commissioner of the Office of Mental Health in New York State. Mr. Hogan has a very good reputation from his recovery-oriented work in Ohio and his work heading up the President’s New Freedom Commission on Mental Health. We look forward to working with Commissioner Hogan after he is confirmed by the NYS Senate, especially given his reputation for working closely with various stakeholder organizations. Following is Governor Spitzer’s January 11th press release. Governor Eliot Spitzer and Lieutenant Governor David Paterson today announced nominations for several senior administration officials as well as various senior appointment nominations.
Critics
Caution Spitzer on Civil Confinement State legislators may not like Governor Eliot Spitzer' call for an end to gerrymandering, but they sure like his insistence on a civil-confinement law. The law would let the state send some sex offenders to psychiatric facilities after they serve their prison sentence. And when Spitzer endorsed it in his State of the State address last week, he got a standing ovation. New York legislators seemed close to passing a confinement law last year, but they couldn't agree on who should decide which prisoners would be re-confined. It's likely that a proposal will be brought up in the new session. Eighteen states have passed civil-confinement laws. But more than half regret the decision, says Stephen Harkavy, an attorney for Mental Hygiene Legal Service. Harkavy represented 12 men who successfully sued New York after former governor George Pataki had them held in psychiatric hospitals after they served their prison sentence. And Harkavy has been a panelist at several national mental-health conferences where civil confinement was the subject. "Most of these states are trying to get out of the civil-confinement business," he says. "It is very, very expensive. The number varies, but the one I think is most reliable is somewhere around $300,000 per prisoner per year. They simply can't afford it. And just as big a concern: what does it accomplish?" Confinement laws, proponents argue, are intended to protect the public from the most dangerous sex offenders. But it's not easy to identify which offenders are most likely to commit their crimes again. Data about risk levels and recidivism rates is sketchy. And mental-health professionals argue that the public's anxiety about sex offenders is largely unwarranted, since most of them respond to treatment. Rochester-area Assemblywoman Susan John says fear is driving the political debate. Spitzer, she says, should take a hard look at the mental-health system as well as the state's prisons. "It is hysteria," she says. "We all want our children to be safe, and nobody wants to be seen as not being concerned about our kids. But it is a very complex issue, and it's not just about safety for our kids. We have to ask ourselves if the role of a public official is to reflect public opinion, or is the job to evaluate real dangers and take the right steps to prevent them from happening." Since the 80's, John says, New York has been filling its prisons with the poor, undereducated, and developmentally disabled --- people who are often convicted of crimes related to mental-health problems that were never treated. "We've got to do a better job of splitting out those populations that need treatment, and how do we get treatment to them earlier," she says. "Right now, we are in a position where we need to bring more treatment into the prisons. The odd thing about the political dynamic is the Senate has passed a [confinement] bill over and over again that provides mental-health treatment for people who will never be released, and no treatment for people who will." John, who favors longer prison sentences for the most dangerous sex offenders, says she thinks a civil-confinement law will be passed. But, she says: "I don't know where it will go. There is a big concern about making the same kind of mistake that was made with the Rockefeller drug laws. My concern is, we are ignoring the conversations we need to be having. Something is wrong when the three growth areas of the Upstate economy are health care, education, and prisons." Donald Thompson, a Rochester attorney who has represented both sex offenders and victims of sex crimes, compares the push for civil confinement to a witch hunt. And he says he would advise Spitzer to avoid the politically expedient. "A small percentage of offenders may pose a continued danger to the community," he says, "but no one has demonstrated any consistently reliable method of determining who falls within that category. This is a slippery slope. What's next? Robbers, murderers, drunk drivers? A percentage of them continue to pose a danger to the community." We asked our readers to cite their most pressing challenges in the coming year. Here are the remaining responses we received. We thank you for your participation.
WASHINGTON, Jan. 10 (UPI) -- The 110th Congress could offer a window of opportunity for legislation requiring insurers to cover mental illness the same way they cover physical ailments, health policy experts said Wednesday. Members of both parties and key stakeholders say an agreement on the issue -- which has eluded them for years -- may be possible. Congress is considering "bills about the principle that mental illnesses are real and health plans shouldn't be able to treat them differently," Andrew Sperling, director of legislative affairs at the National Alliance for the Mentally Ill, told United Press International. "Differences in the bills are likely to be at the margins." Since the Mental Health Parity Act became law in 1996, a movement has been underway to close what some see as loopholes allowing unfair discrimination in coverage against people with mental illness. Mental conditions -- which are estimated to affect one in five American families -- should be covered by insurance the same way as physical ailments like diabetes, advocates say. Critics of such legislation say it is another coverage mandate that will increase the cost of insurance for everyone. More than 40 states -- including New York and Ohio in the past few weeks -- have moved to close those loopholes with state laws. But those laws require varying levels of parity, and do not apply to the 82 million Americans who work for self-funded employers and are thus exempt from state laws. Attempts at the federal level, including bills named after the late Sen. Paul Wellstone of Minnesota who championed rights for mentally ill citizens, have stalled. But there could be a breakthrough. Republican Sens. Mike Enzi, R-Wyo., and Pete Domenici, R-N.M., both say they are looking into introducing bills requiring mental health coverage, and Sen. Edward Kennedy, the Democrat who is now chairman of the Senate Health, Education, Labor and Pensions Committee has indicated interest in co-sponsoring such a bill. "A bi-partisan effort is underway," Enzi spokesman Craig Orfield told UPI. "We don't have a bill agreed to yet -- but we hope to put something together in the near future." Sen. Domenici, who has been one of the most vocal champions of mental health parity in the past, is also in conversations with stakeholders and other Senators, spokesman Matt Letourneau told UPI. "Mental health parity is a priority in the session that's just started and (the Senator) is planning to introduce a bill that will pass." Reps. Patrick Kennedy, D-R.I., and Jim Ramstad, D-Minn., have also announced a series of town hall meetings on the issue in Rhode Island, Minnesota, Maryland and Illinois that are likely the lead-up to new House legislation. Though support for the issue is highly bi-partisan -- at one point 69 Senators and 245 House members had signed on as co-sponsors for such a bill -- House Republican leadership was a consistent stumbling block, holding the proposal up in committee, Sperling said. With Democrats now in control of the House and marginally in control of the Senate, that could change the legislation's prospects. Insurers, who have rejected previous proposals on the grounds that they mandated coverage regardless of medical evidence, resulting in higher costs, are also waiting to see what version of the bills emerge from committee. Meanwhile, activists are focused on bringing the economic and human arguments for the coverage to the public, Sperling said. "We're focused right now on building the case to the public on why legislation is necessary." Current laws allow caps on lifetime mental health expenses, he said, which means that many individuals quickly exhaust their coverage. The burden of treating their illness is then passed on to family members or public safety-net programs. The cost of not treating mental illness also exacts a toll in terms of lost worker productivity -- and simple human suffering, Sperling added. A moderate increase in the cost of insurance would be worth it because, in addition to limiting the social cost of mental illness, mental health parity laws would attack the stigma associated with the disease, said Stephen Hinshaw, chairman of the psychology department at the University of California at Berkeley, author of a recent book on the social costs of mental illness. "Mental
illnesses are as important and deserving of treatment as what we
think of as physical illness," Hinshaw told UPI. "The
last thing you ever want to admit is that you've got a mental illness
... but it's everywhere.
ALBANY -- Last month, former Gov. George Pataki, joined by lawmakers and mental health advocates, announced with great fanfare the approval of Timothy's Law, requiring insurance providers to cover mental health treatment like other illnesses. Signing the bill a few days before Christmas , Pataki declared, "Timothy's Law is an important step to ensure that mental health services are accessible to all individuals and families." But "all," it turns out, doesn't mean everyone. The bill that finally passed after years of lobbying and negotiation doesn't apply to more than 1 million low- and moderate-income New Yorkers who use three state-subsidized health insurance programs. Child Health Plus and Family Health Plus, which provide health insurance for those who make too much to qualify for Medicaid but can't afford regular insurance plans, and Healthy NY, aimed largely at small businesses, are exempt from Timothy's Law. Child Health Plus and Family Health Plus weren't included because to do so would require a hard-to-get federal waiver. Those programs get federal dollars. "That's a whole can of worms that will be difficult to open and will take some time," said Tom Lynch, legislative director for Assemblyman Paul Tonko, D-Amsterdam, who championed the law in his chamber. Healthy NY was exempted simply because it was viewed as too costly by the state Senate, said those involved in creating the law. "Although this is a disappointment to some people, if Healthy NY were to offer all mandated benefits, the cost would be prohibitive," states a Jan. 2 letter a Rensselaer County man received from the state when he asked about getting mental health coverage for his adult son who suffers from mental illness. The man, who requested anonymity in order to protect his family, said he was disappointed to discover there was no coverage and did not know how he would obtain treatment for his son. Timothy's Law, which took effect Jan. 1, was named for Timothy O'Clair, a Rotterdam youth who committed suicide after his parents had to give up custody of their son in order to get him mental health coverage. There is some limited mental health coverage in Family Health Plus and Child Health plus, such as a set number of visits to therapists or hospital days. But that's different from what advocates call parity, or equal treatment without limitations if such treatment is needed, which Timothy's Law provides. "We had to compromise some of it in order to get both houses to agree," said Tom O'Clair, Timothy's father, who campaigned to get the law passed and in the final days staged a vigil outside Pataki's office. He said lawmakers and advocates want to eventually change the law to include the state programs. "That's certainly something we would like to see changed," agreed Michael Seereiter, director of public policy for the state Mental Health Association. Some of those involved in the bill note that getting Timothy's Law passed was an accomplishment in itself, given the concerns voiced by the business community about the cost and Pataki's reluctance to agree to it. "We negotiated right up until the last minute. We lost a lot of battles, including substance abuse," said Lynch. Timothy's Law doesn't mandate parity for substance abuse or addictions -- another compromise needed for its passage. Medicaid, the federal/state health insurance program for the poor, offers full mental health coverage, said Shelly Nortz, deputy executive director for policy at the Coalition for the Homeless. Child Health Plus and Family Health Plus as well as Healthy NY are for those earn above the Medicaid income limits but who nonetheless have trouble paying for their own insurance, which can easily run into hundreds of dollars per month. A family of four with $1,025 monthly income qualifies for Medicaid. By comparison, a family of four with monthly income up to $4,282 could qualify for reduced cost insurance through Healthy NY. Changing the law to include Healthy New York, Nortz said, would mean convincing Senate Republicans who believed it would be too costly for small businesses. Advocates added they were hopeful they could expand at least some of the exempted programs in light of Gov. Eliot Spitzer's plans to provide more health insurance for those who are currently uninsured. Karlin can be reached at 454-5758 or by e-mail at rkarlin@timesunion.com. EXEMPT These subsidized insurance programs for low to moderate income people are exempt from Timothy's Law: Child Health Plus Coverage: 387,178 youngsters. --State-funded health insurance plan for children, available through private insurers. Family Health Plus Coverage: 507,691 adults. --Covers people aged 10 to 64 who earn too much for Medicaid but have no insurance and can't afford private insurance. Healthy NY Coverage: 131,546 people. --Aimed largely at small businesses or sole proprietors, but is also available to students and working individuals. Sources: State Department of Health and Insurance. Statistics as of December 2006.
A law requiring that adults and children with biologically based mental illnesses receive the same healthcare coverage benefits as those provided for any other physical ailment was passed by the New York State Legislature, and signed by outgoing Governor George Pataki last month. Named after 12-year-old Timothy O'Clair from Schenectady, who committed suicide after insurance failed to cover his psychological treatment, Timothy's Law specifically requires at least 30 days of inpatient care and 20 days of outpatient care in a manner that is consistent with coverage provided for other health conditions. "Psychological illness is just as legitimate as any other illness, and costs our society not just in human terms, which is self-evident, but it also costs us monetarily," said state Assemblyman Fred Thiele (R-Bridgehampton). "Preventive treatment can provide substantial savings for the state, businesses and the healthcare industry by catching diseases before they progress." The bill would cover biologically based mental illnesses, which are, according to Thiele, defined as a mental, nervous or emotional condition that is caused by a biological disorder of the brain and results in a clinically significant psychological syndrome. Certain biologically based mental illnesses include major depression, bipolar disorder, schizophrenia/psychotic disorders, and obsessive compulsive disorder, as well as serious cases of children with attention deficit disorders and disruptive behavior disorders. Under Timothy's Law, explained Thiele, higher deductibles and more restrictive limits for treatment of biologically based mental illnesses will not be permitted. "This would ensure that people who suffer from these illnesses receive fair treatment and attain a healthy and successful recovery," he said. The bill does not require coverage of alcoholism and substance abuse treatment, said Thiele - a caveat which was a compromise between the Assembly and the Senate as a means to get the bill approved. "Of course, with most mental illnesses there is a crossover of diagnosis, which often includes the patient self-medicating with substances to dull psychological pain," said Thiele. "However, the legislative process isn't perfect and this is a good first step." The legislative journey of this bill has been a long and arduous one, according to Thiele, with it being approved over the years in the Assembly and stalled in the Senate. "It was the provision of coverage for alcoholism and substance abuse treatment which the Senate viewed as too costly and expansive," said Thiele. "We had to compromise on this provision in order to address this issue and get the bill passed." Assemblywoman Ginny Fields (D-Sayville) said that this is a bill that transcends political parties. "This is going to make a huge difference in how we treat mental illness as a society and how society is affected by these diseases," Fields said. Fields explained that her support for the bill is based upon the "common sense" notion that if mental illness is caught early and treated it can prevent more serious social ills that are much more costly to address. "If mental illness, which is just as legitimate a health issue as a broken arm or high blood pressure, is caught early, people can resume normal lives, instead of spiraling into worse situations, such as hospitalizations, suicide, or homelessness, which affect not only the individual but our entire society," she said. A former administrator in the healthcare industry, Fields said that it is incumbent upon society to resist the temptation of marginalizing those affected by mental illness. "Most people either know someone with [a] mental illness or are affected by it themselves at some point in their lives," she said. "In this regard, I do believe that the Senate finally saw the light in the importance of passing this bill." When asked about the lack of coverage for alcohol and substance abuse in the legislation, Fields said that her hopes are for New York State Governor Eliot Spitzer to make it a priority in his administration. "I believe that our new governor will pay a lot of attention to this issue," said Fields. Meanwhile,
she said that she is committed to tackling the issue of alcohol
and substance abuse recovery through the sponsoring of the sober
homes bill, which provides for strict governmental regulation of
social service homes where people reside during their treatment. Fields said the sober homes legislation provides for oversight, such as an extensive database that tracks each client and the individual services that they need. Each client has a single room and every house is required to be in compliance with zoning regulations, complete with smoke and fire alarms, and sprinkler systems. As for Timothy's Law, state Senator Ken LaValle (R-Selden) was extremely supportive of the legislation. "This was a long time coming," said LaValle, "and I think it is an essential healthcare component that people should have in today's modern world. People accept that it is okay to go for counseling and get help." LaValle said that it was a "very frustrating number of years trying to get both Houses together on this." Although he said he would have liked to address the issue of alcohol and substance abuse, he believed that ultimately, it would have been too costly to include that in this particular bill. "For years it was a mode of thinking, an all-or-nothing situation," said LaValle. "Unfortunately, in the legislative process there are stakeholders who play chicken, to see who will blink first. What they don't realize is that they are playing with people's lives. Although this legislation will make a difference in thousands of lives, there is still more work to be done." The compromise of excluding alcohol and substance abuse treatment was a "simple concept" in the minds of the members of the Senate, according to LaValle. "Adding this provision blows out the costs, and may jeopardize coverage for everyone, forcing businesses to not offer healthcare at all," he said. LaValle said it remains to be seen just how this legislation will be dealt with "in the marketplace ... It is important in treatment for people to face the underlying problems as to why they are doing drugs," he said. "Life-altering issues, such as eating disorders, abuse and rape, are all very complicated and intertwined with self-destructive behaviors. I don't know how it is all going to shake out, but this legislation will still make a dramatic difference." Full
Parity for Mental Care a Goal - Timothy’s Law a step, but
those with state plans in gap Timothy’s Law stands among the great achievements of the 2006 legislative season, one mental health advocate said Friday, even as it fails to reach hundreds of thousands of New Yorkers who rely on state-assisted health care. “Timothy’s Law is a monumental step forward in getting mental health coverage for millions of people, and it serves as the incremental model that programs like Family Health Plus and Child Health Plus and Healthy New York should pursue,” said Shelly Noltz, deputy executive director of the Coalition for the Homeless. Advocates for the law, including key legislative sponsor Assemblyman Paul Tonko, D-Amsterdam, said they hope the new law will pave the way for improved benefits under the state’s extended Medicaid programs — Family Health Plus and Child Health Plus — and the state-sponsored Healthy New York small business insurance program. “We had this very broad but good bill — one that was total parity — and we had to compromise in order to make a major step forward and make a good step forward,” Tonko said. “My goal is certainly to fill up the gaps and the empty silence that needs to be addressed for full mental health parity.” Timothy’s Law, signed by then-Gov. George Pataki on Dec. 22, sets standards for mental health insurance coverage of biologically based illnesses among both small and large employers. “No health insurance policy sold in New York state will have anything less than 30 days of inpatient coverage and 20 days of outpatient coverage,” said Michael Seereiter, director of public policy for the Mental Health Association of New York City. Large-scale employers, those with 50 employees or more, must offer unlimited treatment of certain mental illnesses with copays comparable to those required for physical health coverage. Small-scale employers must offer health insurance packages that include mental health coverage with, at a minimum, the socalled “30-20 ” industry standard. And the bill requires the state to aid small-scale employers with the expanded coverage. But Timothy’s Law will not apply to the 1 million New Yorkers enrolled in the three state programs. About 500,000 low-income New Yorkers ages 18 to 64 rely on Family Health Plus, while 400,000 children are enrolled in Child Health Plus. Both programs are run under a federal waiver that allows the state to extend certain Medicaid benefits to residents who exceed the Medicaid income thresholds. Although both programs provide some mental health coverage — at least the “30-20 ” standard, Nortz said — neither live up to the full parity coverage of Medicaid, which is available to individuals and families earning less than those enrolled in Child and Family Health Plus. Another 125,000 residents buy health care through Healthy New York, a program tailored to small businesses. The earliest versions of Timothy’s Law, drafted more than a decade ago, included coverage for substance abuse and stronger mandates for small businesses, and a version introduced earlier in 2006 included coverage for those enrolled in Healthy New York, Nortz said. But many provisions, including the requirements for Healthy New York, were removed to gain approval in both houses of the Legislature. “It was one of the compromises that was made to get Timothy’s Law to become a law,” Nortz said. “It was a heavy list to get as far as we did with small employers.” Still, mental health advocates call the new law a triumph. “What we’ve finally gotten after 20 years of struggle in the Assembly is a bill that will end discrimination in private health insurance policies for millions of New Yorkers,” Seereiter said. “This is an amazing step, and to take shots at it is not the same issue.” Nortz said state law could not have changed the Medicaid-based Child Health Plus and Family Health Plus programs. “It’s not even within the power of the Legislature as I understand it to negotiate those waivers with the federal government,” Nortz said. “It’s an executive matter — the Department of Health and people who are the governor’s counsel. Those are the people who go to Washington and negotiate waivers.” While mental health advocates say they will be busy monitoring implementation and enforcement of the new law, Tonko said he will push for expansion through the Medicaid waivers and Healthy New York. “I think we would try and write legislation that would further amend the great progress we made with Timothy’s Law, which affects millions of New Yorkers and which provides a great outcome but falls short of parity,” Tonko said.
On Friday, Dec. 23, in one of his final acts in office, Gov. George Pataki signed Timothy's Law. “Today,” Pataki said, “the memories will not all be sad.” More than 3.6 million New Yorkers will be impacted by this bill, that will end the discrimination that currently exists in insurance coverage for people with psychiatric disabilities. Additionally, this bill can be seen as ending the stigma felt by those who are treated for a psychiatric condition; now ensuring that there is parity in how those with a physical and/or mental illness are covered by insurance. Passage of this bill makes New York the 38th state in the nation to enact mental health parity. “It is vital that our society take care of those in need, especially our most vulnerable children,” Pataki said. “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. Insurance coverage serves as a safety net and with this new law, we have extended this protection to children and families across the state. I commend the efforts of Tom and Donna O'Clair in helping to get this law enacted. Sharing their experiences and sense of loss 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,” the governor added. According to the governor's press release, the new law was to take affect Jan. 1. Health insurance providers are now required to provide comparable insurance coverage for mental illnesses as the policies provide for other medical care. “This will allow adults and children with biologically-based mental illnesses to receive the same health care coverage benefits as those provided for other physical ailments. In a calendar year, the coverage must include at least 30 days of active inpatient (hospital) care, and at least 20 days of active treatment in a facility operated by the State Office of Mental Health (OMH), a psychiatrist or psychologist licensed to practice in New York, or a university faculty practice corporation. The cost of any premiums and deductibles must be consistent with those imposed for other benefits available under the insurance policy. “Insurance coverage for businesses with 50 or more employees must include treatment for schizophrenia/psychotic disorders, major depression, obsessive compulsive disorders, bulimia, anorexia, serious cases of attention deficit disorders in children, disruptive disorders, or pervasive development disorders. In addition, children under 18 years of age are eligible for coverage if they have serious suicidal symptoms or other life-threatening self-destructive behaviors, significant psychotic symptoms, behavior caused by emotional disturbance that place the child at risk of causing personal injury or significant property damage, or behavior caused by emotional disturbances that place the child at substantial risk of removal from the household,” the press release pointed out. We would like to thank both the Assembly members and senators who represent our area for their “yes” votes. Previously, Assembly members Brian Kolb and Bob Oaks had voted against the bill, but when the bill went up for another vote on Dec. 13 our entire delegation voted for its passage. We also want to thank Assemblyman Gary Finch for his early and continued support of this bill. With mental health parity, which is something many advocates have been working on for years, it will indeed be a good year for many in 2007. Thought
of the Day: - Amanda Derby is the housing advocate for Options for Independence, located at 75 Genesee St., Auburn. She can be reached at 255-3447. |
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