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Tuesday, May 11, 2004
Senate Majority Leader Joseph L. Bruno and Senator Thomas Libous (R-C, Binghamton) today unveiled Senate legislation that would provide parity in insurance coverage for mental illnesses. The proposal would require insurance companies to cover most mental illnesses and would require coverage for a broad range of mental illnesses and conditions specifically related to children.
"Mental illness can result in tragedy if it is not properly treated, however many families do not have access to the proper treatment," Senator Bruno said. "I�ve met several times with Tom and Donna O�Clair who lost their son Timothy as a result of mental illness. They have courageously advocated for a law that would require insurance companies to provide coverage for mental illness in the same manner as health care. This Senate bill would provide parity in coverage and would help people get the treatment they need so other families won�t have to suffer the kind of tragedy suffered by the O�Clairs. I applaud their courage and I applaud Senator Libous for the hard work he has done to address such a complex and critically important issue."
"The legislation we�re introducing today is a critical step toward providing the vital care that people with mental illnesses need. After a lot of discussion with mental health advocates, we have a bill that would make commonsense reforms to improve access to care without creating escalating insurance costs for small businesses," said Senator Libous, who chairs the Senate Committee on Mental Health and Developmental Disabilities.
Senator Bruno and Senator Libous announced the Senate mental health parity legislation at a Capitol news conference where they were joined by Harvey Rosenthal, Executive Director of the New York State Association of Psychiatric Rehabilitation Services, Melissa Devine, Executive Director of the National Association of Social Workers, Richard Gallo of the New York State Psychiatric Association, Liz Dears Kent of the Medical Society of the State of New York and Cynthia Dames of the Coalition of Voluntary Mental Health Agencies and the National Association of Social Workers - New York City.
COVERAGE FOR TREATMENT OF MENTAL ILLNESSES
The Senate bill would require insurance companies to cover biologically based mental illnesses, including the following: Schizophrenia, Schizoaffective Disorder, Major Depression, Bipolar Disorder, Delusional Disorders, Paranoia, Panic Disorder, Obsessive Compulsive Disorder, Bulimia, Anorexia and Binge Eating. Seven other states with parity laws base their required coverage on biologically based mental illnesses.
The Assembly�s mental health parity bill is based on a very broad diagnostic manual and would require insurance coverage of treatment for hundreds of afflictions ranging from caffeine anxiety disorder to gender identity confusion.
COVERAGE FOR CHILDREN WITH MENTAL ILLNESS
In addition, the Senate bill would require insurance coverage for children under age 18 with attention deficit disorder, disruptive behavior disorders or pervasive development disorders where there are serious suicidal symptoms or other life-threatening self-destructive behavior; significant psychotic symptoms (hallucinations, delusion, bizarre behaviors); behavior caused by emotional disturbances that placed the child at risk of causing personal injury or significant property damage; or behavior caused by emotional disturbances that placed the child at substantial risk of removal from the household.
"In terms of providing mental health coverage for childhood mental illnesses, the Senate bill is preferable because it lines out in law which illnesses must be covered, as opposed to the Assembly bill that would leave those decisions up to a state agency," Senator Libous said. "The Senate bill goes beyond the scope of the Assembly bill because it takes the guesswork out of it and doesn�t leave such an important decision up to the interpretation of agency bureaucrats."
LIMITING THE COST IMPACT
Serious concerns have been raised that requiring businesses to provide mental health insurance coverage for employees would result in higher insurance premiums that could lead to an increase in the number of uninsured New Yorkers. Mental health advocacy groups have estimated that the broad coverage required in the Assembly�s parity bill would result in premium increases of less than one percent. Business organizations have projected significantly larger increases.
To address cost concerns, the Senate bill would exempt any company or organization that can prove to the state Superintendent of Insurance that they have experienced an insurance rate increase of two percent or more as a direct result of having to provide mental health coverage. Currently, nine states with parity laws provide such an exemption ranging from 1 percent to four percent.
In addition, the Senate bill would exempt businesses of 50 or fewer employees from having to provide mental health coverage. Fifteen states with parity laws provide a similar exemption. Also, the federal government�s mental health parity law includes an exemption for businesses of 50 or less employees.
The bill would also require the state Insurance Department and the Office of Mental Health to conduct a two year study to determine the effectiveness and impact of mental health parity legislation in New York and other states. If enacted, the bill would take effect January 1, 2005 and sunset on December 31, 2007, to provide for an opportunity to amend the law based on the findings and recommendations of the study.
Melissa Devine, Executive Director of the National Association of Social Workers, New York State Chapter, said: "On behalf of the National Association of Social Workers, both the New York State and New York City Chapters, we are very pleased that today we move one step closer to providing mental health parity to New Yorkers. We thank Senator Bruno and Senator Libous for their leadership on this important issue and look forward to working with them and the members of the New York State Legislature in making mental health services accessible to those in need in New York State. As we move in this direction we have an opportunity to change history in New York, eliminating the barriers to treatment experienced by those suffering with mental illness."
Phil Saperia, Executive Director of the Coalition of Voluntary Mental Health Agencies, said: "We are inspired by the work of the Senate, in particular Senator Joe Bruno and Senator Tom Libous, who have honored their stated commitment to advance mental health parity in New York. We further applaud the attention paid to children who suffer serious emotional disturbance, and know that many families will find comfort in what we believe will become landmark legislation. With the help of our colleagues in both houses of the New York State Legislature, it is our hope that mental health parity, will begin to end the stigma and discrimination felt in our communities.
Harvey Rosenthal, Executive Director of the New York Association of Psychiatric Rehabilitation Services, said: "Today marks a historic moment in the decade-long effort to bring mental health insurance parity to New York. Senators Bruno and Libous have moved us many steps closer towards the negotiation of an appropriate agreement with the Assembly to assure adequate access to proper mental health care for children and adults in New York State."
Alan Lubin, Executive Vice President of the New York State United Teachers, representing the New York State Psychological Association, said: "The Senate has taken a significant step forward which should bring us close to enactment of a mental health parity law in New York State, which adequately addresses the mental health needs of New Yorkers."
Barry Perlman, MD., President of the New York State Psychiatric Association, said: "The New York State Psychiatric Association applauds Senate Majority Leader Joseph Bruno and Senator Thomas W. Libous, Chairman of the Senate Mental Health Committee for their leadership in advancing this historic legislation which will result in improved access to mental health services for millions of New Yorkers."
William B. Rosenblatt, M.D., President of the Medical Society of the State of New York congratulated Senate Majority Leader Joseph Bruno and Senator Thomas W. Libous, Chairman of the Senate Mental Health Committee for their sponsorship of meaningful legislation to improve the delivery of health care to individuals living with mental illness in New York State.
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Senate Mental Health Parity Legislation
Summary of Provisions
Extent of Coverage
Insurance Companies would be required to cover most biologically based mental illnesses.
Specifically, the bill would mandate coverage of:
� Schizophrenia
� Schizoaffective Disorder
� Major Depression
� Bipolar Disorder
� Delusional Disorders
� Paranoia
� Panic Disorder
� Obsessive Compulsive Disorder
� Bulimia
� Anorexia
� Binge Eating
Added coverage for children under age 18 will include any child with attention deficit disorder, disruptive behavior disorders or pervasive development disorders where there are one or more of the following:
� Serious suicidal symptoms or other life-threatening self-destructive behavior
� Significant psychotic symptoms (hallucinations, delusion, bizarre behaviors)
� Behavior caused by emotional disturbances that placed the child at risk of causing personal injury or significant property damage or
� Behavior caused by emotional disturbances that placed the child at substantial risk of removal from the household.
Other States with Biologically Based Parity Laws are:
Colorado, Massachusetts, New Hampshire, New Jersey, South Dakota, Delaware and Virginia.
Exemptions
An organization, company, group or other business enterprise may be exempt from coverage if they can prove to the Superintendent of the State Insurance Department that insurance premium costs increased 2% or more as a direct result of having to provide coverage mentioned above.
Other States with such exemption are:
Arizona (1%), Arkansas (1.5%), Indiana (4%), Michigan (3%), Mississippi (1%), Nevada (2%), Oklahoma (2%), Tennessee (1%), West Virginia (1%).
An organization, company, group or other business enterprise may be exempt if they have fifty or fewer employees. As of January of 2004, the following States offered business exemptions.
Other States with such exemption are: Mississippi, Kentucky, Alabama, Arizona, Indiana, Illinois, Oklahoma, Pennsylvania, Texas, Nevada, Tennessee, Virginia, Hawaii, Maine, Nebraska and the Federal Government.
Other Considerations
Insurance Companies may continue to use medical management or review such as:
� prospective, concurrent or retrospective utilization review
� preauthorization
� "appropriateness criteria as to the level and intensity of treatment applicable to behavioral health"
Insurance Companies are not required to offer policies for individuals who
are incarcerated or to pay for services solely because they�re ordered by the court.
The bill would also require the state Insurance Department and the Office of Mental Health to conduct a two year study to determine the effectiveness and impact of mental health parity legislation in New York and other states. If enacted, the bill would take effect January 1, 2005 and sunset on December 31, 2007, to provide for an opportunity to amend the law based on the findings and recommendations of the study.
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