Timothy's Law
Encyclopedia
Timothy's Law is the reference used for a New York
state statute signed into law on December 22, 2006 by Governor George E. Pataki which took effect January 1, 2007. The law requires that health plans
sold in the state provide comparable coverage for mental health ailments as it does for physical aliments. This is often referred to as mental health parity.
"Timothy's Law" was sponsored by Senators Thomas Morahan
and Thomas Libous and passed the state senate on September 15, 2006. It was Sponsored by Assembly Members Paul Tonko
and Peter Rivera
and passed the Assembly consecutively for 5 years. Timothy's Law was sent to the governor on December 13, 2006 who later signed it into law. A condition of Timothy's Law passing the NY State legislature was it have a 2 year sunset clause to provide for an actuarial study on the cost effectiveness (the shortest sunset of any law in NY history). Timothy's Law became effective January 1, 2007. In May, 2009, the Superintendent of the New York State Insurance Department released the actuarial study on the cost effectiveness of Timothy's Law, and reported that the law had considerably increased mental health parity at a nominal cost to employers. It stated that neither consumers nor brokers viewed the mandates as a significant issue relative to cost or their overall purchasing decision.
After both houses of the NYS Legislature voted to make Timothy's Law permanent in the 2009 session, Governor Patterson signed the bill into law on July 11, 2009. "Timothy's Law" was originally set to expire on December 31, 2009.
This is a mandatory benefit. For mental, nervous or emotional disorders, insurers must offer inpatient care of not less than thirty (30) days per year and outpatient care of not less than twenty (20) visits per year at the same cost sharing limits as applicable to other health coverages.
This is a mandatory parity benefit. For treatment of adults and children with biologically based mental illness
es (“BBMI”) and for treatment of children with serious emotional disturbances (“SED
"), insurer must offer benefits comparable to other health care and medical services coverage.
This is a mandatory benefit. For mental, nervous or emotional disorders, insurers must offer inpatient care of not less than thirty (30) days per year and outpatient care of not less than twenty (20) visits per year at the same cost sharing limits as applicable to other health coverages.
The added level of BBMI/SED
coverage is not required in small group policies or contracts (50 or fewer employees), but insurers are required to offer it on a “make available” basis (i.e., if requested by a small group purchaser). The BBMI and SED “make available” benefits are not subsidized.
The added premium cost of the 30/20 benefit mandate over the cost of benefits small employers were already purchasing before the law is estimated to be a nominal fraction (under one half of one percent) of total monthly policy cost.
The total cost of the optional BBMI/SED
benefits in the small group market is under one percent of total monthly cost. Under a scenario where BBMI/SED
benefits were mandated in the small group market, eliminating antiselection, the Insurance Department projects the cost would drop to under one half of one percent of monthly policy costs.
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
state statute signed into law on December 22, 2006 by Governor George E. Pataki which took effect January 1, 2007. The law requires that health plans
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
sold in the state provide comparable coverage for mental health ailments as it does for physical aliments. This is often referred to as mental health parity.
History
The law was named after Timothy O’Clair, a boy from Schenectady, NY who committed suicide at age 12 on March 16, 2001. Timothy had been diagnosed with several behavioral disorders and severe depression but had exhausted the mental health benefits on his family's health plan. As a result, the O'Clairs were forced to relinquish full custody of their child in order to make him eligible for Medicaid which paid for all the services which Timothy needed. However, when Timothy returned home, he once again exhausted his benefits. In 2003, Timothy's parents joined other mental health advocates and lent Timothy's name to the parity movement in New York State and petitioned the state government to pass a law that would require health plans to provide coverage for mental health ailments and behavioral disorders comparable with coverage for physical ailments."Timothy's Law" was sponsored by Senators Thomas Morahan
Thomas Morahan
Thomas P. Morahan was a member of the New York State Senate, for the 38th district covering all of Rockland County and parts of Orange County, New York...
and Thomas Libous and passed the state senate on September 15, 2006. It was Sponsored by Assembly Members Paul Tonko
Paul Tonko
Paul David Tonko is the U.S. Representative for , serving since 2009. He is a member of the Democratic Party. The district is located in the heart of the Capital District...
and Peter Rivera
Peter Rivera
Peter Rivera represents District 76 in the New York State Assembly, which comprises West Farms, Van Nest, Castle Hill and Parkchester....
and passed the Assembly consecutively for 5 years. Timothy's Law was sent to the governor on December 13, 2006 who later signed it into law. A condition of Timothy's Law passing the NY State legislature was it have a 2 year sunset clause to provide for an actuarial study on the cost effectiveness (the shortest sunset of any law in NY history). Timothy's Law became effective January 1, 2007. In May, 2009, the Superintendent of the New York State Insurance Department released the actuarial study on the cost effectiveness of Timothy's Law, and reported that the law had considerably increased mental health parity at a nominal cost to employers. It stated that neither consumers nor brokers viewed the mandates as a significant issue relative to cost or their overall purchasing decision.
After both houses of the NYS Legislature voted to make Timothy's Law permanent in the 2009 session, Governor Patterson signed the bill into law on July 11, 2009. "Timothy's Law" was originally set to expire on December 31, 2009.
Major provisions
The legislation included several provisions that affect the way health insurers in the state cover mental health services.- Coverage must be included in plans for at least 30 days of inpatient care and at least 20 days of outpatient treatment with a psychiatristPsychiatristA psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
or psychologistPsychologistPsychologist is a professional or academic title used by individuals who are either:* Clinical professionals who work with patients in a variety of therapeutic contexts .* Scientists conducting psychological research or teaching psychology in a college...
in a state-certified facility, a facility operated by the state, or a group or academic practice. - Plans must have premiums and patient cost-sharing for services that are consistent with the costs for physical treatments.
- Plans for employers with 50 or more eligible employees must provide unlimited coverage for biologically based mental illnessBiologically based mental illness-New York:Under Timothy's Law the following disorders are classified as biologically based mental illness:*Schizophrenia/psychotic disorder*Major depression*Bipolar disorder*Delusional disorders*Panic Disorder*Obsessive Compulsive Disorder*Bulimia*Anorexia...
es, defined as schizophreniaSchizophreniaSchizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
/psychotic disorders, major depression, bipolar disorderBipolar disorderBipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
, delusional disorderDelusional disorderDelusional disorder is an uncommon psychiatric condition in which patients present with circumscribed symptoms of non-bizarre delusions, but with the absence of prominent hallucinations and no thought disorder, mood disorder, or significant flattening of affect...
s, panic disorderPanic disorderPanic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
, Obsessive–compulsive disorder, bulimiaBulimia nervosaBulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is...
, anorexiaAnorexia nervosaAnorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...
, and binge eatingBinge eatingBinge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is sometimes as a symptom of binge eating disorder. During such binges, a person rapidly consumes an excessive amount of food...
. Plans for employers with 49 or less employees must offer this coverage as an option. - Children under age 18 with must be covered for serious suicidalSuicideSuicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
symptoms or other life-threatening self-destructive behaviors, significant psychotic symptoms, behavior caused by emotional disturbance that places 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 law requires the state to develop a method to help small employers pay for the additional biologically-based coverage if elected.
Large Group ( 50 + employees)
- 30/20 benefit
This is a mandatory benefit. For mental, nervous or emotional disorders, insurers must offer inpatient care of not less than thirty (30) days per year and outpatient care of not less than twenty (20) visits per year at the same cost sharing limits as applicable to other health coverages.
- BBMI/SED benefit
This is a mandatory parity benefit. For treatment of adults and children with biologically based mental illness
Biologically based mental illness
-New York:Under Timothy's Law the following disorders are classified as biologically based mental illness:*Schizophrenia/psychotic disorder*Major depression*Bipolar disorder*Delusional disorders*Panic Disorder*Obsessive Compulsive Disorder*Bulimia*Anorexia...
es (“BBMI”) and for treatment of children with serious emotional disturbances (“SED
Sed
sed is a Unix utility that parses text and implements a programming language which can apply transformations to such text. It reads input line by line , applying the operation which has been specified via the command line , and then outputs the line. It was developed from 1973 to 1974 as a Unix...
"), insurer must offer benefits comparable to other health care and medical services coverage.
Small Group (less than 50 employees)
- 30/20 Benefit
This is a mandatory benefit. For mental, nervous or emotional disorders, insurers must offer inpatient care of not less than thirty (30) days per year and outpatient care of not less than twenty (20) visits per year at the same cost sharing limits as applicable to other health coverages.
-
- Government subsidy
- "Out of concern for the potential burden that the added premium cost of the 30/20 benefit might impose on small businesses in the State, the Law provided that the Superintendent of Insurance would develop and implement a methodology to fully cover small employers’ cost for the newly mandated benefitBenefitBenefit or Benefits may refer to:* Benefit concert, any activity performed for a charitable purpose* Benefit , an album by Jethro Tull* "Benefits" , a 2009 episode of the show How I Met Your Mother...
, and that such methodology would be financed from monies from the General Fund.
- The Superintendent developed a reimbursement methodology which pays insurers directly for the premiumPremiumPremium may refer to:* Premium , a promotional item that can be received for a small fee when redeeming proofs of purchase that come with or on retail products....
cost of the added 30/20 benefit. (Administratively, direct payment to insurers on a quarterly basis was considered more efficient than paying the approximately 300,000 small employers a monthly amount to then remit to their respective insurers for the coverage.)
- Insurers are required to submit detailed justification for their per member per month (“PMPM”) charge for the mandated benefits to Department actuaries for review. The subsidies are thus on a “prior approval” basis. If, after review, Department actuaries are :satisfied that the proposed reimbursement amounts are reasonable, insurers are notified.".
- BBMI/SEDSedsed is a Unix utility that parses text and implements a programming language which can apply transformations to such text. It reads input line by line , applying the operation which has been specified via the command line , and then outputs the line. It was developed from 1973 to 1974 as a Unix...
benefit
The added level of BBMI/SED
Sed
sed is a Unix utility that parses text and implements a programming language which can apply transformations to such text. It reads input line by line , applying the operation which has been specified via the command line , and then outputs the line. It was developed from 1973 to 1974 as a Unix...
coverage is not required in small group policies or contracts (50 or fewer employees), but insurers are required to offer it on a “make available” basis (i.e., if requested by a small group purchaser). The BBMI and SED “make available” benefits are not subsidized.
Cost impact on small groups
"In the small group market, Timothy’s Law resulted in a 25% increase in the basic 30/20 benefits (subsidized by the State) and an increase in the number of insureds purchasing the unsubsidized BBMI/SED benefits, from under 10% prior to the law to about 44% after the law went into effect.The added premium cost of the 30/20 benefit mandate over the cost of benefits small employers were already purchasing before the law is estimated to be a nominal fraction (under one half of one percent) of total monthly policy cost.
The total cost of the optional BBMI/SED
Sed
sed is a Unix utility that parses text and implements a programming language which can apply transformations to such text. It reads input line by line , applying the operation which has been specified via the command line , and then outputs the line. It was developed from 1973 to 1974 as a Unix...
benefits in the small group market is under one percent of total monthly cost. Under a scenario where BBMI/SED
Sed
sed is a Unix utility that parses text and implements a programming language which can apply transformations to such text. It reads input line by line , applying the operation which has been specified via the command line , and then outputs the line. It was developed from 1973 to 1974 as a Unix...
benefits were mandated in the small group market, eliminating antiselection, the Insurance Department projects the cost would drop to under one half of one percent of monthly policy costs.