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Mental health and Timothy’s Law (Rep. Paul Tonko)

Timothy was like any other boy his age — happy and energetic, eager to go fishing or camping, and he loved playing baseball. As Timothy got older he began to show signs of emotional problems, and by his eighth birthday, his family decided to seek mental-health help for their son. Timothy was triply diagnosed with depression, attention-deficit hyperactivity disorder, and oppositional defiance disorder.

Over the years I watched the O’Clairs struggle to access mental healthcare for their son. Timothy’s father was employed with the state and had access to great health insurance coverage, but his plan only allowed 20 outpatient mental-health visits a year, which they quickly exhausted. Over time, Timothy grew worse and his family’s finances were stretched — paying the growing out-of-pocket costs for psychiatric visits and hospitalizations. Eventually after exhausting all covered treatment options and their savings, the O’Clairs were forced to give Timothy up, so he could go into foster care and have his treatments covered by Medicaid. When Timothy finally returned home, he had a brief improvement, and then things went downhill. He was caught for five years in a system where care was sporadic, disjointed, and costly — even though his family had full health insurance coverage. Shortly before his 13th birthday, Timothy completed suicide.

The O’Clairs were devastated by their loss and resolved to work so that no one would have their same experience. We went to work drafting Timothy’s Law, which I introduced in the New York State Assembly in 2003 and saw signed into law in 2006. Timothy’s Law requires health insurers in New York to offer mental health coverage and mandated that the mental-health coverage must be on par with other medical benefits. It was a major victory for mental-health advocates in New York, and a major victory for the O’Clair family, who have continued fighting for equal coverage for, and equal treatment of, people with mental illnesses.

Today, on the federal level, the Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act of 2008 is being implemented. This federal mental-health parity law, championed in the House by Congressman Patrick Kennedy (D-R.I.) and former Congressman Jim Ramstad (R-Minn.), requires health insurance companies offering mental-health and substance-use-disorder coverage to provide coverage that is on par with coverage for other medical benefits. The regulations, which took effect on July 1, were hailed by the behavioral health community as exceptionally strong. The new rules bar insurance companies from having different requirements for mental-health benefits and other medical benefits, including rules on lifetime and annual limits, co-pays, deductibles, treatment limits and out-of-network benefits.

The Affordable Care Act builds on the advances made by the Mental Health and Addiction Equity Act (MHPAEA). While the MHPAEA was a major step forward, the law did not require plans to offer mental-health and substance-abuse coverage and it only applied the parity rules to insurance plans offered by large employers. The Affordable Care Act fills these gaps by requiring all plans offered in exchanges to offer substance-abuse and mental-health coverage. This means that starting in 2014, when most small businesses will purchase insurance through exchanges, coverage will have to offer these benefits. The Affordable Care Act also requires Medicaid to start covering mental-health and substance-abuse services, which has been optional thus far for states.

As these advances are made in mental-health parity, it is important to remember that there is much more to be done. As millions more people gain health insurance coverage, including mental-health coverage, we need to strengthen our healthcare delivery system. Now that mental health and substance abuse have gained equal footing when it comes to coverage, they need to be a standard part of a primary care visit, with physicians screening patients and talking about treatment options. Before the new requirements and protections in the Affordable Care Act take effect in 2014, we need to ensure that our mental-health safety net programs, like the Mental Health Block Grant, are adequately funded.

If our Little Leaguer Timothy went through today’s system, with mental-health parity rules in place, would he get the care he needed? What about in 2014, when there will be more coverage options? Timothy deserved that opportunity. So do the millions of other Americans suffering from mental illnesses and substance use disorders. Until I am certain that Timothy O’Clair would have gotten direct, immediate and affordable access to the care he needed, there will be more work to do.


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