Advocates Want Mandatory Health Insurance Coverage For PTSD

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NYAPRS Note: Following is today's piece in the Legislative Gazette
regarding last Tuesday's Albany new conference pressing a top priority
of members of NYAPRS and our state advocacy partners: extension of
Timothy's Law parity protections to include those with post traumatic
stress disorders, most notably returning veterans, victims of sexual
abuse and domestic violence and disasters.



Advocates Want Mandatory Health Insurance Coverage For Posttraumatic
Stress Disorder

By ARAMIS M. GRANT Legislative Gazette April 21, 2008



The number of soldiers returning home from war with mental health
problems is among the reasons advocates in Albany last week were pushing
for an expansion of Timothy's Law.



A coalition of mental health advocacy groups calling themselves the
Timothy's Law Campaign are lobbying the Legislature to broaden the scope
of the legislation, which was signed into law by Gov. George E. Pataki
in December 2006 to mandate parity in the private insurance industry's
coverage of physical and mental health illnesses.



The campaign wants an amendment that would include posttraumatic stress
disorder among the biologically based mental illnesses Timothy's Law
requires insurance companies provide coverage for.



The amendment (A.10078/S.6818) is being sponsored by the chairmen of the
Senate and Assembly's mental health committees: Sen. Thomas Morahan,
R,C,I,WF-New City, and Assemblyman Peter Rivera, D-Bronx, who met with
the coalition in Albany last week to speak about the importance of
coverage for posttraumatic stress disorder.



"Timothy's Law has significantly advanced access to mental health
treatment," said Morohan. "However, the exclusion of posttraumatic
stress disorder negatively impacts returning veterans, children and
adults who have suffered sexual abuse and trauma," he said.



"This is a great first step to expanding Timothy's Law to a population
who needs it," said Rivera. The assemblyman said the amendment could
help society deal with the problems suffered by troops returning home
from Iraq.



Timothy's Law was named for Timothy O'Clair, who in 2001 committed
suicide at the age of 12 after his parents reached the limit on what
their insurance carrier would cover for their son's treatments.



Timothy's Law covers major depression, bipolar disorder, schizophrenia
(psychotic) disorders, delusional disorders, panic disorder,
obsessive-compulsive disorders, anorexia and bulimia. The proposed
amendment would add posttraumatic stress disorder to the list.



The campaign argues that posttraumatic stress disorder was not
originally included into Timothy's Law, even though its inclusion was
proposed, due to the belief that treatment for soldiers would be covered
under benefits they receive from the U.S. Department of Veterans
Affairs.



But only 35 percent of veterans seek help from Veterans Affairs,
according to John Javis, chairman of the Veterans Health Alliance of
Long Island.



Javis said veterans are reluctant to seek help from the federal agency
for a number of reasons, including a concern that information about
their mental health problems will wind up on their personal records. And
Javis said there are also problems with access because the agency's
office hours usually conflict with veterans' work schedules and because
they might have to travel long distances to get to an office.



Javis also said women may be reluctant to visit a Veterans Affairs
facility because of sexual abuse experiences that may have taken place
during their time of service, making them fearful of personal
interactions.



The coalition said for individuals in the acute phases of posttraumatic
stress disorder, the base mental health benefit required by Timothy's
Law might not cover all of their treatment needs. The proposed amendment
would cover treatment past the currently mandated 20 outpatient and 30
inpatient visits for insured individuals and cover all treatment for
posttraumatic stress disorder sufferers, even if they are only in an
acute phase of the condition, when more intensive inpatient and
outpatient treatment is medically necessary to help the person reach a
state of stability.



According to Shelly Nortz, deputy executive director for policy at the
Coalition for the Homeless, there are about 20,000 to 25,000 people in
New York who would be covered by the amendment.



Nortz estimated it would cost insurance companies an additional $500,000
annually should the amendment pass. The amount is so small, she
explained, because few people require treatment past the 30 inpatient
visits already covered by Timothy's Law.



But the New York Health Plan Association, which represents 27 managed
care health plans it says provide comprehensive health care services to
nearly 6 million New Yorkers, is opposed to the proposed expansion of
Timothy's Law expansion proposal and said in a press release that the
inclusion of posttraumatic stress disorder would be costly and
unnecessary.



"This bill appears to be a solution in search of a problem," said Paul
Macielak, Health Plan Association president. He said the majority of the
proposed amendment is aimed at helping returning soldiers and survivors
of the attacks of Sept. 11, 2001, who already have access to services.



In addition to the cost-free health care services provided to veterans,
including reservists and National Guard members, the association pointed
out that in 2005, New York passed the World Trade Center disability law
to "provide that any injury or illness directly related to terrorist
attack on September 11, 2001, be presumptively eligible for an
accidental disability."



Also noted by the association was that in the crafting of Timothy's Law,
posttraumatic stress disorder was ultimately not included in the final
draft because "the Legislature made a decision to limit the scope of
covered conditions specifically so as to not require coverage of every
condition listed in the Diagnostic and Statistical Manual for Mental
Disorders-IV" - a section of a handbook for mental health professionals
that lists different categories of mental disorders and the criteria for
diagnosing them.



Also, the association argues that a provision of Timothy's Law requires
the state Department of Insurance and the Office of Mental Health to
study the legislation's effectiveness.



"This study is to encompass two years of experience with the new law and
is not scheduled to be insued until April 1, 2009. Expanding the scope
of the law's coverage to include PTSD undermines the value of a
meaningful analysis," Macielak said.



Dr. Frank Dowling, a professor of psychiatry at the State University of
New York at Stony Brook, said posttraumatic stress disorder is a
treatable illness that develops after being witness to or victim of a
traumatic event. "The event stays with them ... reminders may trigger
thoughts of the event," said Dowling.



Dowling said that just like depression and panic disorders,
posttraumatic stress disorder is a common response to traumatic events.
"It should be covered just the same," Dowling argued. "It's all the same
spectrum and a response to the same types of events," he said.



Pat Purdie, who said she was diagnosed with posttraumatic stress
disorder a year ago after being sexually abused by family members, said
her abuse affected her significantly.



Purdie said she has tried to take her life on more than one occasion and
still experiences flashbacks, frustration and anger. She said treatment
for the illness has given her a "will to live," which Purdie said she
lost after her abuse and after experiencing the symptoms of
posttraumatic stress disorder.



"Who wouldn't want to add PTSD into the Timothy's Law today?" Purdie
asked. "Because without treatment, we couldn't make it out there ... I
wouldn't know where I would be today if I hadn't gotten treatment," she
said.



The Assembly's version of the bill was referred from the Mental Health
Committee to the Ways and Means Committee on March 11, and the Senate
bill advanced to a third reading on Feb. 26.




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