Legislation mandating insurance parity for mental health conditions has
advanced in several states this year, including a measure in New York that
advocates have been urging for 20 years.
A bill in New York known as "Timothy's Law" (A 02912), for
example, would require insurance companies to cover most mental illnesses,
including a broad range of mental illnesses and conditions specifically
related to children.
Lawmakers in both chambers of the state legislature reached agreement on
the measure shortly before adjourning in June, and they are expected to
formally approve it when they reconvene later this year.
"This is a good plan for New York that offers a reasonable amount of
coverage for individuals and families of those with mental illness,"
said Ann Marie Sullivan, M.D., who represents Area 2 on the APA Board of
One of the most important aspects of the measure, Sullivan told
Psychiatric News, is its mandate that copayments for psychotropic
drugs not exceed the costs of medications for other conditions. The need for
regular medication for many serious mental illnesses has traditionally placed
a large financial burden on people with such disorders.
Advocates of the measure, which included the National Alliance on Mental
Illness, have pushed for a parity measure in the state for 20 years, said
Sullivan. The measure was repeatedly passed in the Assembly but stalled in the
Senate on concerns it would hurt small businesses. Gov. George Pataki (R) has
not indicated whether he would sign such legislation.
To address the cost concerns raised by small businesses, the measure would
exempt businesses with fewer than 50 employees from any increase in insurance
premiums that result from it.
The legislation would require insurance companies to cover 30 inpatient and
20 outpatient days of treatment for "biologically based" mental
illnesses, defined as schizophrenia/psychotic disorders, major depression,
bipolar disorder, delusional disorders, panic disorder, obsessive-compulsive
disorder, bulimia, anorexia, and binge eating.
In addition, the bill would require insurance coverage for children under
age 18 with conditions such as attention-deficit/hyperactivity disorder,
disruptive behavior disorders, and pervasive development disorders when there
are serious suicidal symptoms or other life-threatening, self-destructive
The bill cited studies that found parity measures in other states increased
cost per insurance policy between 0 percent and 3.5 percent a year, depending
on the benefit level and whether the benefits are managed. It contrasted that
with the estimated $79 billion annual cost in lost productivity and increased
absenteeism found to stem from the lack of mental health care.
A measure to provide Idaho state employees with parity in mental health
treatment went into effect in July. The law (HB 615) covers "serious
mental illness" in seven major illness categories: schizophrenia,
paranoia and other psychotic disorders, bipolar disorder, major depressive
disorder, schizoaffective disorder, panic disorder, and obsessive-compulsive
The law created a pilot program to determine the real costs and benefits of
including mental health coverage in group health insurance coverage. A report
on its costs and benefits is due to the legislature by 2011, including whether
it reduces repetitive visits for physical ailments that may be associated with
untreated mental illness.
State officials estimated the fiscal impact on health insurance plans at
about 1.8 percent of total plan costs, or about $1.89 million.
Illinois amended its existing parity statute to increase from 35 to 60 the
number of "medically necessary" outpatient mental health visits
covered in a calendar year. The measure (HB 4202), signed into law in June and
sponsored by rep. Lou Lang (D), aims to reduce the "special
limits" insurers place on coverage for mental illness.
Advocates of the measure said it was needed to bolster Illinois' 2001
parity law, which was much weaker than the parity laws enacted in most other
states. They described the change as cost-effective because treatment in the
community is far less expensive than the hospitalization that could result
when symptoms of serious mental illnesses are left untreated.
Another measure signed into law in June (HB 4125) added health maintenance
organizations to the requirements of the state's parity law.