Timothy's Law

[gardilimo]

Hey, what do you guys think of Timothy's Law. It seems as if private insurance companies in NY/NJ/CT have adopted it since Gov Pataki signed the bill this past September. Do you know of any other states adopting more stringent mental health requirements than NY?


TIMOTHY'S LAW:

COVERAGE FOR TREATMENT OF MENTAL ILLNESSES

The agreement would require insurance companies to cover 30 inpatient days of treatment and 20 outpatient days of treatment for all mental illnesses.

The agreement would also require insurance companies to fully cover biologically based mental illnesses, including the following: Schizophrenia/psychotic disorders, Major Depression, Bipolar Disorder, Delusional Disorders, Panic Disorder, Obsessive Compulsive Disorder, Bulimia, Anorexia and Binge Eating.

COVERAGE FOR CHILDREN WITH MENTAL ILLNESS

In addition, the agreed upon 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.

To address cost concerns raised by small businesses, the agreement directs the state Superintendent of Insurance to develop a methodology that would hold businesses with 50 or fewer employees harmless from any increase in insurance premiums that result from this measure.

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. When enacted, the bill would take effect January 1, 2007 and sunset on December 31, 2009, to provide for an opportunity to amend the law based on the findings and recommendations of the study.



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[Adam_K]

While I am a big believer in providing care to the severe and persistently mentally ill, I do not believe that this is the solution to our medical insurance mess.

By including MDD (and bipolar II, presumably?) on the list, just about every adult patient with insurance, whether they need it or not will be eligible for inpatient care.

I predict that the measure will increase the cost of private insurance in the state, putting insurance even more out of reach of those who need it. There is no way it can be fiscally neutral for the small businesses.

 

[toby jones]

> The agreement would also require insurance companies to fully cover biologically based mental illnesses, including the following: Schizophrenia/psychotic disorders, Major Depression, Bipolar Disorder, Delusional Disorders, Panic Disorder, Obsessive Compulsive Disorder, Bulimia, Anorexia and Binge Eating.

There are mental illnesses that aren't biologically based?

What do they think they are made of?

Immortal mind-stuff?

ROFL

I'd be interested to know what grounds they have for the biologically based / not biologically based distinction.
Neurological differences have been found in borderline personality disorder, for example. Do they consider that one to be biologically based or not?
How about addiction? Even if you grant that the neurological changes are caused by the drug surely a similar thing could be said for the neurological changes in anorexia being caused by starvation?

 

[OldPsychDoc]

What is probably more important is the federal Mental Health Parity bill which is finally getting a long-overdue hearing in congress.
It has BROAD bipartisan support. Let your representatives know that you support it too!

(Link is to Senate bill--House bill is co-sponsored by Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) and isn't yet introduced.)

 

[gardilimo]

> The agreement would also require insurance companies to fully cover biologically based mental illnesses, including the following: Schizophrenia/psychotic disorders, Major Depression, Bipolar Disorder, Delusional Disorders, Panic Disorder, Obsessive Compulsive Disorder, Bulimia, Anorexia and Binge Eating.

There are mental illnesses that aren't biologically based?

What do they think they are made of?

Immortal mind-stuff?

ROFL

I'd be interested to know what grounds they have for the biologically based / not biologically based distinction.
Neurological differences have been found in borderline personality disorder, for example. Do they consider that one to be biologically based or not?
How about addiction? Even if you grant that the neurological changes are caused by the drug surely a similar thing could be said for the neurological changes in anorexia being caused by starvation?

I was quite interested by this as well. how and where did they get the info that these particular disorders were biological, etc? the dsm 4 is still the standard we use today, to diagnose and define a disease, and i have not seen any biological tid bits in their definitions...

 

[whopper]

Well, the data supports that all of the above illnesses have biological basis. E.g. Depressed people have less serotonin metabolites in CSF, D2 blockage does improve psychotic sx, several (though not all) antiepileptics do improve bipolar do sx.

Yes, DSM IV does not use biological markers to dx disorders. One of the reasons why is while there is strong evidence that the above dos have biological basis, there is no clinically useful method to dx a patient with such.

So while these dos do have biological basis, DSM (a means to dx) does not use the biological methods to dx. Perhaps in the future, with improvements in technology, this can happen.

One problem in the wording we have used in such disorders is other mental illnesses have biological/organic problems but are considered in the avenue of internal medicine, not psychiatry. E.g. delirium or psychosis or depression due to a medical condition.
These too are biologically based, but are not well differentiated in the wording in such laws.

The interpretation of these laws by several-the docs, the judges, the clinical directors, etc all point that psychiatric/mental do sx that are induced by a medical condition such as hepatic encephalopathy is not grounds to commit. However the wording of the laws do not clearly distinguish between these disorders. In NJ one of the only references is "an organic cause". (trust me the other references also are a bit murky and ambiguous).
We interpret organic cause to mean hepatic encephalopathy, but we don't mean it to include for example schizophrenia, even though we all know that SCZ has strong biological basis.

Yet despite the ambiguity, everyone involved in the interpretation of the law don't seem to disagree.


Then add to the confusion, several Axis II dos, now thanks to newer data are being found to have have some biological basis that can be identified.

If you ask me, this thing needs to be cleared up in the wording of the laws.

 

[toby jones]

48% concordance for identical twins with schizophrenia.

Take one twin with schizophrenia.
Figure out all their genes...
The other twin has the same genes...

You would predict the other twin has schizophrenia?

Genes won't help us diagnose schizophrenia.

Maybe you think neurology will help?????????

 

[Demosthenes]

> The agreement would also require insurance companies to fully cover biologically based mental illnesses, including the following: Schizophrenia/psychotic disorders, Major Depression, Bipolar Disorder, Delusional Disorders, Panic Disorder, Obsessive Compulsive Disorder, Bulimia, Anorexia and Binge Eating.

There are mental illnesses that aren't biologically based?

How about addiction? Even if you grant that the neurological changes are caused by the drug surely a similar thing could be said for the neurological changes in anorexia being caused by starvation?

Actually, a lot of insurance plans around here treat EDs under their addiction coverage, rather than mental health coverage. Thank goodness, since that coverage tends to be broader and more inclusive.

Still, coverage for AN is generally pretty inadequate, and now I'll step down from my soapbox.