Timothy’s Law and Mental Health Parity in the Empire Plan

Legislation known as “Timothy’s Law” changed coverage requirements for mental health benefits in group health plans, including the Empire Plan and NYSHIP HMOs, effective 1/1/07. Timothy’s Law requires that health plans provide for no less than 30 days of inpatient care and 20 days of outpatient care for the diagnosis and treatment of mental, nervous or emotional disorders. Timothy’s Law does not affect substance abuse benefits.

For the most part, network-level benefits provided under the Empire Plan Managed Mental Health and Substance Abuse Program already meet or exceed those required by Timothy’s Law. The law also requires that these benefits be covered to the same extent when services are received from non-network providers. Appropriate changes to the Empire Plan have been made to meet this requirement.

Because the law’s effective date is 1/1/07, these changes are being implemented retroactively. All claims adjustments and explanations were scheduled to be sent to enrollees by 6/1/07. If you have a question about your Empire Plan benefits and Timothy’s Law, call the Empire Plan Information Center at 1-877-7-NYSHIP (1-877-769-7447), then select Option 3.