Relates to coverage for the screening, diagnosis and treatment of autism spectrum disorder; removes provisions of the monetary limit for coverage of applied behavior analysis.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A537
SPONSOR: Abinanti (MS) TITLE OF BILL: An act to amend the insurance law, in relation to
coverage for the screening, diagnosis and treatment of autism spectrum
disorder
PURPOSE OR GENERAL IDEA OF BILL: To delete the provisions that limit
the coverage for applied behavior analysis to a maximum of forty-five
thousand dollars per year.
SUMMARY OF SPECIFIC PROVISIONS: Section 1 of the bill amends insurance
law section 3216 (1) (25) (3), as amended by chapter 596 of the laws of
2011, to delete the limitation on coverage for applied behavior analysis
to a maximum benefit of forty-five thousand dollars per year.
Section 2 of the bill amends insurance law section 3221 (1) (12) (B).,
as amended by chapter 596 of the laws of 2011, to delete the aforemen-
tioned provision.
Section 3 of the bill amends insurance law section 4303 (cc) (2), as
amended by chapter 596 of the laws of 2011, to delete the aforementioned
provision.
Section 4 of the bill is the effective date.
JUSTIFICATION: Autism is the fastest growing disabling disorder
affecting American children. Research demonstrates that early diagnosis
and treatment of autism spectrum disorders is essential and should be
provided as soon as possible without interruption. Delay or interruption
of treatment may cause irreversible affects. This legislation will
relieve families from the burden of the high cost of applied behavior
analysis treatment as prescribed by a licensed physician or psychologist
for the treatment of autism spectrum disorder.
PRIOR LEGISLATIVE HISTORY: A.8912, 2012 referred to Insurance,
FISCAL IMPLICATIONS: The cost implications have not been fully deter-
mined. The treatment of autism spectrum disorders will result in better
long-term health outcomes for those diagnosed with this condition and
should therefore lessen costs which are borne by taxpayers.
EFFECTIVE DATE:; Immediately.
STATE OF NEW YORK
________________________________________________________________________
537
2013-2014 Regular Sessions
IN ASSEMBLY(Prefiled)
January 9, 2013
___________
Introduced by M. of A. ABINANTI, STEVENSON, TITONE, COOK, ENGLEBRIGHT,
ROBINSON, BENEDETTO -- Multi-Sponsored by -- M. of A. FINCH, GIBSON,
GRAF, RAIA, THIELE -- read once and referred to the Committee on
Insurance
AN ACT to amend the insurance law, in relation to coverage for the
screening, diagnosis and treatment of autism spectrum disorder
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraph (B) of paragraph 25 of subsection (i) of
2 section 3216 of the insurance law, as amended by chapter 596 of the laws
3 of 2011, is amended to read as follows:
4 (B) Every policy which provides physician services, medical, major
5 medical or similar comprehensive-type coverage shall provide coverage
6 for the screening, diagnosis and treatment of autism spectrum disorder
7 in accordance with this paragraph and shall not exclude coverage for the
8 screening, diagnosis or treatment of medical conditions otherwise
9 covered by the policy because the individual is diagnosed with autism
10 spectrum disorder. Such coverage may be subject to annual deductibles,
11 copayments and coinsurance as may be deemed appropriate by the super-
12 intendent and shall be consistent with those imposed on other benefits
13 under the policy. [Coverage for applied behavior analysis shall be
14 subject to a maximum benefit of forty-five thousand dollars per year per
15 covered individual and such maximum annual benefit will increase by the
16 amount calculated from the average ten year rolling average increase of
17 the medical component of the consumer price index.] This paragraph shall
18 not be construed as limiting the benefits that are otherwise available
19 to an individual under the policy, provided however that such policy
20 shall not contain any limitations on visits that are solely applied to
21 the treatment of autism spectrum disorder. No insurer shall terminate
22 coverage or refuse to deliver, execute, issue, amend, adjust, or renew
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03639-01-3
A. 537 2
1 coverage to an individual solely because the individual is diagnosed
2 with autism spectrum disorder or has received treatment for autism spec-
3 trum disorder. Coverage shall be subject to utilization review and
4 external appeals of health care services pursuant to article forty-nine
5 of this chapter as well as, case management, and other managed care
6 provisions.
7 § 2. Subparagraph (B) of paragraph 17 of subsection (l) of section
8 3221 of the insurance law, as amended by chapter 596 of the laws of
9 2011, is amended to read as follows:
10 (B) Every group or blanket policy which provides physician services,
11 medical, major medical or similar comprehensive-type coverage shall
12 provide coverage for the screening, diagnosis and treatment of autism
13 spectrum disorder in accordance with this paragraph and shall not
14 exclude coverage for the screening, diagnosis or treatment of medical
15 conditions otherwise covered by the policy because the individual is
16 diagnosed with autism spectrum disorder. Such coverage may be subject to
17 annual deductibles, copayments and coinsurance as may be deemed appro-
18 priate by the superintendent and shall be consistent with those imposed
19 on other benefits under the group or blanket policy. [Coverage for
20 applied behavior analysis shall be subject to a maximum benefit of
21 forty-five thousand dollars per year per covered individual and such
22 maximum annual benefit will increase by the amount calculated from the
23 average ten year rolling average increase of the medical component of
24 the consumer price index.] This paragraph shall not be construed as
25 limiting the benefits that are otherwise available to an individual
26 under the group or blanket policy, provided however that such policy
27 shall not contain any limitations on visits that are solely applied to
28 the treatment of autism spectrum disorder. No insurer shall terminate
29 coverage or refuse to deliver, execute, issue, amend, adjust, or renew
30 coverage to an individual solely because the individual is diagnosed
31 with autism spectrum disorder or has received treatment for autism spec-
32 trum disorder. Coverage shall be subject to utilization review and
33 external appeals of health care services pursuant to article forty-nine
34 of this chapter as well as, case management, and other managed care
35 provisions.
36 § 3. Paragraph 2 of subsection (ee) of section 4303 of the insurance
37 law, as amended by chapter 596 of the laws of 2011, is amended to read
38 as follows:
39 (2) Every contract which provides physician services, medical, major
40 medical or similar comprehensive-type coverage shall provide coverage
41 for the screening, diagnosis and treatment of autism spectrum disorder
42 in accordance with this subsection and shall not exclude coverage for
43 the screening, diagnosis or treatment of medical conditions otherwise
44 covered by the contract because the individual is diagnosed with autism
45 spectrum disorder. Such coverage may be subject to annual deductibles,
46 copayments and coinsurance as may be deemed appropriate by the super-
47 intendent and shall be consistent with those imposed on other benefits
48 under the contract. [Coverage for applied behavior analysis shall be
49 subject to a maximum benefit of forty-five thousand dollars per year per
50 covered individual and such maximum annual benefit will increase by the
51 amount calculated from the average ten year rolling average increase of
52 the medical component of the consumer price index.] This paragraph shall
53 not be construed as limiting the benefits that are otherwise available
54 to an individual under the contract, provided however that such contract
55 shall not contain any limitations on visits that are solely applied to
56 the treatment of autism spectrum disorder. No insurer shall terminate
A. 537 3
1 coverage or refuse to deliver, execute, issue, amend, adjust, or renew
2 coverage to an individual solely because the individual is diagnosed
3 with autism spectrum disorder or has received treatment for autism spec-
4 trum disorder. Coverage shall be subject to utilization review and
5 external appeals of health care services pursuant to article forty-nine
6 of this chapter as well as, case management, and other managed care
7 provisions.
8 § 4. This act shall take effect immediately.
