Requires health insurance policies to provide coverage for screening, tests, assessments and treatment including any medically necessary care for the treatment of autism spectrum disorder, including Asperger's disorder and pervasive developmental disorders.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1611
SPONSOR: Ortiz TITLE OF BILL: An act to amend the insurance law, in relation to
requiring health insurance policies to provide coverage for medically
necessary care for the treatment of autism spectrum disorder
SUMMARY OF PROVISIONS:
Amends paragraph 25 of subsection I of section section 3216 of the
insurance law, as added by chapter 557 of the laws of 2006, to state
that every policy that provides coverage for hospital, surgical, medical
care must provide the diagnosis and treatment (which includes all diag-
nostic screening, tests, and assessments and treatments, as well as
habilitation, rehabilitation, speech, behavioral, occupational and phys-
ical therapies, pediatric, neurological, gastro-enterologic and any
other medically necessary care) of autism spectrum disorder.
"Autism Spectrum disorder" is defined as a neurobiclogioal condition
that includes autism, Asperger syndrome, Rett's syndrome, or pervasive
developmental disorder.
Amends section 3221 of the insurance law, as added by chapter 557 of the
laws of 2006, to state that a blanket accident policy, health insurance
policy, or issuing group or blanket policy which provide hospital,
surgical, or medical care coverage must provide the diagnosis and treat-
ment of autism spectrum disorder.
Amends subsection fee) of section 6303 of the insurance law as added by
chapter 557 of the laws of 2006, to state that a medical expanse indem-
nity corporation, a hospital service corporation or a health service
corporation which provides coverage for hospital surgical, or medical
conditions must provide coverage for diagnosis and treatment of autism
spectrum disorder.
JUSTIFICATION: The Center for Disease Control and Prevention issued a
report in December of 2009 that concluded that the prevalence of autism
in our nation is 1 in 110. births; for males it is nearly 1 in 70. As
the prevalence of autism is increasing in our communities, it is impor-
tant that we encourage and support the treatment of this disorder.
Autism typically appears during the first three years of life and, if
left untreated can drastically affect a. person's ability to communicate
and interact with. others. Studies have shown that early diagnosis and
intervention lead to significantly improved outcomes. For this reason,
it is important that insurance companies provide coverage for autism
spectrum disorder treatments.
The lifetime costs for raising a child with autism ranges from 53.5
million to 55 million. When the burden of these costs is left on the
shoulders of parents alone, i.e. can leave families with few options.
LEGISLATIVE HISTORY: 2009/10 - A11432 - Referred to Insurance
FISCAL IMPLICATIONS: Minimal.
EFFECTIVE DATE: This act shall take effect on the first of January
next succeeding the date on which it shall have become a law.
STATE OF NEW YORK
________________________________________________________________________
1611
2011-2012 Regular Sessions
IN ASSEMBLY
January 11, 2011
___________
Introduced by M. of A. ORTIZ -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to requiring health
insurance policies to provide coverage for medically necessary care
for the 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. Paragraph 25 of subsection (i) of section 3216 of the
2 insurance law, as added by chapter 557 of the laws of 2006, is amended
3 to read as follows:
4 (25) (A) Every policy which provides coverage for hospital, surgical,
5 or medical care coverage shall not exclude coverage for diagnosis and
6 treatment of medical conditions otherwise covered by the policy solely
7 because the treatment is provided to diagnose or treat autism spectrum
8 disorder. For purposes of this section, "autism spectrum disorder" means
9 a neurobiological condition that includes autism, Asperger syndrome,
10 Rett's syndrome, or pervasive developmental disorder.
11 (B) Every policy which provides coverage for hospital, surgical, or
12 medical care coverage shall provide any and all diagnostic screening,
13 tests, and assessments and treatment including medical care, consulta-
14 tion, habilitation, rehabilitation, speech, behavioral, occupational and
15 physical therapies, pediatric, neurological, gastro-enterologic, and any
16 other medically necessary care that is provided by a licensed provider
17 required for the treatment of autism spectrum disorder, including
18 Asperger's disorder and pervasive developmental disorders as determined
19 by the treating physician.
20 § 2. Paragraph 17 of subsection (1) of section 3221 of the insurance
21 law, as added by chapter 557 of the laws of 2006, is amended to read as
22 follows:
23 (17) (A) A group or blanket accident or health insurance policy or
24 issuing a group or blanket policy for delivery in this state which
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03999-01-1
A. 1611 2
1 provides coverage for hospital, surgical, or medical care coverage shall
2 not exclude coverage for diagnosis and treatment of medical conditions
3 otherwise covered by the policy because the treatment is provided to
4 diagnose or treat autism spectrum disorder. For purposes of this
5 section, "autism spectrum disorder" means a neurobiological condition
6 that includes autism, Asperger syndrome, Rett's syndrome, or pervasive
7 developmental disorder.
8 (B) Every policy which provides coverage for hospital, surgical, or
9 medical care coverage shall provide any and all diagnostic screening,
10 tests, and assessments and treatment including medical care, consulta-
11 tion, habilitation, rehabilitation, speech, behavioral, occupational and
12 physical therapies, pediatric, neurological, gastro-enterologic, and any
13 other medically necessary care that is provided by a licensed provider
14 required for the treatment of autism spectrum disorder, including
15 Asperger's disorder and pervasive developmental disorders as determined
16 by the treating physician.
17 § 3. Subsection (ee) of section 4303 of the insurance law, as added by
18 chapter 557 of the laws of 2006, is amended to read as follows:
19 (ee) (1) A medical expense indemnity corporation, a hospital service
20 corporation or a health service corporation which provides coverage for
21 hospital, surgical, or medical care coverage shall not exclude coverage
22 for diagnosis and treatment of medical conditions otherwise covered by
23 the policy solely because the treatment is provided to diagnose or treat
24 autism spectrum disorder. For purposes of this section, "autism spectrum
25 disorder" means a neurobiological condition that includes autism, Asper-
26 ger syndrome, Rett's syndrome, or pervasive developmental disorder.
27 (2) Every policy which provides coverage for hospital, surgical, or
28 medical care coverage shall provide any and all diagnostic screening,
29 tests, and assessments and treatment including medical care, consulta-
30 tion, habilitation, rehabilitation, speech, behavioral, occupational and
31 physical therapies, pediatric, neurological, gastro-enterologic, and any
32 other medically necessary care that is provided by a licensed provider
33 required for the treatment of autism spectrum disorder, including
34 Asperger's disorder and pervasive developmental disorders as determined
35 by the treating physician.
36 § 4. This act shall take effect on the first of January next succeed-
37 ing the date on which it shall have become a law and shall apply to all
38 policies or contracts issued, renewed, modified, altered or amended on
39 and after such effective date.
