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: A6236
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
PURPOSE: The purpose of this bill is to allow for insurance coverage
for medically necessary care for the treatment of autism spectrum disor-
der.
SUMMARY OF PROVISIONS: Amends paragraph 25 of subsection I of 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, surgi-
cal, medical care must provide the diagnosis and treatment (which
includes all diagnostic screening, tests, and assessments and treat-
ments, as well as habilitation, rehabilitation, speech, behavioral,
occupational and physical therapies, pediatric, neurological, gastro-
enterologic and any other medically necessary care) of autism spectrum
disorder.
"Autism spectrum disorder" is defined as a neurobiological 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 important
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, it can leave families with few options.
LEGISLATIVE HISTORY: 2009/10: A11432 Referred to Insurance 2011/12:
A1611 Referred to Insurance 2013/14: A5917 Referred to Insurance
FISCAL IMPLICATIONS: Minimal
EFFECTIVE DATE: January l after enactment
STATE OF NEW YORK
________________________________________________________________________
6236
2015-2016 Regular Sessions
IN ASSEMBLY
March 18, 2015
___________
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 is amended by adding a new subparagraph (H) to read as
3 follows:
4 (H) Every policy which provides coverage for hospital, surgical, or
5 medical care coverage shall provide any and all diagnostic screening,
6 tests, and assessments and treatment including medical care, consulta-
7 tion, habilitation, rehabilitation, speech, behavioral, occupational and
8 physical therapies, pediatric, neurological, gastro-enterologic, and any
9 other medically necessary care that is provided by a licensed provider
10 required for the treatment of autism spectrum disorder, including
11 Asperger's disorder and pervasive developmental disorders as determined
12 by the treating physician.
13 § 2. Paragraph 17 of subsection (1) of section 3221 of the insurance
14 law is amended by adding a new subparagraph (H) to read as follows:
15 (H) Every policy which provides coverage for hospital, surgical, or
16 medical care coverage shall provide any and all diagnostic screening,
17 tests, and assessments and treatment including medical care, consulta-
18 tion, habilitation, rehabilitation, speech, behavioral, occupational and
19 physical therapies, pediatric, neurological, gastro-enterologic, and any
20 other medically necessary care that is provided by a licensed provider
21 required for the treatment of autism spectrum disorder, including
22 Asperger's disorder and pervasive developmental disorders as determined
23 by the treating physician.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04388-01-5
A. 6236 2
1 § 3. Subsection (ee) of section 4303 of the insurance law is amended
2 by adding a new paragraph 8 to read as follows:
3 (8) Every policy which provides coverage for hospital, surgical, or
4 medical care coverage shall provide any and all diagnostic screening,
5 tests, and assessments and treatment including medical care, consulta-
6 tion, habilitation, rehabilitation, speech, behavioral, occupational and
7 physical therapies, pediatric, neurological, gastro-enterologic, and any
8 other medically necessary care that is provided by a licensed provider
9 required for the treatment of autism spectrum disorder, including
10 Asperger's disorder and pervasive developmental disorders as determined
11 by the treating physician.
12 § 4. This act shall take effect on the first of January next succeed-
13 ing the date on which it shall have become a law and shall apply to all
14 policies or contracts issued, renewed, modified, altered or amended on
15 and after such effective date.
