Relates to coverage for the screening, diagnosis and treatment of autism spectrum disorder: does away with 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: A8912
SPONSOR: Abinanti 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 subpara-
graph (B) of paragraph 25 of subsection (1) of section 3216 of the
insurance law, 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 Subparagraph (B) of paragraph 17 of
subsection (1) of section 3221 of the insurance law, as amended by chap-
ter 596 of the laws of 2011, to delete the aforementioned provision.
Section 3 of the bill amends paragraph 2 of subsection (ee) of section
4303 of the insurance law, as amended by chapter 596 of the laws of
2011, to delete the aforementioned provision.
Section 4 of the bill provides for an effective date on the same date
and in the same manner as chapter 595 of the laws of 2011, as amended,
takes effect.
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.
PRIOR LEGISLATIVE HISTORY: None
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: The same date and in the same manner as chapter 595 of
the laws of 2011, as amended, takes effect.
STATE OF NEW YORK
________________________________________________________________________
8912
IN ASSEMBLY(Prefiled)
January 4, 2012
___________
Introduced by M. of A. ABINANTI -- read once and referred to the Commit-
tee 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
23 coverage to an individual solely because the individual is diagnosed
24 with autism spectrum disorder or has received treatment for autism spec-
25 trum disorder. Coverage shall be subject to utilization review and
26 external appeals of health care services pursuant to article forty-nine
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13727-01-2
A. 8912 2
1 of this chapter as well as, case management, and other managed care
2 provisions.
3 § 2. Subparagraph (B) of paragraph 17 of subsection (l) of section
4 3221 of the insurance law, as amended by chapter 596 of the laws of
5 2011, is amended to read as follows:
6 (B) Every group or blanket policy which provides physician services,
7 medical, major medical or similar comprehensive-type coverage shall
8 provide coverage for the screening, diagnosis and treatment of autism
9 spectrum disorder in accordance with this paragraph and shall not
10 exclude coverage for the screening, diagnosis or treatment of medical
11 conditions otherwise covered by the policy because the individual is
12 diagnosed with autism spectrum disorder. Such coverage may be subject to
13 annual deductibles, copayments and coinsurance as may be deemed appro-
14 priate by the superintendent and shall be consistent with those imposed
15 on other benefits under the group or blanket policy. [Coverage for
16 applied behavior analysis shall be subject to a maximum benefit of
17 forty-five thousand dollars per year per covered individual and such
18 maximum annual benefit will increase by the amount calculated from the
19 average ten year rolling average increase of the medical component of
20 the consumer price index.] This paragraph shall not be construed as
21 limiting the benefits that are otherwise available to an individual
22 under the group or blanket policy, provided however that such policy
23 shall not contain any limitations on visits that are solely applied to
24 the treatment of autism spectrum disorder. No insurer shall terminate
25 coverage or refuse to deliver, execute, issue, amend, adjust, or renew
26 coverage to an individual solely because the individual is diagnosed
27 with autism spectrum disorder or has received treatment for autism spec-
28 trum disorder. Coverage shall be subject to utilization review and
29 external appeals of health care services pursuant to article forty-nine
30 of this chapter as well as, case management, and other managed care
31 provisions.
32 § 3. Paragraph 2 of subsection (ee) of section 4303 of the insurance
33 law, as amended by chapter 596 of the laws of 2011, is amended to read
34 as follows:
35 (2) Every contract which provides physician services, medical, major
36 medical or similar comprehensive-type coverage shall provide coverage
37 for the screening, diagnosis and treatment of autism spectrum disorder
38 in accordance with this subsection and shall not exclude coverage for
39 the screening, diagnosis or treatment of medical conditions otherwise
40 covered by the contract because the individual is diagnosed with autism
41 spectrum disorder. Such coverage may be subject to annual deductibles,
42 copayments and coinsurance as may be deemed appropriate by the super-
43 intendent and shall be consistent with those imposed on other benefits
44 under the contract. [Coverage for applied behavior analysis shall be
45 subject to a maximum benefit of forty-five thousand dollars per year per
46 covered individual and such maximum annual benefit will increase by the
47 amount calculated from the average ten year rolling average increase of
48 the medical component of the consumer price index.] This paragraph shall
49 not be construed as limiting the benefits that are otherwise available
50 to an individual under the contract, provided however that such contract
51 shall not contain any limitations on visits that are solely applied to
52 the treatment of autism spectrum disorder. No insurer shall terminate
53 coverage or refuse to deliver, execute, issue, amend, adjust, or renew
54 coverage to an individual solely because the individual is diagnosed
55 with autism spectrum disorder or has received treatment for autism spec-
56 trum disorder. Coverage shall be subject to utilization review and
A. 8912 3
1 external appeals of health care services pursuant to article forty-nine
2 of this chapter as well as, case management, and other managed care
3 provisions.
4 § 4. This act shall take effect on the same date and in the same
5 manner as chapter 595 of the laws of 2011, as amended, takes effect.
