S02707 Summary:

BILL NOS02707A
 
SAME ASNo same as
 
SPONSORPARKER
 
COSPNSR
 
MLTSPNSR
 
Add S342, amd SS3216, 3221 & 4303, Ins L
 
Requires health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder; establishes an advisory panel on health insurance coverage for autism spectrum disorder to annually compile a list of treatments and therapy options for which health insurers will be required to provide coverage; establishes a toll-free, 24 hour a day, autism and health insurance coverage hotline to receive and act upon complaints and questions from families with autistic children, relating to insurance coverage for autism spectrum disorder.
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S02707 Actions:

BILL NOS02707A
 
01/23/2013REFERRED TO INSURANCE
01/08/2014REFERRED TO INSURANCE
02/24/2014AMEND AND RECOMMIT TO INSURANCE
02/24/2014PRINT NUMBER 2707A
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S02707 Memo:

Memo not available
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S02707 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2707--A
 
                               2013-2014 Regular Sessions
 
                    IN SENATE
 
                                    January 23, 2013
                                       ___________
 
        Introduced  by  Sen.  PARKER -- read twice and ordered printed, and when
          printed to be committed to the Committee on Insurance  --  recommitted
          to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
          --  committee  discharged,  bill amended, ordered reprinted as amended
          and recommitted to said committee
 

        AN ACT to amend the insurance law, in relation to establishing an  advi-
          sory panel on health insurance coverage for autism spectrum disorder
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1.  The insurance law is amended by adding a new  section  342
     2  to read as follows:
     3    §  342. Coverage for autism spectrum disorder. (a) (1) There is hereby
     4  established within the department an advisory panel on health  insurance
     5  coverage  for  autism spectrum disorder. Such panel shall be composed of
     6  nine members who are experts in health care and  appointed  as  follows:
     7  seven members who are officers or employees of the department of health,
     8  office  of  mental  health  or  the office for people with developmental

     9  disabilities shall be appointed by the governor; and the temporary pres-
    10  ident of the senate and the speaker of the assembly shall each appoint a
    11  member who is a representative of an autism advocacy group. Each  member
    12  shall  serve a term of two years. The governor shall designate the chair
    13  of the panel from among his or her appointees. Vacancies in the  member-
    14  ship  of  the  panel shall be filled in the manner provided for original
    15  appointments.
    16    (2) The members of the panel shall receive no compensation  for  their
    17  services  but  shall  be  allowed  their  actual  and necessary expenses
    18  incurred in the performance of their duties pursuant to this subsection.
    19    (3) The advisory panel on health insurance coverage for  autism  spec-

    20  trum  disorder shall annually, on or before September first, compile and
    21  submit to the superintendent a list of successful treatment and  therapy
    22  options for autism spectrum disorder that will be required to be covered
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD06971-02-4

        S. 2707--A                          2
 
     1  pursuant  to  paragraph  twenty-five  of subsection (i) of section three
     2  thousand two hundred sixteen, paragraph seventeen of subsection  (1)  of
     3  section  three  thousand  two  hundred twenty-one and subsection (ee) of
     4  section four thousand three hundred three of this chapter.

     5    (4)  Within forty-five days of receipt of each list submitted pursuant
     6  to paragraph three of this subsection, the superintendent shall,  on  an
     7  emergency  basis, promulgate and implement rules and regulations requir-
     8  ing coverage for the treatment and therapy options included in each such
     9  list.
    10    (b) (1) Within one hundred  eighty  days  of  the  submission  of  the
    11  initial  list  to  the  superintendent  pursuant  to  paragraph three of
    12  subsection (a) of this section, the department shall establish and oper-
    13  ate an autism and health insurance coverage hotline. The  hotline  shall
    14  be a toll-free, twenty-four hour a day consumer call center for families
    15  with  autistic children who have complaints about or questions on insur-

    16  ers and coverage for autism spectrum disorder. All  complaints  received
    17  by  such  hotline  shall  be  documented and referred to the appropriate
    18  official in the department for corrective action.
    19    (2) The department may contract with a qualified not-for-profit corpo-
    20  ration for the provision and operation of the hotline required  by  this
    21  subsection. Any such contract shall only be awarded after the department
    22  has  conducted  a  request  for  proposals process. The department shall
    23  select a not-for-profit corporation which has the resources and  ability
    24  to  operate  a  statewide  hotline,  and  is staffed by employees and/or
    25  volunteers with strong experience in autism spectrum disorder.

    26    (3) If the department elects to  establish  and  operate  the  hotline
    27  using  its own personnel and resources, such hotline shall be staffed by
    28  officers and employees with strong experience in autism spectrum  disor-
    29  der.  Until  the  state  civil service commission shall have established
    30  civil service titles  and  competitive  examinations  for  positions  as
    31  employees  of the hotline, the superintendent is authorized and directed
    32  to appoint and employ such qualified officers and employees as shall  be
    33  necessary to operate the autism and health insurance coverage hotline.
    34    (4)  The  superintendent is authorized to promulgate and implement any
    35  rules and regulations necessary to carry  out  the  provisions  of  this
    36  subsection.

    37    §  2.  Subparagraphs  (A) and (B) of paragraph 25 of subsection (i) of
    38  section 3216 of the insurance law, subparagraph (A) as amended by  chap-
    39  ter  595 of the laws of 2011, and subparagraph (B) as amended by section
    40  38 of part D of chapter 56 of the laws of 2013, are amended to  read  as
    41  follows:
    42    (A)  Every  policy  which  provides  coverage for hospital or surgical
    43  coverage shall [not exclude] include full coverage for  the  prevention,
    44  early  detection,  screening, diagnosis and treatment of [medical condi-
    45  tions otherwise covered by the policy solely because  the  treatment  is
    46  provided to diagnose or treat] autism spectrum disorder.
    47    (B)  Every  policy  that  provides  physician services, medical, major

    48  medical or similar comprehensive-type coverage shall provide full cover-
    49  age for the screening, diagnosis and treatment of autism spectrum disor-
    50  der in accordance with this paragraph and shall not exclude coverage for
    51  the prevention, early detection, screening, diagnosis  or  treatment  of
    52  medical  conditions otherwise covered by the policy because the individ-
    53  ual is diagnosed with autism spectrum disorder.  Such  coverage  may  be
    54  subject  to  annual  deductibles,  copayments  and coinsurance as may be
    55  deemed appropriate by the superintendent and shall  be  consistent  with
    56  those  imposed  on other benefits under the policy. Coverage for applied

        S. 2707--A                          3
 
     1  behavior analysis shall be subject to a maximum benefit of  six  hundred

     2  eighty  hours of treatment per policy or calendar year per covered indi-
     3  vidual. This paragraph shall not be construed as limiting  the  benefits
     4  that are otherwise available to an individual under the policy, provided
     5  however  that  such  policy  shall not contain any limitations on visits
     6  that are solely applied to the treatment of autism spectrum disorder. No
     7  insurer shall terminate coverage or refuse to deliver,  execute,  issue,
     8  amend,  adjust,  or  renew  coverage to an individual solely because the
     9  individual is diagnosed with autism spectrum disorder  or  has  received
    10  treatment  for  autism  spectrum  disorder. Coverage shall be subject to
    11  utilization review and external appeals of health care services pursuant
    12  to article forty-nine of this chapter as well as, case  management,  and
    13  other managed care provisions.

    14    §  3.  Subparagraphs  (A) and (B) of paragraph 17 of subsection (l) of
    15  section 3221 of the insurance law, subparagraph (A) as amended by  chap-
    16  ter  595  of the laws of 2011, subparagraph (B) as amended by section 39
    17  of part D of chapter 56 of the laws of 2013,  are  amended  to  read  as
    18  follows:
    19    (A) Every group or blanket accident and health insurance policy deliv-
    20  ered  or  issued  for delivery in this state which provides coverage for
    21  hospital or surgical care coverage  shall  [not  exclude]  include  full
    22  coverage  for  the prevention, early detection, screening, diagnosis and
    23  treatment of medical conditions otherwise covered by the policy  because
    24  the treatment is provided to diagnose or treat autism spectrum disorder.
    25    (B)  Every  group  or blanket policy that provides physician services,

    26  medical, major medical  or  similar  comprehensive-type  coverage  shall
    27  provide  full  coverage  for the prevention, early detection, screening,
    28  diagnosis and treatment of autism spectrum disorder in  accordance  with
    29  this paragraph and shall not exclude coverage for the screening, diagno-
    30  sis  or  treatment of medical conditions otherwise covered by the policy
    31  because the individual is diagnosed with autism spectrum disorder.  Such
    32  coverage  may  be  subject to annual deductibles, copayments and coinsu-
    33  rance as may be deemed appropriate by the superintendent  and  shall  be
    34  consistent with those imposed on other benefits under the group or blan-
    35  ket policy. Coverage for applied behavior analysis shall be subject to a
    36  maximum  benefit  of six hundred eighty hours of treatment per policy or
    37  calendar year per  covered  individual.  This  paragraph  shall  not  be

    38  construed  as  limiting  the benefits that are otherwise available to an
    39  individual under the group or blanket policy, provided however that such
    40  policy shall not contain any  limitations  on  visits  that  are  solely
    41  applied  to  the treatment of autism spectrum disorder. No insurer shall
    42  terminate coverage or refuse to deliver, execute, issue, amend,  adjust,
    43  or  renew  coverage  to  an  individual solely because the individual is
    44  diagnosed with autism spectrum disorder or has  received  treatment  for
    45  autism  spectrum  disorder.  Coverage  shall  be  subject to utilization
    46  review and external appeals of health care services pursuant to  article
    47  forty-nine  of  this  chapter  as  well  as,  case management, and other
    48  managed care provisions.
    49    § 4. Subsection (ee) of section 4303 of the insurance law, as  amended

    50  by chapter 596 of the laws of 2011 and paragraph 2 as amended by section
    51  40  of  part  D of chapter 56 of the laws of 2013, is amended to read as
    52  follows:
    53    (ee) (1) A medical expense indemnity corporation, a  hospital  service
    54  corporation  or a health service corporation which provides coverage for
    55  hospital or surgical care coverage  shall  [not  exclude]  include  full
    56  coverage  for  the prevention, early detection, screening, diagnosis and

        S. 2707--A                          4
 
     1  treatment of medical conditions otherwise covered by the contract solely
     2  because the treatment is provided to diagnose or treat  autism  spectrum
     3  disorder.
     4    (2)  Every  contract  that 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  full  coverage
     8  for  the  prevention, early detection, screening, diagnosis or treatment
     9  of medical conditions otherwise covered  by  the  contract  because  the
    10  individual is diagnosed with autism spectrum disorder. Such coverage may
    11  be  subject  to annual deductibles, copayments and coinsurance as may be
    12  deemed appropriate by the superintendent and shall  be  consistent  with
    13  those imposed on other benefits under the contract. Coverage for applied
    14  behavior  analysis  shall be subject to a maximum benefit of six hundred
    15  eighty hours of treatment per contract  or  calendar  year  per  covered
    16  individual.  This paragraph shall not be construed as limiting the bene-
    17  fits that are otherwise available to an individual under  the  contract,

    18  provided however that such contract shall not contain any limitations on
    19  visits  that  are  solely  applied  to  the treatment of autism spectrum
    20  disorder. No insurer shall terminate  coverage  or  refuse  to  deliver,
    21  execute, issue, amend, adjust, or renew coverage to an individual solely
    22  because the individual is diagnosed with autism spectrum disorder or has
    23  received  treatment  for  autism  spectrum  disorder.  Coverage shall be
    24  subject to utilization  review  and  external  appeals  of  health  care
    25  services pursuant to article forty-nine of this chapter as well as, case
    26  management, and other managed care provisions.
    27    §  5.  This  act shall take effect on the thirtieth day after it shall
    28  have become a law.
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