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.
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.