Relates to coverage for the screening, diagnosis and treatment of autism spectrum disorder; removes provisions of the monetary limit for coverage of applied behavior analysis.
STATE OF NEW YORK
________________________________________________________________________
3664
2015-2016 Regular Sessions
IN SENATE
February 13, 2015
___________
Introduced by Sen. ORTT -- read twice and ordered printed, and when
printed to be committed to the Committee 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 section 38 of part D of
3 chapter 56 of the laws of 2013, is amended to read as follows:
4 (B) Every policy [that] which provides physician services, medical,
5 major medical or similar comprehensive-type coverage shall provide
6 coverage for the screening, diagnosis and treatment of autism spectrum
7 disorder in accordance with this paragraph and shall not exclude cover-
8 age for the screening, diagnosis or treatment of medical conditions
9 otherwise covered by the policy because the individual is diagnosed with
10 autism spectrum disorder. Such coverage may be subject to annual deduct-
11 ibles, copayments and coinsurance as may be deemed appropriate by the
12 superintendent and shall be consistent with those imposed on other bene-
13 fits under the policy. [Coverage for applied behavior analysis shall be
14 subject to a maximum benefit of six hundred eighty hours of treatment
15 per policy or calendar year per covered individual.] This paragraph
16 shall not be construed as limiting the benefits that are otherwise
17 available to an individual under the policy, provided however that such
18 policy shall not contain any limitations on visits that are solely
19 applied to the treatment of autism spectrum disorder. No insurer shall
20 terminate coverage or refuse to deliver, execute, issue, amend, adjust,
21 or renew coverage to an individual solely because the individual is
22 diagnosed with autism spectrum disorder or has received treatment for
23 autism spectrum disorder. Coverage shall be subject to utilization
24 review and external appeals of health care services pursuant to article
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD09014-01-5
S. 3664 2
1 forty-nine of this chapter as well as, case management, and other
2 managed care provisions.
3 § 2. Subparagraph (B) of paragraph 17 of subsection (l) of section
4 3221 of the insurance law, as amended by section 39 of part D of chapter
5 56 of the laws of 2013, is amended to read as follows:
6 (B) Every group or blanket policy [that] which provides physician
7 services, medical, major medical or similar comprehensive-type coverage
8 shall provide coverage for the screening, diagnosis and treatment of
9 autism 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 six
17 hundred eighty hours of treatment per policy or calendar year per
18 covered individual.] This paragraph shall not be construed as limiting
19 the benefits that are otherwise available to an individual under the
20 group or blanket policy, provided however that such policy shall not
21 contain any limitations on visits that are solely applied to the treat-
22 ment of autism spectrum disorder. No insurer shall terminate coverage or
23 refuse to deliver, execute, issue, amend, adjust, or renew coverage to
24 an individual solely because the individual is diagnosed with autism
25 spectrum disorder or has received treatment for autism spectrum disor-
26 der. Coverage shall be subject to utilization review and external
27 appeals of health care services pursuant to article forty-nine of this
28 chapter as well as, case management, and other managed care provisions.
29 § 3. Paragraph 2 of subsection (ee) of section 4303 of the insurance
30 law, as amended by section 40 of part D of chapter 56 of the laws of
31 2013, is amended to read as follows:
32 (2) Every contract [that] which provides physician services, medical,
33 major medical or similar comprehensive-type coverage shall provide
34 coverage for the screening, diagnosis and treatment of autism spectrum
35 disorder in accordance with this paragraph and shall not exclude cover-
36 age for the screening, diagnosis or treatment of medical conditions
37 otherwise covered by the contract because the individual is diagnosed
38 with autism spectrum disorder. Such coverage may be subject to annual
39 deductibles, copayments and coinsurance as may be deemed appropriate by
40 the superintendent and shall be consistent with those imposed on other
41 benefits under the contract. [Coverage for applied behavior analysis
42 shall be subject to a maximum benefit of six hundred eighty hours of
43 treatment per contract or calendar year per covered individual.] This
44 paragraph shall not be construed as limiting the benefits that are
45 otherwise available to an individual under the contract, provided howev-
46 er that such contract shall not contain any limitations on visits that
47 are solely applied to the treatment of autism spectrum disorder. No
48 insurer shall terminate coverage or refuse to deliver, execute, issue,
49 amend, adjust, or renew coverage to an individual solely because the
50 individual is diagnosed with autism spectrum disorder or has received
51 treatment for autism spectrum disorder. Coverage shall be subject to
52 utilization review and external appeals of health care services pursuant
53 to article forty-nine of this chapter as well as, case management, and
54 other managed care provisions.
55 § 4. This act shall take effect immediately.
