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
________________________________________________________________________
4206--A
2011-2012 Regular Sessions
IN ASSEMBLY
February 2, 2011
___________
Introduced by M. of A. P. RIVERA, McENENY, V. LOPEZ, CAHILL, LIFTON,
WEISENBERG, CLARK, BENEDETTO, J. RIVERA, THIELE, LATIMER, TITONE,
CAMARA, MAISEL, JAFFEE, GUNTHER, LANCMAN, CASTRO, BARRON, TITUS --
Multi-Sponsored by -- M. of A. ARROYO, AUBRY, BOYLAND, BRENNAN,
BURLING, CASTELLI, COLTON, CONTE, COOK, CURRAN, DUPREY, GABRYSZAK,
GIGLIO, HIKIND, JEFFRIES, KATZ, LUPARDO, MALLIOTAKIS, MARKEY, McDO-
NOUGH, McKEVITT, McLAUGHLIN, J. MILLER, M. MILLER, MILLMAN, MONTESANO,
NOLAN, PEOPLES-STOKES, REILLY, N. RIVERA, ROBINSON, SALADINO, SAYWARD,
SCHIMEL, STEVENSON, SWEENEY, TOBACCO, WEINSTEIN, ZEBROWSKI -- read
once and referred to the Committee on Insurance -- recommitted to the
Committee on Health in accordance with Assembly Rule 3, sec. 2 --
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-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00127-05-2
A. 4206--A 2
1 ship of the panel shall be filled in the manner provided for original
2 appointments.
3 (2) The members of the panel shall receive no compensation for their
4 services but shall be allowed their actual and necessary expenses
5 incurred in the performance of their duties pursuant to this subsection.
6 (3) The advisory panel on health insurance coverage for autism spec-
7 trum disorder shall annually, on or before September first, compile and
8 submit to the superintendent a list of successful treatment and therapy
9 options for autism spectrum disorder that will be required to be covered
10 pursuant to paragraph twenty-five of subsection (i) of section three
11 thousand two hundred sixteen, paragraph seventeen of subsection (1) of
12 section three thousand two hundred twenty-one and subsection (ee) of
13 section four thousand three hundred three of this chapter.
14 (4) Within forty-five days of receipt of each list submitted pursuant
15 to paragraph three of this subsection, the superintendent shall, on an
16 emergency basis, promulgate and implement rules and regulations requir-
17 ing coverage for the treatment and therapy options included in each such
18 list.
19 (b) (1) Within one hundred eighty days of the submission of the
20 initial list to the superintendent pursuant to paragraph three of
21 subsection (a) of this section, the department shall establish and oper-
22 ate an autism and health insurance coverage hotline. The hotline shall
23 be a toll-free, twenty-four hour a day consumer call center for families
24 with autistic children who have complaints about or questions on insur-
25 ers and coverage for autism spectrum disorder. All complaints received
26 by such hotline shall be documented and referred to the appropriate
27 official in the department for corrective action.
28 (2) The department may contract with a qualified not-for-profit corpo-
29 ration for the provision and operation of the hotline required by this
30 subsection. Any such contract shall only be awarded after the department
31 has conducted a request for proposals process. The department shall
32 select a not-for-profit corporation which has the resources and ability
33 to operate a statewide hotline, and is staffed by employees and/or
34 volunteers with strong experience in autism spectrum disorder.
35 (3) If the department elects to establish and operate the hotline
36 using its own personnel and resources, such hotline shall be staffed by
37 officers and employees with strong experience in autism spectrum disor-
38 der. Until the state civil service commission shall have established
39 civil service titles and competitive examinations for positions as
40 employees of the hotline, the superintendent is authorized and directed
41 to appoint and employ such qualified officers and employees as shall be
42 necessary to operate the autism and health insurance coverage hotline.
43 (4) The superintendent is authorized to promulgate and implement any
44 rules and regulations necessary to carry out the provisions of this
45 subsection.
46 § 2. Paragraph 25 of subsection (i) of section 3216 of the insurance
47 law, as added by chapter 557 of the laws of 2006, is amended to read as
48 follows:
49 (25) Every policy which provides coverage for hospital, surgical, or
50 medical care coverage shall [not exclude] include full coverage for the
51 prevention, early detection, diagnosis and treatment of [medical condi-
52 tions otherwise covered by the policy solely because the treatment is
53 provided to diagnose or treat] autism spectrum disorder. For purposes of
54 this section, "autism spectrum disorder" means a neurobiological condi-
55 tion that includes autism, Asperger syndrome, Rett's syndrome, or perva-
56 sive developmental disorder.
A. 4206--A 3
1 § 3. Subparagraph (A) of paragraph 25 of subsection (i) of section
2 3216 of the insurance law, as amended by chapter 595 of the laws of
3 2011, is amended to read as follows:
4 (A) Every policy which provides coverage for hospital or surgical
5 coverage shall [not exclude] include full coverage for [screening,] the
6 prevention, early detection, diagnosis and treatment of [medical condi-
7 tions otherwise covered by the policy solely because the treatment is
8 provided to diagnose or treat] autism spectrum disorder.
9 § 4. Paragraph 17 of subsection (l) of section 3221 of the insurance
10 law, as added by chapter 557 of the laws of 2006, is amended to read as
11 follows:
12 (17) A group or blanket accident or health insurance policy or issuing
13 a group or blanket policy for delivery in this state which provides
14 coverage for hospital, surgical, or medical care coverage shall [not
15 exclude] include full coverage for the prevention, early detection,
16 diagnosis and treatment of [medical conditions otherwise covered by the
17 policy because the treatment is provided to diagnose or treat] autism
18 spectrum disorder. For purposes of this section, "autism spectrum disor-
19 der" means a neurobiological condition that includes autism, Asperger
20 syndrome, Rett's syndrome, or pervasive developmental disorder.
21 § 5. Subparagraph (A) of paragraph 17 of subsection (1) of section
22 3221 of the insurance law, as amended by chapter 595 of the laws of
23 2011, is amended to read as follows:
24 (A) Every group or blanket accident and health insurance policy deliv-
25 ered or issued for delivery in this state which provides coverage for
26 hospital or surgical care coverage shall [not exclude] include full
27 coverage for [screening,] the prevention, early detection, diagnosis and
28 treatment of [medical conditions otherwise covered by the policy because
29 the treatment is provided to diagnose or treat] autism spectrum disor-
30 der.
31 § 6. Subsection (ee) of section 4303 of the insurance law, as added by
32 chapter 557 of the laws of 2006, is amended to read as follows:
33 (ee) A medical expense indemnity corporation, a hospital service
34 corporation or a health service corporation which provides coverage for
35 hospital, surgical, or medical care coverage shall [not exclude] include
36 full coverage for the prevention, early detection, diagnosis and treat-
37 ment of [medical conditions otherwise covered by the policy solely
38 because the treatment is provided to diagnose or treat] autism spectrum
39 disorder. For purposes of this section, "autism spectrum disorder" means
40 a neurobiological condition that includes autism, Asperger syndrome,
41 Rett's syndrome, or pervasive developmental disorder.
42 § 7. Paragraph 1 of subsection (ee) of section 4303 of the insurance
43 law, as amended by chapter 596 of the laws of 2011, is amended to read
44 as follows:
45 (1) A medical expense indemnity corporation, a hospital service corpo-
46 ration or a health service corporation which provides coverage for
47 hospital or surgical care coverage shall [not exclude] include full
48 coverage for [screening,] the prevention, early detection, diagnosis and
49 treatment of medical conditions otherwise covered by the contract solely
50 because the treatment is provided to diagnose or treat autism spectrum
51 disorder.
52 § 8. This act shall take effect on the thirtieth day after it shall
53 have become a law; provided, however, that sections three, five and
54 seven of this act shall take effect on the same date and in the same
55 manner as chapter 595 of the laws of 2011, as amended, takes effect.
