Requires health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder

Title of bill

An act to amend the insurance law, in relation to requiring health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder

Purpose

This bill requires health insurers to provide full coverage for the prevention, early detection, diagnosis, and treatment of autism spectrum disorder.

Summary of provisions

Section 1 adds new section 342 to the insurance law to establish an advisory committee composed of professionals from department of health, office of mental health, and the office of mental retardation and developmental disabilities and representatives of autism advocacy groups, appointed by the speaker of assembly, governor and president pro-temp of the senate. This section also requires annual reports by the committee of safe and successful treatments. It also requires a hot-line to be established to help parents through the insurance process.

Section 2 amends paragraph 25 of subsection (i) of section 3216 of insurance law to require full coverage for prevention and early detection of autism (in addition to already covered treatment), even if the methods are experimental.

Section 3 amends paragraph 17 of subsection (1) of section 3221 of the insurance law to require the same.

Section 4 amends subsection (ee) of section 4303 of the insurance law to require the same.

Section 5 makes the act take effect on the thirtieth day after it shall become a law, provided that all necessary policies and contracts are issued, renewed, modified, altered or amended.

Justification

Autism is a complex neurobiological disorder that severely affects the way autistic individuals relate to others socially and their ability to communicate and learn. Although it is considered a life span disorder of varying severity, autism is treatable. Early diagnosis and intense early intervention have been proven to provide the same benefits to individuals with autism that medication or medical procedures provide to individuals afflicted with other similar physical or bio-neurological disorders. However, many children with autism are not properly diagnosed until years after the first symptoms appear. Furthermore, although insurance companies and health maintenance organizations routinely cover treatment for similar neurobiological disorders, most health insurance plans in the state of New York do not cover autism treatment. Furthermore, many experimental treatments are available but not currently utilized because of health coverage problem.

This bill would require health insurers to provide full coverage for the prevention, early detection, diagnosis, and treatment of autism spectrum disorder, even if it is experimental.

If we do not help these children, we are essentially condemning them to a lifetime of disability, unemployment and, for many, institutionalization. On human grounds, this is tragic. But it's also bad economics. The few hundred thousand dollars needed to do intensive early intervention for four or five years - while a lot - is only one-tenth the expected cost of supporting someone for a lifetime on the dole. Enactment of a New York bill that ends health insurance discrimination will be a big step forward for all persons with autism.

Legislative history

New legislation.

Fiscal implications

To be determined.

Effective date

This bill will take effect on the thirtieth day after it shall become a law, provided that all necessary policies and contracts are issued, renewed, modified, altered or amended.