Requires requiring health insurance policies to provide coverage for medically necessary care for the treatment of autism spectrum disorder

BILL NUMBER:S4996

Title of bill

An act to amend the insurance law, in relation to requiring health insurance policies to provide coverage for medically necessary care for the treatment of autism spectrum disorder

Purpose

This legislation will require health insurance policies to provide coverage for medically necessary care for the treatment of autism spectrum disorder and Asperger's disorder. This coverage will include hospital or surgical care, all diagnostic screening tests, assessments and treatments, rehabilitation, speech, behavioral, occupational and physical therapies, pediatric, neurological, gastro-enterologic and any other medically necessary care that is provided by a licensed provider required for the treatment of autism spectrum disorder and Asperger's disorder and pervasive developmental disorders as determined by the treatment physician.

Summary of provisions

Section 1 amends paragraph 25 of section 3216 of the insurance law, to state that every policy that provides coverage for hospital, surgical, medical care must provide the diagnosis and treatment (which includes all diagnostic screening, tests, and assessments and treatments, as well as habilitation, rehabilitation, speech, behavioral, occupational and physical therapies, pediatric, neurological, gastro-enterologic and any other medically necessary care) of autism spectrum disorder.

Section 1 also defines "Autism Spectrum Disorder" as a neurobiological condition that includes autism, Asperger syndrome, Rett's syndrome, or pervasive developmental disorder.

Section 2 Amends section 3221 of the insurance law, as added by chapter 557 of the laws of 2006, to state that a blanket accident policy, health insurance policy, or issuing group or blanket policy which provide hospital, surgical, or medical care coverage must provide the diagnosis and treatment of autism spectrum disorder.

Section 3 Amends section 4303 of the insurance law as added by chapter 557 of the laws of 2006, to state that a medical expanse indemnity corporation, a hospital service corporation or a health service corporation which provides coverage for hospital surgical, or medical conditions must provide coverage for diagnosis and treatment of autism spectrum disorder.

Justification

Autism typically appears during the first three years of life. Studies have shown that early diagnosis and intervention lead to significantly improved outcomes.

There are tens of thousands of families in New York State who are paying out-of-pocket to provide their loved ones with the therapies they need and deserve in order to live a full and active life. The

lifetime costs for raising a child with autism ranges from 53.5 million to 55 million. This immense financial burden that comes with caring for a person with an Autism Spectrum Disorder has left many families with no choice but to incur massive debts in order to ensure their loved one is properly cared for. No family should have to chose between bankruptcy and forgoing certain treatments that could greatly improve their loved ones quality of life.

This legislation will allow parents of children with Autism and Asperger's worry about the health and progress of their child, rather than the cost of treatment.

Legislative history

This is a new bill.

Fiscal implications

None noted.

Effective date

This act shall take effect January 1st next succeeding the date on which it shall have become a law and shall apply to all policies or contracts issued, renewed, modified, altered or amended on and after such effective date.