Relates to coverage for the screening, diagnosis and treatment of autism spectrum disorder

BILL NUMBER:S5845

Title of bill

An act to amend the insurance law, in relation to coverage for the screening, diagnosis and treatment of autism spectrum disorder; and to amend a chapter of the laws of 2011 amending the insurance law relating to coverage for the screening, diagnosis and treatment of autism spectrum disorder, as proposed in legislative bill numbers S.4005-A and A.6305-A, in relation to the effectiveness of such chapter

Purpose

To provide for insurance coverage for the screening, diagnosis and treatment of autism spectrum disorders.

Summary of provisions

Section 1: Amends section 3216 of the insurance law to provide for an annual benefit for applied behavior analysis of $45,000 per year per covered person. The Commissioner of education is required to be consulted on the promulgation of regulations by the superintendent with respect to standards of professionalism, supervision and relevant experience for behavioral analysis. The term "related medical equipment" is amended to "assistive communication device".

Section 2: Section 3221 of the insurance law is amended to provide for the aforementioned provisions.

Section 3: Section 4303 of the insurance law is amended to provide for the aforementioned provisions.

Sections 4 & 5: Provides for an effective date of the original chapter of one year following enactment.

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. Today the Centers for Disease Control (CDC) estimate that the number of children with autism is 1 in 110 nationwide, making it more common than pediatric cancer, diabetes, and AIDS combined. It occurs in all racial, ethnic, and social groups and is four times more likely to strike boys than girls.

Existing state law requires that insurance coverage for autism "not exclude" the diagnosis and treatment of autism spectrum disorder. Current law does not provide sufficient clarity or an affirmative obligation of health insurance to cover costs relating to autism treatments. Moreover, parents are often faced with significant gaps in treatments which may be needed over and above those provided pursuant to an individualized family, education or service plan. These families often pay as much as they can out-of-pocket for services that can cost upwards of $50,000 per year. In the process, many risk their homes and the education of their unaffected children essentially mortgaging their futures. This legislation would expedite diagnosis and treatment by providing insurance parity for

autism sufferers by requiring equitable coverage of the disorder by insurance companies.

If enacted, New York would join with 23 other states in requiring cover- age for conditions relating to autism spectrum disorder.

Legislative history

New bill.

Fiscal implications

Undetermined.

Effective date

Section 4: Amends the effective state of the original chapter to one year following enactment.

Section 5: Provides that this act shall take effect immediately provided that sections 1-3 shall take effect on the same date as the original chapter.