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

BILL NUMBER:S2707A

Title of bill

An act to amend the insurance law, in relation to establishing an advisory panel on health insurance coverage for autism spectrum disorder

Purpose

To establish an advisory panel to report to the superintendent regarding successful treatment options for autism spectrum disorder that will be required to be covered by insurance.

Summary of provisions

Section 1 adds section 342 to the insurance law to establish an advisory panel on health insurance coverage to be composed of health professionals from the department of health, office of mental health, and/or the office of people with developmental disabilities and representatives of autism advocacy groups. These individuals will be appointed by the governor, the temporary president of the senate, and the speaker of the assembly. Additionally, this section requires the panel to submit an annual report on treatment efficacy that will be covered by insurance, as well as, establish a hotline to assist healthcare providers with the insurance process.

Section 2 amends the insurance law as added by chapter 56 of the laws of 2013, to include full coverage for diagnosis and treatment of autism spectrum disorder.

Section 3 amends the insurance law, to include full coverage for screening, diagnosis and treatment of autism spectrum disorder.

Section 4 amends the insurance law, to include full coverage for diagnosis and treatment of autism spectrum disorder.

Section 5 Effective Date

Justification

According to the National Centers for Disease Control and Prevention it is estimated that an average of 1 in 110 children in the United States has an autism spectrum disorder (ASD). Research indicates that early detection of ASD, when paired with proper intervention, can lead to better outcomes for children. These outcomes include improved language, social, and adaptive functioning, and a reduction in inappropriate behaviors.

Consequently, it is critical to identify and refer children with ASD as early as possible.

Unfortunately, many children with autism are not properly diagnosed until years after the first symptoms appear. Until the passage of Chapter 596 of the laws of New York 2011, most health insurance plans in the state of New York did not cover autism treatment.

Now that ASD is included in the list of neurological disorders covered by insurance it is imperative that we establish an advisory panel to report on the successful treatment and therapy options which will be required under the new law. It is also necessary to establish a hotline for personnel to streamline insurance coverage questions that will likely occur due to changes in the insurance law.

The passage of Chapter 596 of the Laws of New York 2011 (S.5845) is major accomplishment in terms of decreasing exclusions in health insurance based solely on the fact that an individual is diagnosed with autism spectrum disorder. This bill takes this recently enacted law one step further by including the prevention, diagnosis and treatment of autism spectrum disorder, just as any other neurobiological condition that would be included in hospital, surgical or medical care coverage.

Legislative history

2010-2011: S.3405 - Died in insurance; but see Chapter 596 of the Laws of New York 2011 2009-2010: S.385/A.2759 Died in Insurance 2007-2008: S.3121/A.539 Died in Insurance

Fiscal implication

Minimal.

Effective date

This act shall take effect on the thirtieth day after it becomes a law.