What's happening
This bill requires health insurance policies in New York to cover all medically necessary care for autism spectrum disorder, including related therapies and treatments.
Why it matters
Expands the definition of covered autism care. to include a wide range of therapies and treatments—such as speech, behavioral, occupational, physical, neurological, and gastroenterological services—ensuring that individuals with autism can access comprehensive, multidisciplinary care.
Eliminates insurer discretion on what therapies are “necessary,”. by mandating coverage for any medically necessary care as determined by the treating physician, not by the insurer, giving families and doctors more authority over treatment plans.
Applies to all relevant insurance types. (hospital, surgical, or medical care coverage), ensuring that the mandate is broad and consistent across various insurance policies and contracts in New York State.
Addresses potential gaps in current coverage. by explicitly including related conditions, such as Asperger’s disorder and other pervasive developmental disorders, reducing the risk of denial of care for those with similar diagnoses.
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Who cares
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Cover Autism Treatment Costs
Plain English, a few words. Used as the page title.
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History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3172
2017-2018 Regular Sessions
IN ASSEMBLY
January 27, 2017
Introduced by M. of A. ORTIZ -- read once and referred to the Committee on Insurance
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
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 25 of subsection (i) of section 3216 of the insurance law is amended by adding a new subparagraph (H) to read as follows:
(H) Every policy which provides coverage for hospital, surgical, or medical care coverage shall provide any and all diagnostic screening, tests, and assessments and treatment including medical care, consultation, habilitation, 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, including Asperger's disorder and pervasive developmental disorders as determined by the treating physician.
§ 2. Paragraph 17 of subsection (1) of section 3221 of the insurance law is amended by adding a new subparagraph (H) to read as follows:
(H) Every policy which provides coverage for hospital, surgical, or medical care coverage shall provide any and all diagnostic screening, tests, and assessments and treatment including medical care, consultation, habilitation, 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, including Asperger's disorder and pervasive developmental disorders as determined by the treating physician.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08208-01-7
A. 3172 2
§ 3. Subsection (ee) of section 4303 of the insurance law is amended by adding a new paragraph 8 to read as follows:
(8) Every policy which provides coverage for hospital, surgical, or medical care coverage shall provide any and all diagnostic screening, tests, and assessments and treatment including medical care, consultation, habilitation, 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, including Asperger's disorder and pervasive developmental disorders as determined by the treating physician.
§ 4. This act shall take effect on the first of January 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.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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