What's happening
This bill requires health insurance coverage for medically necessary autism testing and treatment.
Why it matters
Statewide coverage. Adds a requirement to New York insurance law for policies covering hospital, surgical or medical care, including care for Asperger’s disorder and pervasive developmental disorders.
Broad treatment mandate. Requires coverage for diagnostic screening, tests, assessments and treatments including speech, behavioral, occupational and physical therapies. Medically necessary care must be provided by a licensed provider, as determined by the treating physician.
Implementation. Takes effect January 1 following becoming law and applies to policies or contracts issued, renewed, modified, altered or amended on or after that date.
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Who cares
People with autism and their families
The bill would require coverage for medically necessary testing, therapies and other autism care.
Health insurers
Policies covered by the bill would have to include the specified autism services.
Treating physicians
Their determinations would establish the medically necessary care required for autism treatment.
Licensed therapists and other care providers
Their medically necessary autism services would fall within the coverage requirement.
Headline styles
Require Autism Care Coverage
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
2877
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
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.
LBD07080-01-9
A. 2877 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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