Bill S2707A-2013

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

Requires health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder; establishes an advisory panel on health insurance coverage for autism spectrum disorder to annually compile a list of treatments and therapy options for which health insurers will be required to provide coverage; establishes a toll-free, 24 hour a day, autism and health insurance coverage hotline to receive and act upon complaints and questions from families with autistic children, relating to insurance coverage for autism spectrum disorder.

Details

Actions

  • Feb 24, 2014: PRINT NUMBER 2707A
  • Feb 24, 2014: AMEND AND RECOMMIT TO INSURANCE
  • Jan 8, 2014: REFERRED TO INSURANCE
  • Jan 23, 2013: REFERRED TO INSURANCE

Memo

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.


Text

STATE OF NEW YORK ________________________________________________________________________ 2707--A 2013-2014 Regular Sessions IN SENATE January 23, 2013 ___________
Introduced by Sen. PARKER -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to establishing an advi- sory panel on health insurance coverage for autism spectrum disorder THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The insurance law is amended by adding a new section 342 to read as follows: S 342. COVERAGE FOR AUTISM SPECTRUM DISORDER. (A) (1) THERE IS HEREBY ESTABLISHED WITHIN THE DEPARTMENT AN ADVISORY PANEL ON HEALTH INSURANCE COVERAGE FOR AUTISM SPECTRUM DISORDER. SUCH PANEL SHALL BE COMPOSED OF NINE MEMBERS WHO ARE EXPERTS IN HEALTH CARE AND APPOINTED AS FOLLOWS: SEVEN MEMBERS WHO ARE OFFICERS OR EMPLOYEES OF THE DEPARTMENT OF HEALTH, OFFICE OF MENTAL HEALTH OR THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL BE APPOINTED BY THE GOVERNOR; AND THE TEMPORARY PRES- IDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY SHALL EACH APPOINT A MEMBER WHO IS A REPRESENTATIVE OF AN AUTISM ADVOCACY GROUP. EACH MEMBER SHALL SERVE A TERM OF TWO YEARS. THE GOVERNOR SHALL DESIGNATE THE CHAIR OF THE PANEL FROM AMONG HIS OR HER APPOINTEES. VACANCIES IN THE MEMBER- SHIP OF THE PANEL SHALL BE FILLED IN THE MANNER PROVIDED FOR ORIGINAL APPOINTMENTS. (2) THE MEMBERS OF THE PANEL SHALL RECEIVE NO COMPENSATION FOR THEIR SERVICES BUT SHALL BE ALLOWED THEIR ACTUAL AND NECESSARY EXPENSES INCURRED IN THE PERFORMANCE OF THEIR DUTIES PURSUANT TO THIS SUBSECTION. (3) THE ADVISORY PANEL ON HEALTH INSURANCE COVERAGE FOR AUTISM SPEC- TRUM DISORDER SHALL ANNUALLY, ON OR BEFORE SEPTEMBER FIRST, COMPILE AND SUBMIT TO THE SUPERINTENDENT A LIST OF SUCCESSFUL TREATMENT AND THERAPY OPTIONS FOR AUTISM SPECTRUM DISORDER THAT WILL BE REQUIRED TO BE COVERED
PURSUANT TO PARAGRAPH TWENTY-FIVE OF SUBSECTION (I) OF SECTION THREE THOUSAND TWO HUNDRED SIXTEEN, PARAGRAPH SEVENTEEN OF SUBSECTION (1) OF SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE AND SUBSECTION (EE) OF SECTION FOUR THOUSAND THREE HUNDRED THREE OF THIS CHAPTER. (4) WITHIN FORTY-FIVE DAYS OF RECEIPT OF EACH LIST SUBMITTED PURSUANT TO PARAGRAPH THREE OF THIS SUBSECTION, THE SUPERINTENDENT SHALL, ON AN EMERGENCY BASIS, PROMULGATE AND IMPLEMENT RULES AND REGULATIONS REQUIR- ING COVERAGE FOR THE TREATMENT AND THERAPY OPTIONS INCLUDED IN EACH SUCH LIST. (B) (1) WITHIN ONE HUNDRED EIGHTY DAYS OF THE SUBMISSION OF THE INITIAL LIST TO THE SUPERINTENDENT PURSUANT TO PARAGRAPH THREE OF SUBSECTION (A) OF THIS SECTION, THE DEPARTMENT SHALL ESTABLISH AND OPER- ATE AN AUTISM AND HEALTH INSURANCE COVERAGE HOTLINE. THE HOTLINE SHALL BE A TOLL-FREE, TWENTY-FOUR HOUR A DAY CONSUMER CALL CENTER FOR FAMILIES WITH AUTISTIC CHILDREN WHO HAVE COMPLAINTS ABOUT OR QUESTIONS ON INSUR- ERS AND COVERAGE FOR AUTISM SPECTRUM DISORDER. ALL COMPLAINTS RECEIVED BY SUCH HOTLINE SHALL BE DOCUMENTED AND REFERRED TO THE APPROPRIATE OFFICIAL IN THE DEPARTMENT FOR CORRECTIVE ACTION. (2) THE DEPARTMENT MAY CONTRACT WITH A QUALIFIED NOT-FOR-PROFIT CORPO- RATION FOR THE PROVISION AND OPERATION OF THE HOTLINE REQUIRED BY THIS SUBSECTION. ANY SUCH CONTRACT SHALL ONLY BE AWARDED AFTER THE DEPARTMENT HAS CONDUCTED A REQUEST FOR PROPOSALS PROCESS. THE DEPARTMENT SHALL SELECT A NOT-FOR-PROFIT CORPORATION WHICH HAS THE RESOURCES AND ABILITY TO OPERATE A STATEWIDE HOTLINE, AND IS STAFFED BY EMPLOYEES AND/OR VOLUNTEERS WITH STRONG EXPERIENCE IN AUTISM SPECTRUM DISORDER. (3) IF THE DEPARTMENT ELECTS TO ESTABLISH AND OPERATE THE HOTLINE USING ITS OWN PERSONNEL AND RESOURCES, SUCH HOTLINE SHALL BE STAFFED BY OFFICERS AND EMPLOYEES WITH STRONG EXPERIENCE IN AUTISM SPECTRUM DISOR- DER. UNTIL THE STATE CIVIL SERVICE COMMISSION SHALL HAVE ESTABLISHED CIVIL SERVICE TITLES AND COMPETITIVE EXAMINATIONS FOR POSITIONS AS EMPLOYEES OF THE HOTLINE, THE SUPERINTENDENT IS AUTHORIZED AND DIRECTED TO APPOINT AND EMPLOY SUCH QUALIFIED OFFICERS AND EMPLOYEES AS SHALL BE NECESSARY TO OPERATE THE AUTISM AND HEALTH INSURANCE COVERAGE HOTLINE. (4) THE SUPERINTENDENT IS AUTHORIZED TO PROMULGATE AND IMPLEMENT ANY RULES AND REGULATIONS NECESSARY TO CARRY OUT THE PROVISIONS OF THIS SUBSECTION. S 2. Subparagraphs (A) and (B) of paragraph 25 of subsection (i) of section 3216 of the insurance law, subparagraph (A) as amended by chap- ter 595 of the laws of 2011, and subparagraph (B) as amended by section 38 of part D of chapter 56 of the laws of 2013, are amended to read as follows: (A) Every policy which provides coverage for hospital or surgical coverage shall [not exclude] INCLUDE FULL coverage for THE PREVENTION, EARLY DETECTION, screening, diagnosis and treatment of [medical condi- tions otherwise covered by the policy solely because the treatment is provided to diagnose or treat] autism spectrum disorder. (B) Every policy that provides physician services, medical, major medical or similar comprehensive-type coverage shall provide FULL cover- age for the screening, diagnosis and treatment of autism spectrum disor- der in accordance with this paragraph and shall not exclude coverage for the PREVENTION, EARLY DETECTION, screening, diagnosis or treatment of medical conditions otherwise covered by the policy because the individ- ual is diagnosed with autism spectrum disorder. Such coverage may be subject to annual deductibles, copayments and coinsurance as may be deemed appropriate by the superintendent and shall be consistent with those imposed on other benefits under the policy. Coverage for applied
behavior analysis shall be subject to a maximum benefit of six hundred eighty hours of treatment per policy or calendar year per covered indi- vidual. This paragraph shall not be construed as limiting the benefits that are otherwise available to an individual under the policy, provided however that such policy shall not contain any limitations on visits that are solely applied to the treatment of autism spectrum disorder. No insurer shall terminate coverage or refuse to deliver, execute, issue, amend, adjust, or renew coverage to an individual solely because the individual is diagnosed with autism spectrum disorder or has received treatment for autism spectrum disorder. Coverage shall be subject to utilization review and external appeals of health care services pursuant to article forty-nine of this chapter as well as, case management, and other managed care provisions. S 3. Subparagraphs (A) and (B) of paragraph 17 of subsection (l) of section 3221 of the insurance law, subparagraph (A) as amended by chap- ter 595 of the laws of 2011, subparagraph (B) as amended by section 39 of part D of chapter 56 of the laws of 2013, are amended to read as follows: (A) Every group or blanket accident and health insurance policy deliv- ered or issued for delivery in this state which provides coverage for hospital or surgical care coverage shall [not exclude] INCLUDE FULL coverage for THE PREVENTION, EARLY DETECTION, screening, diagnosis and treatment of medical conditions otherwise covered by the policy because the treatment is provided to diagnose or treat autism spectrum disorder. (B) Every group or blanket policy that provides physician services, medical, major medical or similar comprehensive-type coverage shall provide FULL coverage for the PREVENTION, EARLY DETECTION, screening, diagnosis and treatment of autism spectrum disorder in accordance with this paragraph and shall not exclude coverage for the screening, diagno- sis or treatment of medical conditions otherwise covered by the policy because the individual is diagnosed with autism spectrum disorder. Such coverage may be subject to annual deductibles, copayments and coinsu- rance as may be deemed appropriate by the superintendent and shall be consistent with those imposed on other benefits under the group or blan- ket policy. Coverage for applied behavior analysis shall be subject to a maximum benefit of six hundred eighty hours of treatment per policy or calendar year per covered individual. This paragraph shall not be construed as limiting the benefits that are otherwise available to an individual under the group or blanket policy, provided however that such policy shall not contain any limitations on visits that are solely applied to the treatment of autism spectrum disorder. No insurer shall terminate coverage or refuse to deliver, execute, issue, amend, adjust, or renew coverage to an individual solely because the individual is diagnosed with autism spectrum disorder or has received treatment for autism spectrum disorder. Coverage shall be subject to utilization review and external appeals of health care services pursuant to article forty-nine of this chapter as well as, case management, and other managed care provisions. S 4. Subsection (ee) of section 4303 of the insurance law, as amended by chapter 596 of the laws of 2011 and paragraph 2 as amended by section 40 of part D of chapter 56 of the laws of 2013, is amended to read as follows: (ee) (1) A medical expense indemnity corporation, a hospital service corporation or a health service corporation which provides coverage for hospital or surgical care coverage shall [not exclude] INCLUDE FULL coverage for THE PREVENTION, EARLY DETECTION, screening, diagnosis and
treatment of medical conditions otherwise covered by the contract solely because the treatment is provided to diagnose or treat autism spectrum disorder. (2) Every contract that provides physician services, medical, major medical or similar comprehensive-type coverage shall provide coverage for the screening, diagnosis and treatment of autism spectrum disorder in accordance with this paragraph and shall not exclude FULL coverage for the PREVENTION, EARLY DETECTION, screening, diagnosis or treatment of medical conditions otherwise covered by the contract because the individual is diagnosed with autism spectrum disorder. Such coverage may be subject to annual deductibles, copayments and coinsurance as may be deemed appropriate by the superintendent and shall be consistent with those imposed on other benefits under the contract. Coverage for applied behavior analysis shall be subject to a maximum benefit of six hundred eighty hours of treatment per contract or calendar year per covered individual. This paragraph shall not be construed as limiting the bene- fits that are otherwise available to an individual under the contract, provided however that such contract shall not contain any limitations on visits that are solely applied to the treatment of autism spectrum disorder. No insurer shall terminate coverage or refuse to deliver, execute, issue, amend, adjust, or renew coverage to an individual solely because the individual is diagnosed with autism spectrum disorder or has received treatment for autism spectrum disorder. Coverage shall be subject to utilization review and external appeals of health care services pursuant to article forty-nine of this chapter as well as, case management, and other managed care provisions. S 5. This act shall take effect on the thirtieth day after it shall have become a law.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Discuss!

blog comments powered by Disqus