BILL NUMBER:S3890

TITLE OF BILL:  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

PURPOSE:  This legislation will require health insurance policies to
provide coverage for medically necessary care for the treatment of
autism spectrum disorder and Asperger's disorder. This coverage will
include hospital or surgical care, all diagnostic screening tests,
assessments and treatments, 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 and Asperger's disorder and pervasive developmental
disorders as determined by the treatment physician.

SUMMARY OF PROVISIONS:

Section 1 amends paragraph 25 of section 3216 of the insurance law, to
state that every policy that provides coverage for hospital, surgical,
medical care must provide the diagnosis and treatment (which includes
all diagnostic screening, tests, and assessments and treatments, as
well as habilitation, rehabilitation, speech, behavioral, occupational
and physical therapies, pediatric, neurological, gastro-enterologic
and any other medically necessary care) of autism spectrum disorder.
              

Section 1 also defines "Autism Spectrum Disorder" as a neurobiological
condition that includes autism, Asperger syndrome, Rett's syndrome, or
pervasive developmental disorder.

Section 2 Amends section 3221 of the insurance law, as added by
chapter 557 of the laws of 2006, to state that a blanket accident
policy, health insurance policy, or issuing group or blanket policy
which provide hospital, surgical, or medical care coverage must
provide the diagnosis and treatment of autism spectrum disorder.

Section 3 Amends section 4303 of the insurance law as added by chapter
557 of the laws of 2006, to state that a medical expanse indemnity
corporation, a hospital service corporation or a health service
corporation which provides coverage for hospital surgical, or medical
conditions must provide coverage for diagnosis and treatment of autism
spectrum disorder.

JUSTIFICATION:  Autism typically appears during the first three years
of life. Studies have shown that early diagnosis and intervention lead
to significantly improved outcomes.

There are tens of thousands of families in New York State who are
paying out-of-pocket to provide their loved ones with the therapies
they need and deserve in order to live a full and active life. The
lifetime costs for raising a child with autism ranges from 53.5
million to 55 million. This immense financial burden that comes with
caring for a person with an Autism Spectrum Disorder has left many
families with no choice but to incur massive debts in order to ensure
their loved one is properly cared for. No family should have to chose


between bankruptcy and forgoing certain treatments that could greatly
improve their loved ones quality of life.

This legislation will allow parents of children with Autism and
Asperger's worry about the health and progress of their child, rather
than the cost of treatment.

LEGISLATIVE HISTORY:  01/04/12 Referred to insurance.

FISCAL IMPLICATIONS:  None noted.

EFFECTIVE DATE:  This act shall take effect January 1st 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.