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New York Includes Autism Benefits in Health Reform Plan

October 02, 2012

ALBANY (October 2, 2012) -- New York has included autism coverage as part of the "essential health benefits" package individual and small group health plans will have to begin offering in the state in 2014 as part of federal health care reform.

Under the Affordable Care Act (ACA) enacted in 2010 and upheld last summer by the U.S. Supreme Court, the states are required to develop a list of essential health benefits, such as hospitalization, emergency care and prescription drugs, that many individual and small group health plans will have to provide. New York has decided to include the autism insurance benefits signed into law last year by Governor Andrew Cuomo as part of its package.

Both New York and California, which enacted state autism insurance reform laws in late 2011, have now decided to incorporate the benefits as they implement health care reform.

Congress specified in the ACA that behavioral health treatment, such as ABA, be included on the list of 10 essential health benefits. But Autism Speaks has expressed concern that the U.S. Department of Health and Human Services, which is overseeing implementation of the law, has not been clear enough with the states in requiring that the coverage be included.

New York State selected as its "benchmark plan" Oxford EPO, the state's largest small group health plan.