State Proposal Would Gut Insurance Reform Law

NEW YORK (November 21, 2012) -- The New York Department of Financial Services today published emergency regulations that would effectively deny access to ABA coverage under the state's 2011 autism insurance reform law. Autism Speaks immediately demanded the rules be revised or withdrawn.

The proposed rules would require Applied Behavior Analysis (ABA) to be provided only by certified behavior analysts licensed under New York law even though the 2011 autism insurance reform law specifically called only for national licensure of providers. In addition, New York has no state licensure process.

"As currently drafted, the Regulations contravene the plain language of the Act, subvert the legislature’s carefully constructed statutory scheme, and will result in irreparable harm to individuals deprived of the critical, time-sensitive healthcare the statute was enacted to secure," Autism Speaks said in a letter to the department's general counsel.

"Specifically, by imposing unwarranted and problematic licensure requirements on ABA providers beyond the national certification required by statute, the Emergency Rule exceeds the authority granted by the legislature and drastically limits insureds’ access to care," the letter continued.  "In the face of such a perverse result, the frustration and disappointment on the part of thousands of New York families who believed that enactment of autism insurance legislation would greatly assist their loved ones in securing needed treatment and services cannot be overstated."

Judith Ursitti, Autism Speaks' director of state government affairs, said the state licensure requirement also was proposed by regulators in West Virginia and Rhode Island after those states enacted autism insurance reform laws in 2011. In each case, Autism Speaks worked with local advocates and legislative leaders to get the requirements reversed or modified so that families could access ABA as provided under the law.

"We want New York families to know we are very familiar with this issue given our experience in other states and that we are confident we will be equally successful in getting this resolved in Albany," Ursitti said. "This has already been a painfully slow process in gaining ABA coverage and we understand the frustration felt by New York families."

New York's 2011 autism insurance reform law took effect at the beginning of this month. It requires state-regulated health plans to cover up to $45,000 a year in ABA services provided or supervised by a Board Certified Behavior Analyst.

The law was signed by Gov. Andrew Cuomo on November 2, 2011. The emergency ABA regulations were not issued until Oct. 31, 2012, a day before the law took effect and made public today.