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Summary of 2011 Autism Insurance Reform Bill in New York

S.5845 - Sponsored by Senator Charles J. Fuschillo (R-Nassau); A.8512 - Sponsored by Assemblyman Joseph D. Morelle (D-Monroe)
March 31, 2011

The bill would:

  • Require private health insurance companies to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorders including:
  1. behavioral health treatment (such as applied behavior analysis)
  2. pharmacy care (if the policy covers other prescription drugs)
  3. psychiatric care
  4. psychological care
  5. therapeutic care, including non-restorative therapy (if the policy covers therapeutic care for other conditions)
  6. any other medical care provided by a licensed health care provider
  • Impose no age caps, and impose no visit caps that apply solely to ASD
  • Provide coverage for applied behavior analysis to $45,000 a year; that limit will increase annually based on increases in the medical consumer price index
  • Allow deductibles, co-pays, co-insurance, care management, utilization review, external appeals, and use of provider networks only in the same manner as a policy applies to coverage of other conditions
  • Not affect any obligation to provide services to an individual under an individualized family service plan, an individualized education program (IEP), or an individualized services plan. The purpose of this bill is to require insurance coverage for services provided outside of an educational setting for services prescribed by a physician or psychologist
  • Prohibit an insurance company from terminating coverage or refusing to renew, adjust, amend, issue, or execute a policy solely because the individual has been diagnosed or received treatment for autism spectrum disorders
  • Take effect one year after signed into law
  • Apply only to state-regulated insurance plans; it does not apply to self-funded insurance plans which are regulated by the federal government under ERISA law