New York State-Regulated Insurance Coverage

New York requires meaningful coverage for autism under state-regulated plans.

New York’s autism insurance bills, S 4005-A and A 6305A, were enacted in 2011 and became effective on November 1, 2012.

To which plan types does the state autism insurance law apply?

  • Individual Plans - YES
  • Fully Insured Large Group Plans - YES
  • Fully Insured Small Group Plans - YES

What services are covered by law?

  • Diagnosis
  • Behavioral health treatment (Applied Behavior Analysis)
  • Psychiatric Care
  • Psychological Care
  • Therapeutic care (i.e. services provided by licensed or certified speech therapists, occupational therapists, social workers and physical therapists)

For purposes of this law, “behavioral health treatment” is defined as “counseling and treatment programs, when provided by a licensed provider, and applied behavior analysis, when provided or supervised by a behavior analyst certified pursuant to the behavior analyst certification board, that are necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual.”

Does New York have caps on ABA coverage? 

No.

Where can I find more details about the New York autism insurance law?

A copy of S 4005-A and A 6305A as enrolled can be found here.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.  This includes quantitative treatment limits like age and dollar caps.  Learn more here.

If you have additional questions, please email advocacy@autismspeaks.org.

 

Last Updated: December 2019

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