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July 7th, 2010

Legislature passes bill to provide autism coverage

New York State Senator Thomas P. Morahan

Albany - New York State Senator Thomas P. Morahan, Chairman of the Senate Committee on Mental Health and Developmental Disabilities has announced that the State Assembly joined the State Senate in passing legislation this evening amending the Insurance Law to provide coverage for the screening, diagnosis and treatment of autism spectrum disorders. The landmark legislation provides that coverage may be subject to annual deductibles, co-payments and coinsurance as may be deemed appropriate by the superintendent of insurance and shall be consistent with those imposed on other benefits under the contract.

"I am pleased to have joined Senator Neil Breslin as a co-prime sponsor of this vital legislation, which will clearly close a significant gap in insurance coverage for individuals with autism. It is estimated that the number of children with autism is 1 in 110 nationwide. This bill is one of the strongest in the nation, not only requiring policies to cover autism, but does so without a financial cap," said Senator Morahan. " "The bill would only allow evidence-based and clinically proven treatments to be covered. Furthermore, the coverage is extended for the entire life span of the individual."

The legislation provides:

• That the commissioner of health, in consultation with the superintendent of insurance, commissioner of the office of mental retardation and developmental disabilities and commissioner of the office of mental health shall promulgate regulations which establish which treatment and therapy options insurers shall be covered for the diagnosis and treatment of autism spectrum disorders.

• That coverage for behavioral therapies required pursuant to the legislation shall not be denied on the basis that such therapies are educational or habilitative in nature unless such treatments are provided pursuant to an individualized education program.

• That the provision of services pursuant to an individualized family service plan, an individualized education program or an individualized service plan shall not affect coverage under the policy for services provided on a supplemental basis outside of an educational setting if such services are deemed medically necessary.

• That this Bill not affect any obligation to provide services to an individual under an individualized family service plan or individualized education program or an individualized service plan.

This bill requires policies to provide such coverage for individuals with autism spectrum disorder throughout their entire life span. The bill also provides for an updated definition of the term "autism spectrum disorder".

The bill amends existing provisions of the insurance law to require coverage under health insurance policies issued by indemnity and nonprofit insurers, as well as health maintenance organizations. Coverage would specifically be required for the group of neurological conditions know as "autism spectrum disorder", limited only by whatever restrictions are otherwise contained in the policy.

The legislation insures that only those treatments and therapies which have been determined by recognized medical authority as evidence-based and clinically proven will be covered.

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