NY State Senate Bill 2009-S385

Senate Bill S385

2009-2010 Legislative Session

Requires health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2010	referred to insurance
Jan 07, 2009	referred to insurance

2009-S385 (ACTIVE) - Details

See Assembly Version of this Bill:: A2759
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Add §342, amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2011-2012: S3405, A4206
2013-2014: S2707
2015-2016: S2751
2017-2018: S2222
2019-2020: S3251
2021-2022: S3301
2023-2024: S5762

2009-S385 (ACTIVE) - Summary

Requires health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder; establishes an advisory panel on health insurance coverage for autism spectrum disorder to annually compile a list of treatments and therapy options for which health insurers will be required to provide coverage; establishes a toll-free, 24 hour a day, autism and health insurance coverage hotline to receive and act upon complaints and questions from families with autistic children, relating to insurance coverage for autism spectrum disorder.

2009-S385 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S385

 TITLE OF BILL :
An act to amend the insurance law, in relation to requiring health
insurers to provide full coverage for the prevention, early detection,
diagnosis and treatment of autism spectrum disorder


 PURPOSE :
This bill requires health insurers to provide full coverage for the
prevention, early detection, diagnosis, and treatment of autism
spectrum disorder.

 SUMMARY OF PROVISIONS :
Section 1 adds new section 342 to the insurance law to establish an
advisory committee composed of professionals from department of
health, office of mental health, and the office of mental retardation
and developmental disabilities and representatives of autism advocacy
groups, appointed by the speaker of assembly, governor and president
pro-temp of the senate. This section also requires annual reports by
the committee of safe and successful treatments. It also requires a
hot-line to be established to help parents through the insurance
process.

Section 2 amends paragraph 25 of subsection (i) of section 3216 of
insurance law to require full coverage for prevention and early

detection of autism (in addition to already covered treatment), even
if the methods are experimental.

Section 3 amends paragraph 17 of subsection (1) of section 3221 of the
insurance law to require the same.

Section 4 amends subsection (ee) of section 4303 of the insurance law
to require the same.

Section 5 makes the act take effect on the thirtieth day after it
shall become a law, provided that all necessary policies and contracts
are issued, renewed, modified, altered or amended.

 JUSTIFICATION :
Autism is a complex neurobiological disorder that severely affects the
way autistic individuals relate to others socially and their ability
to communicate and learn. Although it is considered a life span
disorder of varying severity, autism is treatable. Early diagnosis and
intense early intervention have been proven to provide the same
benefits to individuals with autism that medication or medical
procedures provide to individuals afflicted with other similar
physical or bio-neurological disorders. However, many children with
autism are not properly diagnosed until years after the first symptoms
appear. Furthermore, although insurance companies and health
maintenance organizations routinely cover treatment for similar
neurobiological disorders, most health insurance plans in the state of
New York do not cover autism treatment. Furthermore, many experimental
treatments are available but not currently utilized because of health
coverage problem.

This bill would require health insurers to provide full coverage for
the prevention, early detection, diagnosis, and treatment of autism
spectrum disorder, even if it is experimental.

If we do not help these children, we are essentially condemning them
to a lifetime of disability, unemployment and, for many,
institutionalization. On human grounds, this is tragic. But it's also
bad economics. The few hundred thousand dollars needed to do intensive
early intervention for four or five years - while a lot - is only
one-tenth the expected cost of supporting someone for a lifetime on
the dole. Enactment of a New York bill that ends health insurance
discrimination will be a big step forward for all persons with autism.

 LEGISLATIVE HISTORY :
New legislation.

 FISCAL IMPLICATIONS :
To be determined.

 EFFECTIVE DATE :
This bill will take effect on the thirtieth day after it shall become
a law, provided that all necessary policies and contracts are issued,
renewed, modified, altered or amended.

2009-S385 (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                   385

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 7, 2009
                               ___________

Introduced  by  Sen. MORAHAN -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  requiring  health
  insurers to provide full coverage for the prevention, early detection,
  diagnosis and treatment of autism spectrum disorder

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1.  The insurance law is amended by adding a new  section  342
to read as follows:
  S  342. COVERAGE FOR AUTISM SPECTRUM DISORDER. (A) (1) THERE IS HEREBY
ESTABLISHED WITHIN THE DEPARTMENT AN ADVISORY PANEL ON HEALTH  INSURANCE
COVERAGE  FOR  AUTISM SPECTRUM DISORDER. SUCH PANEL SHALL BE COMPOSED OF
NINE MEMBERS WHO ARE EXPERTS IN HEALTH CARE AND  APPOINTED  AS  FOLLOWS:
SEVEN MEMBERS WHO ARE OFFICERS OR EMPLOYEES OF THE DEPARTMENT OF HEALTH,
OFFICE OF MENTAL HEALTH OR THE OFFICE OF MENTAL RETARDATION AND DEVELOP-
MENTAL  DISABILITIES  SHALL BE APPOINTED BY THE GOVERNOR; AND THE TEMPO-
RARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY SHALL  EACH
APPOINT  A  MEMBER  WHO IS A REPRESENTATIVE OF AN AUTISM ADVOCACY GROUP.
EACH MEMBER SHALL SERVE A TERM OF TWO YEARS. THE GOVERNOR  SHALL  DESIG-
NATE  THE CHAIR OF THE PANEL FROM AMONG HIS OR HER APPOINTEES. VACANCIES
IN THE MEMBERSHIP OF THE PANEL SHALL BE FILLED IN  THE  MANNER  PROVIDED
FOR ORIGINAL APPOINTMENTS.
  (2)  THE  MEMBERS OF THE PANEL SHALL RECEIVE NO COMPENSATION FOR THEIR
SERVICES BUT SHALL  BE  ALLOWED  THEIR  ACTUAL  AND  NECESSARY  EXPENSES
INCURRED IN THE PERFORMANCE OF THEIR DUTIES PURSUANT TO THIS SUBSECTION.
  (3)  THE  ADVISORY PANEL ON HEALTH INSURANCE COVERAGE FOR AUTISM SPEC-
TRUM DISORDER SHALL ANNUALLY, ON OR BEFORE SEPTEMBER FIRST, COMPILE  AND
SUBMIT  TO THE SUPERINTENDENT A LIST OF SUCCESSFUL TREATMENT AND THERAPY
OPTIONS FOR AUTISM SPECTRUM DISORDER THAT WILL BE REQUIRED TO BE COVERED
PURSUANT TO PARAGRAPH TWENTY-FIVE OF SUBSECTION  (I)  OF  SECTION  THREE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

                                                           LBD03667-01-9

S. 385                              2

THOUSAND  TWO  HUNDRED SIXTEEN, PARAGRAPH SEVENTEEN OF SUBSECTION (1) OF
SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE  AND  SUBSECTION  (EE)  OF
SECTION FOUR THOUSAND THREE HUNDRED THREE OF THIS CHAPTER.
  (4)  WITHIN FORTY-FIVE DAYS OF RECEIPT OF EACH LIST SUBMITTED PURSUANT
TO PARAGRAPH THREE OF THIS SUBSECTION, THE SUPERINTENDENT SHALL,  ON  AN
EMERGENCY  BASIS, PROMULGATE AND IMPLEMENT RULES AND REGULATIONS REQUIR-
ING COVERAGE FOR THE TREATMENT AND THERAPY OPTIONS INCLUDED IN EACH SUCH
LIST.
  (B) (1) WITHIN ONE HUNDRED  EIGHTY  DAYS  OF  THE  SUBMISSION  OF  THE
INITIAL  LIST  TO  THE  SUPERINTENDENT  PURSUANT  TO  PARAGRAPH THREE OF
SUBSECTION (A) OF THIS SECTION, THE DEPARTMENT SHALL ESTABLISH AND OPER-
ATE AN AUTISM AND HEALTH INSURANCE COVERAGE HOTLINE. THE  HOTLINE  SHALL
BE A TOLL-FREE, TWENTY-FOUR HOUR A DAY CONSUMER CALL CENTER FOR FAMILIES
WITH  AUTISTIC CHILDREN WHO HAVE COMPLAINTS ABOUT OR QUESTIONS ON INSUR-
ERS AND COVERAGE FOR AUTISM SPECTRUM DISORDER. ALL  COMPLAINTS  RECEIVED
BY  SUCH  HOTLINE  SHALL  BE  DOCUMENTED AND REFERRED TO THE APPROPRIATE
OFFICIAL IN THE DEPARTMENT FOR CORRECTIVE ACTION.
  (2) THE DEPARTMENT MAY CONTRACT WITH A QUALIFIED NOT-FOR-PROFIT CORPO-
RATION FOR THE PROVISION AND OPERATION OF THE HOTLINE REQUIRED  BY  THIS
SUBSECTION. ANY SUCH CONTRACT SHALL ONLY BE AWARDED AFTER THE DEPARTMENT
HAS  CONDUCTED  A  REQUEST  FOR  PROPOSALS PROCESS. THE DEPARTMENT SHALL
SELECT A NOT-FOR-PROFIT CORPORATION WHICH HAS THE RESOURCES AND  ABILITY
TO  OPERATE  A  STATEWIDE  HOTLINE,  AND  IS STAFFED BY EMPLOYEES AND/OR
VOLUNTEERS WITH STRONG EXPERIENCE IN AUTISM SPECTRUM DISORDER.
  (3) IF THE DEPARTMENT ELECTS TO  ESTABLISH  AND  OPERATE  THE  HOTLINE
USING  ITS OWN PERSONNEL AND RESOURCES, SUCH HOTLINE SHALL BE STAFFED BY
OFFICERS AND EMPLOYEES WITH STRONG EXPERIENCE IN AUTISM SPECTRUM  DISOR-
DER.  UNTIL  THE  STATE  CIVIL SERVICE COMMISSION SHALL HAVE ESTABLISHED
CIVIL SERVICE TITLES  AND  COMPETITIVE  EXAMINATIONS  FOR  POSITIONS  AS
EMPLOYEES  OF THE HOTLINE, THE SUPERINTENDENT IS AUTHORIZED AND DIRECTED
TO APPOINT AND EMPLOY SUCH QUALIFIED OFFICERS AND EMPLOYEES AS SHALL  BE
NECESSARY TO OPERATE THE AUTISM AND HEALTH INSURANCE COVERAGE HOTLINE.
  (4)  THE  SUPERINTENDENT IS AUTHORIZED TO PROMULGATE AND IMPLEMENT ANY
RULES AND REGULATIONS NECESSARY TO CARRY  OUT  THE  PROVISIONS  OF  THIS
SUBSECTION.
  S  2.  Paragraph 25 of subsection (i) of section 3216 of the insurance
law, as added by chapter 557 of the laws of 2006, is amended to read  as
follows:
  (25)  Every  policy which provides coverage for hospital, surgical, or
medical care coverage shall [not exclude] INCLUDE FULL coverage for  THE
PREVENTION,  EARLY DETECTION, diagnosis and treatment of [medical condi-
tions otherwise covered by the policy solely because  the  treatment  is
provided  to  diagnose or treat] autism spectrum disorder.  For purposes
of this section, "autism  spectrum  disorder"  means  a  neurobiological
condition  that  includes autism, Asperger syndrome, Rett's syndrome, or
pervasive developmental disorder.
  S 3. Paragraph 17 of subsection (l) of section 3221 of  the  insurance
law,  as added by chapter 557 of the laws of 2006, is amended to read as
follows:
  (17) A group or blanket accident or health insurance policy or issuing
a group or blanket policy for delivery  in  this  state  which  provides
coverage  for  hospital,  surgical,  or medical care coverage shall [not
exclude] INCLUDE FULL coverage  for  THE  PREVENTION,  EARLY  DETECTION,
diagnosis  and treatment of [medical conditions otherwise covered by the
policy because the treatment is provided to diagnose  or  treat]  autism
spectrum  disorder.    For  purposes  of  this section, "autism spectrum

S. 385                              3

disorder" means a neurobiological condition that includes autism, Asper-
ger syndrome, Rett's syndrome, or pervasive developmental disorder.
  S 4. Subsection (ee) of section 4303 of the insurance law, as added by
chapter 557 of the laws of 2006, is amended to read as follows:
  (ee)  A  medical  expense  indemnity  corporation,  a hospital service
corporation or a health service corporation which provides coverage  for
hospital, surgical, or medical care coverage shall [not exclude] INCLUDE
FULL  coverage for THE PREVENTION, EARLY DETECTION, diagnosis and treat-
ment of [medical conditions  otherwise  covered  by  the  policy  solely
because  the treatment is provided to diagnose or treat] autism spectrum
disorder.   For purposes of this  section,  "autism  spectrum  disorder"
means   a  neurobiological  condition  that  includes  autism,  Asperger
syndrome, Rett's syndrome, or pervasive developmental disorder.
  S 5. This act shall take effect on the thirtieth day  after  it  shall
have become a law.

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