S T A T E O F N E W Y O R K
________________________________________________________________________
7000--B
I N S E N A T E
March 5, 2010
___________
Introduced by Sens. BRESLIN, DUANE, C. JOHNSON, FOLEY, FUSCHILLO, HUNT-
LEY, MORAHAN, McDONALD, HASSELL-THOMPSON, ADAMS, ADDABBO, BONACIC,
DeFRANCISCO, DIAZ, DILAN, ESPADA, FARLEY, GOLDEN, GRIFFO, HANNON,
O. JOHNSON, KRUEGER, KRUGER, LANZA, LARKIN, LAVALLE, LITTLE, MARCELLI-
NO, MONTGOMERY, NOZZOLIO, ONORATO, OPPENHEIMER, PADAVAN, PARKER,
PERKINS, ROBACH, SALAND, SAMPSON, SAVINO, SCHNEIDERMAN, SERRANO,
SMITH, SQUADRON, STAVISKY, STEWART-COUSINS, THOMPSON, VALESKY, VOLKER
-- read twice and ordered printed, and when printed to be committed to
the Committee on Insurance -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee --
reported favorably from said committee and committed to the Committee
on Codes -- reported favorably from said committee and committed to
the Committee on Finance -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law and the public health law, in relation
to coverage for the screening, diagnosis and treatment of autism spec-
trum disorder
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. 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] PROVIDE coverage for THE
SCREENING, diagnosis and treatment of [medical conditions otherwise
covered by the policy solely because the treatment is provided to diag-
nose or treat] autism spectrum disorder IN ACCORDANCE WITH THIS PARA-
GRAPH AND SHALL NOT EXCLUDE COVERAGE FOR THE TREATMENT OF MEDICAL CONDI-
TIONS OTHERWISE COVERED BY THE POLICY BECAUSE THE INDIVIDUAL IS
DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER. SUCH COVERAGE MAY BE
SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE
DEEMED APPROPRIATE BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH
THOSE IMPOSED ON OTHER BENEFITS UNDER THE POLICY. THIS PARAGRAPH SHALL
NOT BE CONSTRUED AS LIMITING THE BENEFITS THAT ARE OTHERWISE AVAILABLE
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD16099-12-0
S. 7000--B 2
TO AN INDIVIDUAL UNDER THE POLICY. COVERAGE MAY BE SUBJECT TO UTILIZA-
TION REVIEW OF HEALTH CARE SERVICES, INCLUDING THE REVIEW OF MEDICAL
NECESSITY, CASE MANAGEMENT, AND OTHER MANAGED CARE PROVISIONS.
(A) For purposes of this [section] PARAGRAPH, "autism spectrum disor-
der" means a GROUP OF neurobiological [condition that includes autism,
Asperger syndrome, Rett's syndrome, or pervasive developmental disorder]
CONDITIONS DEFINED IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
DISORDERS IV REVISED, OR ITS SUCCESSOR, AS PERVASIVE DEVELOPMENTAL
DISORDERS.
(B) THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE SUPERINTEN-
DENT, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS-
SIONER OF THE OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILI-
TIES SHALL, NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS
SUBPARAGRAPH, PROMULGATE AND THEREAFTER REGULARLY UPDATE, REGULATIONS
WHICH SHALL IDENTIFY TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE
SHALL BE REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM
SPECTRUM DISORDER PURSUANT TO THIS PARAGRAPH. SUCH TREATMENT AND THERAPY
OPTIONS SHALL BE EVIDENCE-BASED, PEER-REVIEWED AND CLINICALLY PROVEN.
COVERAGE FOR BEHAVIORAL THERAPIES REQUIRED PURSUANT TO THIS SUBPARAGRAPH
SHALL NOT BE DENIED ON THE BASIS THAT SUCH THERAPIES ARE EDUCATIONAL OR
HABILITATIVE IN NATURE, UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE
COVERED PERSON PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTI-
CLE EIGHTY-NINE OF THE EDUCATION LAW. THE PROVISION OF SERVICES PURSU-
ANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND
FIVE HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED
EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE OF THE EDUCATION LAW OR AN
INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE OFFICE OF
MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES 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.
(C) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI-
GATION TO PROVIDE SERVICES TO AN INDIVIDUAL UNDER AN INDIVIDUALIZED
FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE HUNDRED FORTY-FIVE
OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED SERVICE PLAN
PURSUANT TO REGULATIONS OF THE OFFICE OF MENTAL RETARDATION AND DEVELOP-
MENT DISABILITIES.
(D) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI-
GATION TO PROVIDE COVERAGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE
BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES
PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS
ARTICLE OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE
OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES.
(E) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT A POLICY
FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING PROVIDERS WHO
SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUDING PROVIDER
CREDENTIALING.
S 2. 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] EVERY group or blanket accident [or] AND health insurance
policy [or issuing a group or blanket policy for delivery in this state]
DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE which provides coverage
for hospital, surgical, or medical care coverage shall [not exclude]
PROVIDE coverage for THE SCREENING, diagnosis and treatment of [medical
S. 7000--B 3
conditions otherwise covered by the policy because the treatment is
provided to diagnose or treat] autism spectrum disorder IN ACCORDANCE
WITH THIS PARAGRAPH AND SHALL NOT EXCLUDE COVERAGE FOR THE TREATMENT OF
MEDICAL CONDITIONS OTHERWISE COVERED BY THE POLICY BECAUSE THE INDIVID-
UAL IS DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER. SUCH COVERAGE MAY BE
SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE
DEEMED APPROPRIATE BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH
THOSE IMPOSED ON OTHER BENEFITS UNDER THE POLICY. THIS PARAGRAPH SHALL
NOT BE CONSTRUED AS LIMITING THE BENEFITS THAT ARE OTHERWISE AVAILABLE
TO AN INDIVIDUAL UNDER THE POLICY. COVERAGE MAY BE SUBJECT TO UTILIZA-
TION REVIEW OF HEALTH CARE SERVICES, INCLUDING THE REVIEW OF MEDICAL
NECESSITY, CASE MANAGEMENT, AND OTHER MANAGED CARE PROVISIONS.
(A) For purposes of this [section] PARAGRAPH, "autism spectrum disor-
der" means a GROUP OF neurobiological [condition that includes autism,
Asperger syndrome, Rett's syndrome, or pervasive developmental disorder]
CONDITIONS DEFINED IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
DISORDERS IV REVISED, OR ITS SUCCESSOR, AS PERVASIVE DEVELOPMENTAL
DISORDERS.
(B) THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE SUPERINTEN-
DENT, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS-
SIONER OF THE OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILI-
TIES SHALL, NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS
SUBPARAGRAPH, PROMULGATE AND THEREAFTER REGULARLY UPDATE, REGULATIONS
WHICH SHALL IDENTIFY TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE
SHALL BE REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM
SPECTRUM DISORDER PURSUANT TO THIS PARAGRAPH. SUCH TREATMENT AND THERAPY
OPTIONS SHALL BE EVIDENCE-BASED, PEER-REVIEWED AND CLINICALLY PROVEN.
COVERAGE FOR BEHAVIORAL THERAPIES REQUIRED PURSUANT TO THIS SUBPARAGRAPH
SHALL NOT BE DENIED ON THE BASIS THAT SUCH THERAPIES ARE EDUCATIONAL OR
HABILITATIVE IN NATURE, UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE
COVERED PERSON PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTI-
CLE EIGHTY-NINE OF THE EDUCATION LAW. THE PROVISION OF SERVICES PURSU-
ANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND
FIVE HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED
EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE OF THE EDUCATION LAW OR AN
INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE OFFICE OF
MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES 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.
(C) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI-
GATION TO PROVIDE SERVICES TO AN INDIVIDUAL UNDER AN INDIVIDUALIZED
FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE HUNDRED FORTY-FIVE
OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED SERVICE PLAN
PURSUANT TO REGULATIONS OF THE OFFICE OF MENTAL RETARDATION AND DEVELOP-
MENT DISABILITIES.
(D) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI-
GATION TO PROVIDE COVERAGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE
BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES
PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS
ARTICLE OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE
OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES.
(E) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT A POLICY
FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING PROVIDERS WHO
S. 7000--B 4
SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUDING PROVIDER
CREDENTIALING.
S 3. 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] PROVIDE
coverage for THE SCREENING, 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 IN ACCORDANCE
WITH THIS SUBSECTION AND SHALL NOT EXCLUDE COVERAGE FOR THE TREATMENT OF
MEDICAL CONDITIONS OTHERWISE COVERED BY THE POLICY BECAUSE THE INDIVID-
UAL IS DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER. SUCH COVERAGE MAY BE
SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE
DEEMED APPROPRIATE BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH
THOSE IMPOSED ON OTHER BENEFITS UNDER THE CONTRACT. THIS SUBSECTION
SHALL NOT BE CONSTRUED AS LIMITING THE BENEFITS THAT ARE OTHERWISE
AVAILABLE TO AN INDIVIDUAL UNDER THE CONTRACT. COVERAGE MAY BE SUBJECT
TO UTILIZATION REVIEW OF HEALTH CARE SERVICES, INCLUDING THE REVIEW OF
MEDICAL NECESSITY, CASE MANAGEMENT, AND OTHER MANAGED CARE PROVISIONS.
(1) For purposes of this [section] SUBSECTION, "autism spectrum disor-
der" means a GROUP OF neurobiological [condition that includes autism,
Asperger syndrome, Rett's syndrome, or pervasive developmental disorder]
CONDITIONS DEFINED IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
DISORDERS IV REVISED, OR ITS SUCCESSOR, AS PERVASIVE DEVELOPMENTAL
DISORDERS.
(2) THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE SUPERINTEN-
DENT, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS-
SIONER OF THE OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILI-
TIES SHALL, NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS
SUBPARAGRAPH, PROMULGATE AND THEREAFTER REGULARLY UPDATE, REGULATIONS
WHICH SHALL IDENTIFY TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE
SHALL BE REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM
SPECTRUM DISORDER PURSUANT TO THIS SUBSECTION. SUCH TREATMENT AND THERA-
PY OPTIONS SHALL BE EVIDENCE-BASED, PEER-REVIEWED AND CLINICALLY PROVEN.
COVERAGE FOR BEHAVIORAL THERAPIES REQUIRED PURSUANT TO THIS PARAGRAPH
SHALL NOT BE DENIED ON THE BASIS THAT SUCH THERAPIES ARE EDUCATIONAL OR
HABILITATIVE IN NATURE, UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE
COVERED PERSON PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTI-
CLE EIGHTY-NINE OF THE EDUCATION LAW. THE PROVISION OF SERVICES PURSU-
ANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND
FIVE HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED
EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE OF THE EDUCATION LAW OR AN
INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE OFFICE OF
MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES SHALL NOT AFFECT
COVERAGE UNDER THE CONTRACT FOR SERVICES PROVIDED ON A SUPPLEMENTAL
BASIS OUTSIDE OF AN EDUCATIONAL SETTING IF SUCH SERVICES ARE DEEMED
MEDICALLY NECESSARY.
(3) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO AFFECT ANY OBLI-
GATION TO PROVIDE SERVICES TO AN INDIVIDUAL UNDER AN INDIVIDUALIZED
FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE HUNDRED FORTY-FIVE
OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED SERVICE PLAN
PURSUANT TO REGULATIONS OF THE OFFICE OF MENTAL RETARDATION AND DEVELOP-
MENTAL DISABILITIES.
S. 7000--B 5
(4) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO AFFECT ANY OBLI-
GATION TO PROVIDE COVERAGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE
BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES
PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS
CHAPTER OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE
OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES.
(5) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO PREVENT A
CONTRACT FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING
PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
ING PROVIDER CREDENTIALING.
S 4. Section 2500-j of the public health law is amended by adding a
new subdivision 4 to read as follows:
4. THE COMMISSIONER, IN CONSULTATION WITH THE SUPERINTENDENT OF INSUR-
ANCE, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS-
SIONER OF THE OFFICE OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILI-
TIES, SHALL PROMULGATE NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE
DATE OF THIS SUBDIVISION, AND REGULARLY UPDATE, REGULATIONS WHICH SHALL
IDENTIFY TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE SHALL BE
REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM
DISORDER PURSUANT TO SECTIONS THREE THOUSAND TWO HUNDRED SIXTEEN, THREE
THOUSAND TWO HUNDRED TWENTY-ONE AND FOUR THOUSAND THREE HUNDRED THREE OF
THE INSURANCE LAW.
S 5. Severability clause. If any clause, sentence, paragraph, subdivi-
sion, section or part of this act shall be adjudged by any court of
competent jurisdiction to be invalid, such judgment shall not affect,
impair, or invalidate the remainder thereof, but shall be confined in
its operation to the clause, sentence, paragraph, subdivision, section
or part thereof directly involved in the controversy in which such judg-
ment shall have been rendered. It is hereby declared to be the intent of
the legislature that this act would have been enacted even if such
invalid provisions had not been included herein.
S 6. This act shall take effect immediately, provided that sections
one, two and three of this act shall take effect upon the promulgation
of either emergency or permanent rules and regulations by the commis-
sioner of health outlining the treatment insurers are required to
provide to cover autism spectrum disorder as provided for in this act
and shall apply to all policies or contracts issued, renewed, modified,
altered or amended on and after such effective date; provided that the
commissioner of health shall notify the legislative bill drafting
commission upon the promulgation of such emergency or permanent rules
and regulations in order that the commission may maintain an accurate
and timely effective data base of the official text of the laws of the
state of New York in furtherance of effectuating the provisions of
section 44 of the legislative law and section 70-b of the public offi-
cers law.
