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

                                10372--A

                          I N  A S S E M B L Y

                             March 19, 2010
                               ___________

Introduced  by  M.  of A. MORELLE, SILVER, WEISENBERG, NOLAN, SCHROEDER,
  LAVINE, LUPARDO, GOTTFRIED, PERRY, STIRPE, HEVESI, CUSICK,  J. RIVERA,
  SWEENEY, JAFFEE, ZEBROWSKI, GALEF, MAISEL, SPANO, BRODSKY, HYER-SPENC-
  ER  --  Multi-Sponsored  by -- M. of A. BALL, CALHOUN, DESTITO, ENGLE-
  BRIGHT, JORDAN, LIFTON, RAIA -- read once and referred to the  Commit-
  tee on Insurance -- reported and referred to the Committee on Ways and
  Means  --  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
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]

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

                                                           LBD16099-13-0

A. 10372--A                         2

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
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

A. 10372--A                         3

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
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

A. 10372--A                         4

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.
  (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

A. 10372--A                         5

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.