Senate Bill S4996

2011-2012 Legislative Session

Requires requiring health insurance policies to provide coverage for medically necessary care for the treatment of autism spectrum disorder

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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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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 04, 2012	referred to insurance
May 02, 2011	referred to insurance

2011-S4996 (ACTIVE) - Details

See Assembly Version of this Bill:: A1611
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: A11432
2013-2014: S3890, A5917
2015-2016: A6236
2017-2018: A3172
2019-2020: A2877

2011-S4996 (ACTIVE) - Summary

Requires health insurance policies to provide coverage for screening, tests, assessments and treatment including any medically necessary care for the treatment of autism spectrum disorder, including Asperger's disorder and pervasive developmental disorders.

2011-S4996 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S4996

TITLE OF BILL:
An act
to amend the insurance law, in relation to requiring health insurance
policies to provide coverage for medically necessary care for the
treatment of autism spectrum disorder

PURPOSE:
This legislation will require health insurance policies to provide
coverage for medically necessary care for the treatment of autism
spectrum disorder and Asperger's disorder. This coverage will include
hospital or surgical care, all diagnostic screening tests,
assessments and treatments, rehabilitation, speech, behavioral,
occupational and physical therapies, pediatric, neurological,
gastro-enterologic and any other medically necessary care that is
provided by a licensed provider required for the treatment of autism
spectrum disorder and Asperger's disorder and pervasive developmental
disorders as determined by the treatment physician.

SUMMARY OF PROVISIONS:
Section 1 amends paragraph 25 of section 3216 of the insurance law, to
state that every policy that provides coverage for hospital,
surgical, medical care must provide the diagnosis and treatment
(which includes all diagnostic screening, tests, and assessments and
treatments, as well as habilitation, rehabilitation, speech,

behavioral, occupational and physical therapies, pediatric,
neurological, gastro-enterologic and any other medically necessary
care) of autism spectrum disorder.

Section 1 also defines "Autism Spectrum Disorder" as a neurobiological
condition that includes autism, Asperger syndrome, Rett's syndrome,
or pervasive developmental disorder.

Section 2 Amends section 3221 of the insurance law, as added by
chapter 557 of the laws of 2006, to state that a blanket accident
policy, health insurance policy, or issuing group or blanket policy
which provide hospital, surgical, or medical care coverage must
provide the diagnosis and treatment of autism spectrum disorder.

Section 3 Amends section 4303 of the insurance law as added
by chapter 557 of
the laws of 2006, to state that a medical expanse indemnity
corporation, a hospital service corporation or a health service
corporation which provides coverage for hospital surgical, or medical
conditions must provide coverage for diagnosis and treatment of
autism spectrum disorder.

JUSTIFICATION:
Autism typically appears during the first three years of life. Studies
have shown that early diagnosis and intervention lead to
significantly improved outcomes.

There are tens of thousands of families in New York State who are
paying out-of-pocket to provide their loved ones with the therapies
they need and deserve in order to live a full and active life. The


lifetime costs for raising a child with autism ranges from 53.5
million to 55 million.
This immense financial burden that comes with caring for a person with
an Autism Spectrum Disorder has left many families with no choice but
to incur massive debts in order to ensure their loved one is properly
cared for. No family should have to chose between bankruptcy and
forgoing certain treatments that could greatly improve their loved
ones quality of life.

This legislation will allow parents of children with Autism and
Asperger's worry about the health and progress of their child, rather
than the cost of treatment.

LEGISLATIVE HISTORY:
This is a new bill.

FISCAL IMPLICATIONS:
None noted.

EFFECTIVE DATE:
This act shall take effect January 1st next succeeding the date
on which it shall have become a law and shall apply to all
policies or contracts issued, renewed, modified, altered
or amended on and after such effective date.

2011-S4996 (ACTIVE) - Bill Text download pdf

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

                                  4996

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                               May 2, 2011
                               ___________

Introduced  by  Sen.  BALL  --  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
  insurance  policies  to  provide coverage for medically necessary care
  for the 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.  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)  (A) Every policy which provides coverage for hospital, surgical,
or medical care coverage shall not exclude coverage  for  diagnosis  and
treatment  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.
  (B) EVERY POLICY WHICH PROVIDES COVERAGE FOR  HOSPITAL,  SURGICAL,  OR
MEDICAL  CARE  COVERAGE  SHALL PROVIDE ANY AND ALL DIAGNOSTIC SCREENING,
TESTS, AND ASSESSMENTS AND TREATMENT INCLUDING MEDICAL  CARE,  CONSULTA-
TION, HABILITATION, REHABILITATION, SPEECH, BEHAVIORAL, OCCUPATIONAL AND
PHYSICAL THERAPIES, PEDIATRIC, NEUROLOGICAL, GASTRO-ENTEROLOGIC, AND ANY
OTHER  MEDICALLY  NECESSARY CARE THAT IS PROVIDED BY A LICENSED PROVIDER
REQUIRED FOR  THE  TREATMENT  OF  AUTISM  SPECTRUM  DISORDER,  INCLUDING
ASPERGER'S  DISORDER AND PERVASIVE DEVELOPMENTAL DISORDERS AS DETERMINED
BY THE TREATING PHYSICIAN.
  S 2. Paragraph 17 of subsection (1) 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) A group or blanket accident or  health  insurance  policy  or
issuing  a  group  or  blanket  policy  for delivery in this state which

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03999-01-1

S. 4996                             2

provides coverage for hospital, surgical, or medical care coverage shall
not exclude coverage for 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 disorder" means  a  neurobiological  condition
that  includes  autism, Asperger syndrome, Rett's syndrome, or pervasive
developmental disorder.
  (B) EVERY POLICY WHICH PROVIDES COVERAGE FOR  HOSPITAL,  SURGICAL,  OR
MEDICAL  CARE  COVERAGE  SHALL PROVIDE ANY AND ALL DIAGNOSTIC SCREENING,
TESTS, AND ASSESSMENTS AND TREATMENT INCLUDING MEDICAL  CARE,  CONSULTA-
TION, HABILITATION, REHABILITATION, SPEECH, BEHAVIORAL, OCCUPATIONAL AND
PHYSICAL THERAPIES, PEDIATRIC, NEUROLOGICAL, GASTRO-ENTEROLOGIC, AND ANY
OTHER  MEDICALLY  NECESSARY CARE THAT IS PROVIDED BY A LICENSED PROVIDER
REQUIRED FOR  THE  TREATMENT  OF  AUTISM  SPECTRUM  DISORDER,  INCLUDING
ASPERGER'S  DISORDER AND PERVASIVE DEVELOPMENTAL DISORDERS AS DETERMINED
BY THE TREATING PHYSICIAN.
  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) (1) 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  coverage
for  diagnosis  and treatment 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, Asper-
ger syndrome, Rett's syndrome, or pervasive developmental disorder.
  (2) EVERY POLICY WHICH PROVIDES COVERAGE FOR  HOSPITAL,  SURGICAL,  OR
MEDICAL  CARE  COVERAGE  SHALL PROVIDE ANY AND ALL DIAGNOSTIC SCREENING,
TESTS, AND ASSESSMENTS AND TREATMENT INCLUDING MEDICAL  CARE,  CONSULTA-
TION, HABILITATION, REHABILITATION, SPEECH, BEHAVIORAL, OCCUPATIONAL AND
PHYSICAL THERAPIES, PEDIATRIC, NEUROLOGICAL, GASTRO-ENTEROLOGIC, AND ANY
OTHER  MEDICALLY  NECESSARY CARE THAT IS PROVIDED BY A LICENSED PROVIDER
REQUIRED FOR  THE  TREATMENT  OF  AUTISM  SPECTRUM  DISORDER,  INCLUDING
ASPERGER'S  DISORDER AND PERVASIVE DEVELOPMENTAL DISORDERS AS DETERMINED
BY THE TREATING PHYSICIAN.
  S 4. This act shall take effect on the first of January next  succeed-
ing  the date on which it shall have become a law and shall apply to all
policies or contracts issued, renewed, modified, altered or  amended  on
and after such effective date.

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Senate Bill S4996

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

Actions

2011-S4996 (ACTIVE) - Details

2011-S4996 (ACTIVE) - Summary

2011-S4996 (ACTIVE) - Sponsor Memo

2011-S4996 (ACTIVE) - Bill Text download pdf

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Sponsored By

Greg Ball

Archive: Last Bill Status - In Senate Committee Insurance Committee

Actions

2011-S4996 (ACTIVE) - Details

2011-S4996 (ACTIVE) - Summary

2011-S4996 (ACTIVE) - Sponsor Memo

2011-S4996 (ACTIVE) - Bill Text download pdf

Comments