Senate Bill S2707A

2013-2014 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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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Feb 24, 2014	print number 2707a
Feb 24, 2014	amend and recommit to insurance
Jan 08, 2014	referred to insurance
Jan 23, 2013	referred to insurance

Bill Amendments

Original

A (Active)

2013-S2707 - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Add §342, amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S385
2011-2012: S3405
2015-2016: S2751
2017-2018: S2222
2019-2020: S3251
2021-2022: S3301
2023-2024: S5762
2025-2026: S4174

2013-S2707 - 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.

2013-S2707 - Sponsor Memo

                                BILL NUMBER:S2707              REVISED 2/6/13

TITLE OF BILL:  An act to amend the insurance law, in relation to estab-
lishing an advisory panel on health insurance coverage for autism spec-
trum disorder

PURPOSE: To establish an advisory panel to report to the superintendent
regarding successful treatment options for autism spectrum disorder that
will be required to be covered by insurance.

SUMMARY OF PROVISIONS:

Section 1 adds section 342 to the insurance law to establish an advisory
panel on health insurance coverage to be composed of health profes-
sionals from the department of health, office of mental health, and/or
the office of people with developmental disabilities and representatives
of autism advocacy groups. These individuals will be appointed by the
governor, the temporary president of the senate, and the speaker of the
assembly. Additionally, this section requires the panel to submit an
annual report on treatment efficacy that will be covered by insurance,
as well as, establish a hotline to assist healthcare providers with the
insurance process.

Section 2 amends the insurance law as added by chapter 595 of the laws
of 2011, to include full coverage for diagnosis and treatment of autism
spectrum disorder.

Section 3 amends the insurance law, to include full coverage for screen-
ing, diagnosis and treatment of autism spectrum disorder.

Section 4 amends the insurance law, to include full coverage for diagno-
sis and treatment of autism spectrum disorder.

Section 5 Effective Date

JUSTIFICATION: According to the National Centers for Disease Control and
Prevention it is estimated that an average of 1 in 110 children in the
United States has an autism spectrum disorder (ASD). Research indicates
that early detection of ASD, when paired with proper intervention, can
lead to better outcomes for children. These outcomes include improved
language, social,and adaptive functioning, and a reduction in inappro-
priate behaviors. Consequently, it is critical to identify and refer
children with ASD as early as possible.

Unfortunately, many children with autism are not properly diagnosed
until years after the first symptoms appear. Until the passage of Chap-
ter 596 of the laws of New York 2011, most health insurance pans in the
state of New York did not cover autism treatment.

Now that ASD is included in the list of neurological disorders covered
by insurance it is imperative that we establish an advisory panel to

report on the successful treatment and therapy options which will be
required under the new law. It is also necessary to establish a hotline
for personnel to streamline insurance coverage questions that will like-
ly occur due to changes in the insurance law.

The passage of Chapter 596 of the Laws of New York 2011 (S.5845) is
major accomplishment in terms of decreasing exclusions in health insur-
ance based solely on the fact that an individual is diagnosed with
autism spectrum disorder. This bill takes this recently enacted law one
step further by including the prevention, diagnosis and treatment of
autism spectrum disorder, just as any other neurobiological condition
that would be included in hospital, surgical or medical care coverage.

LEGISLATIVE HISTORY: 2010-2011: S.3405 - Died in insurance but see Chap-
ter 596 of the Laws of New York 2011 2009-2010: S.385/A.2759 Died in
Insurance 2007-2008: S.3121/A.539 Died in Insurance

FISCAL IMPLICATION: Minimal.

EFFECTIVE DATE: This act shall take effect on the thirtieth day after it
becomes a law.

2013-S2707 - Bill Text download pdf

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

                                  2707

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 23, 2013
                               ___________

Introduced  by  Sen.  PARKER -- 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 establishing an  advi-
  sory panel on health insurance coverage for 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 FOR PEOPLE WITH DEVELOPMENTAL
DISABILITIES SHALL BE APPOINTED BY THE GOVERNOR; AND THE TEMPORARY PRES-
IDENT 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 DESIGNATE THE CHAIR
OF THE PANEL FROM AMONG HIS OR HER APPOINTEES. VACANCIES IN THE  MEMBER-
SHIP  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
THOUSAND TWO HUNDRED SIXTEEN, PARAGRAPH SEVENTEEN OF SUBSECTION  (1)  OF

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06971-01-3

S. 2707                             2

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.  Subparagraphs  (A) and (B) of paragraph 25 of subsection (i) of
section 3216 of the insurance law, subparagraph (A) as amended by  chap-
ter  595 of the laws of 2011, and subparagraph (B) as amended by chapter
596 of the laws of 2011, are amended to read as follows:
  (A) Every policy which provides  coverage  for  hospital  or  surgical
coverage  shall  [not exclude] INCLUDE FULL coverage for THE PREVENTION,
EARLY DETECTION, 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.
  (B) Every policy which provides  physician  services,  medical,  major
medical or similar comprehensive-type coverage shall provide FULL cover-
age for the PREVENTION, EARLY DETECTION, screening, diagnosis and treat-
ment  of  autism spectrum disorder in accordance with this paragraph and
shall not exclude coverage for the screening, diagnosis or treatment  of
medical  conditions otherwise covered by the policy because the individ-
ual is diagnosed with 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. Coverage for applied
behavior analysis shall be subject to a maximum  benefit  of  forty-five
thousand dollars per year per covered individual and such maximum annual
benefit will increase by the amount calculated from the average ten year

S. 2707                             3

rolling  average increase of the medical component of the consumer price
index. This paragraph shall not be construed as  limiting  the  benefits
that are otherwise available to an individual under the policy, provided
however  that  such  policy  shall not contain any limitations on visits
that are solely applied to the treatment of autism spectrum disorder. No
insurer shall terminate coverage or refuse to deliver,  execute,  issue,
amend,  adjust,  or  renew  coverage to an individual solely because the
individual is diagnosed with autism spectrum disorder  or  has  received
treatment  for  autism  spectrum  disorder. Coverage shall be subject to
utilization review and external appeals of health care services pursuant
to article forty-nine of this chapter as well as, case  management,  and
other managed care provisions.
  S  3.  Subparagraphs  (A) and (B) of paragraph 17 of subsection (l) of
section 3221 of the insurance law, subparagraph (A) as amended by  chap-
ter  595 of the laws of 2011, subparagraph (B) as amended by chapter 596
of the laws of 2011, are amended to read as follows:
  (A) Every group or blanket accident and health insurance policy deliv-
ered or issued for delivery in this state which  provides  coverage  for
hospital  or  surgical  care  coverage  shall [not exclude] INCLUDE FULL
coverage for THE PREVENTION, EARLY DETECTION, screening,  diagnosis  and
treatment  of medical conditions otherwise covered by the policy because
the treatment is provided to diagnose or treat autism spectrum disorder.
  (B) Every group or blanket policy which provides  physician  services,
medical,  major  medical  or  similar  comprehensive-type coverage shall
provide FULL coverage for the PREVENTION,  EARLY  DETECTION,  screening,
diagnosis  and  treatment of autism spectrum disorder in accordance with
this paragraph and shall not exclude coverage for the screening, diagno-
sis or treatment of medical conditions otherwise covered by  the  policy
because  the individual is diagnosed with autism spectrum disorder. Such
coverage may be subject to annual deductibles,  copayments  and  coinsu-
rance  as  may  be deemed appropriate by the superintendent and shall be
consistent with those imposed on other benefits under the group or blan-
ket policy. Coverage for applied behavior analysis shall be subject to a
maximum benefit of forty-five thousand  dollars  per  year  per  covered
individual  and  such maximum annual benefit will increase by the amount
calculated from the average ten year rolling  average  increase  of  the
medical  component of the consumer price index. This paragraph shall not
be construed as limiting the benefits that are otherwise available to an
individual under the group or blanket policy, provided however that such
policy shall not contain any  limitations  on  visits  that  are  solely
applied  to  the treatment of autism spectrum disorder. No insurer shall
terminate coverage or refuse to deliver, execute, issue, amend,  adjust,
or  renew  coverage  to  an  individual solely because the individual is
diagnosed with autism spectrum disorder or has  received  treatment  for
autism  spectrum  disorder.  Coverage  shall  be  subject to utilization
review and external appeals of health care services pursuant to  article
forty-nine  of  this  chapter  as  well  as,  case management, and other
managed care provisions.
  S 4. Subsection (ee) of section 4303 of the insurance law, as  amended
by chapter 596 of the laws of 2011, 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  or  surgical  care  coverage  shall [not exclude] INCLUDE FULL
coverage for THE PREVENTION, EARLY DETECTION, screening,  diagnosis  and
treatment of medical conditions otherwise covered by the contract solely

S. 2707                             4

because  the  treatment is provided to diagnose or treat autism spectrum
disorder.
  (2)  Every  contract which provides physician services, medical, major
medical or similar comprehensive-type coverage shall provide FULL cover-
age for the PREVENTION, EARLY DETECTION, screening, diagnosis and treat-
ment of autism spectrum disorder in accordance with this subsection  and
shall  not exclude coverage for the screening, diagnosis or treatment of
medical conditions otherwise covered by the contract because  the  indi-
vidual  is diagnosed with 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. Coverage for applied
behavior analysis shall be subject to a maximum  benefit  of  forty-five
thousand dollars per year per covered individual and such maximum annual
benefit will increase by the amount calculated from the average ten year
rolling  average increase of the medical component of the consumer price
index.  This paragraph shall not be construed as limiting  the  benefits
that  are  otherwise  available  to  an  individual  under the contract,
provided however that such contract shall not contain any limitations on
visits that are solely applied  to  the  treatment  of  autism  spectrum
disorder.  No  insurer  shall  terminate  coverage or refuse to deliver,
execute, issue, amend, adjust, or renew coverage to an individual solely
because the individual is diagnosed with autism spectrum disorder or has
received treatment for  autism  spectrum  disorder.  Coverage  shall  be
subject  to  utilization  review  and  external  appeals  of health care
services pursuant to article forty-nine of this chapter as well as, case
management, and other managed care provisions.
  S 5. This act shall take effect on the thirtieth day  after  it  shall
have become a law.

2013-S2707A (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Add §342, amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S385
2011-2012: S3405
2015-2016: S2751
2017-2018: S2222
2019-2020: S3251
2021-2022: S3301
2023-2024: S5762
2025-2026: S4174

2013-S2707A (ACTIVE) - Summary

2013-S2707A (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S2707A

TITLE OF BILL:  An act to amend the insurance law, in relation to
establishing an advisory panel on health insurance coverage for autism
spectrum disorder

PURPOSE: To establish an advisory panel to report to the
superintendent regarding successful treatment options for autism
spectrum disorder that will be required to be covered by insurance.

SUMMARY OF PROVISIONS:

Section 1 adds section 342 to the insurance law to establish an
advisory panel on health insurance coverage to be composed of health
professionals from the department of health, office of mental health,
and/or the office of people with developmental disabilities and
representatives of autism advocacy groups. These individuals will be
appointed by the governor, the temporary president of the senate, and
the speaker of the assembly. Additionally, this section requires the
panel to submit an annual report on treatment efficacy that will be
covered by insurance, as well as, establish a hotline to assist
healthcare providers with the insurance process.

Section 2 amends the insurance law as added by chapter 56 of the laws
of 2013, to include full coverage for diagnosis and treatment of
autism spectrum disorder.

Section 3 amends the insurance law, to include full coverage for
screening, diagnosis and treatment of autism spectrum disorder.

Section 4 amends the insurance law, to include full coverage for
diagnosis and treatment of autism spectrum disorder.

Section 5 Effective Date

JUSTIFICATION: According to the National Centers for Disease Control
and Prevention it is estimated that an average of 1 in 110 children in
the United States has an autism spectrum disorder (ASD). Research
indicates that early detection of ASD, when paired with proper
intervention, can lead to better outcomes for children. These outcomes
include improved language, social, and adaptive functioning, and a
reduction in inappropriate behaviors.

Consequently, it is critical to identify and refer children with ASD
as early as possible.

Unfortunately, many children with autism are not properly diagnosed
until years after the first symptoms appear. Until the passage of
Chapter 596 of the laws of New York 2011, most health insurance plans
in the state of New York did not cover autism treatment.

Now that ASD is included in the list of neurological disorders covered
by insurance it is imperative that we establish an advisory panel to
report on the successful treatment and therapy options which will be
required under the new law. It is also necessary to establish a
hotline for personnel to streamline insurance coverage questions that
will likely occur due to changes in the insurance law.


The passage of Chapter 596 of the Laws of New York 2011 (S.5845) is
major accomplishment in terms of decreasing exclusions in health
insurance based solely on the fact that an individual is diagnosed
with autism spectrum disorder. This bill takes this recently enacted
law one step further by including the prevention, diagnosis and
treatment of autism spectrum disorder, just as any other
neurobiological condition that would be included in hospital, surgical
or medical care coverage.

LEGISLATIVE HISTORY:  2010-2011: S.3405 - Died in insurance; but see
Chapter 596 of the Laws of New York 2011 2009-2010: S.385/A.2759 Died
in Insurance 2007-2008: S.3121/A.539 Died in Insurance

FISCAL IMPLICATION: Minimal.

EFFECTIVE DATE: This act shall take effect on the thirtieth day after
it becomes a law.

2013-S2707A (ACTIVE) - Bill Text download pdf

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

                                 2707--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 23, 2013
                               ___________

Introduced  by  Sen.  PARKER -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance  --  recommitted
  to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
  --  committee  discharged,  bill amended, ordered reprinted as amended
  and recommitted to said committee

AN ACT to amend the insurance law, in relation to establishing an  advi-
  sory panel on health insurance coverage for 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 FOR PEOPLE WITH DEVELOPMENTAL
DISABILITIES SHALL BE APPOINTED BY THE GOVERNOR; AND THE TEMPORARY PRES-
IDENT 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 DESIGNATE THE CHAIR
OF THE PANEL FROM AMONG HIS OR HER APPOINTEES. VACANCIES IN THE  MEMBER-
SHIP  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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06971-02-4

S. 2707--A                          2

PURSUANT  TO  PARAGRAPH  TWENTY-FIVE  OF SUBSECTION (I) OF SECTION THREE
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.  Subparagraphs  (A) and (B) of paragraph 25 of subsection (i) of
section 3216 of the insurance law, subparagraph (A) as amended by  chap-
ter  595 of the laws of 2011, and subparagraph (B) as amended by section
38 of part D of chapter 56 of the laws of 2013, are amended to  read  as
follows:
  (A)  Every  policy  which  provides  coverage for hospital or surgical
coverage shall [not exclude] INCLUDE FULL coverage for  THE  PREVENTION,
EARLY  DETECTION,  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.
  (B)  Every  policy  that  provides  physician services, medical, major
medical or similar comprehensive-type coverage shall provide FULL cover-
age for the screening, diagnosis and treatment of autism spectrum disor-
der in accordance with this paragraph and shall not exclude coverage for
the PREVENTION, EARLY DETECTION, screening, diagnosis  or  treatment  of
medical  conditions otherwise covered by the policy because the individ-
ual is diagnosed with 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. Coverage for applied

S. 2707--A                          3

behavior analysis shall be subject to a maximum benefit of  six  hundred
eighty  hours of treatment per policy or calendar year per covered indi-
vidual. This paragraph shall not be construed as limiting  the  benefits
that are otherwise available to an individual under the policy, provided
however  that  such  policy  shall not contain any limitations on visits
that are solely applied to the treatment of autism spectrum disorder. No
insurer shall terminate coverage or refuse to deliver,  execute,  issue,
amend,  adjust,  or  renew  coverage to an individual solely because the
individual is diagnosed with autism spectrum disorder  or  has  received
treatment  for  autism  spectrum  disorder. Coverage shall be subject to
utilization review and external appeals of health care services pursuant
to article forty-nine of this chapter as well as, case  management,  and
other managed care provisions.
  S  3.  Subparagraphs  (A) and (B) of paragraph 17 of subsection (l) of
section 3221 of the insurance law, subparagraph (A) as amended by  chap-
ter  595  of the laws of 2011, subparagraph (B) as amended by section 39
of part D of chapter 56 of the laws of 2013,  are  amended  to  read  as
follows:
  (A) Every group or blanket accident and health insurance policy deliv-
ered  or  issued  for delivery in this state which provides coverage for
hospital or surgical care coverage  shall  [not  exclude]  INCLUDE  FULL
coverage  for  THE PREVENTION, EARLY DETECTION, screening, diagnosis and
treatment of medical conditions otherwise covered by the policy  because
the treatment is provided to diagnose or treat autism spectrum disorder.
  (B)  Every  group  or blanket policy that provides physician services,
medical, major medical  or  similar  comprehensive-type  coverage  shall
provide  FULL  coverage  for the PREVENTION, EARLY DETECTION, screening,
diagnosis and treatment of autism spectrum disorder in  accordance  with
this paragraph and shall not exclude coverage for the screening, diagno-
sis  or  treatment of medical conditions otherwise covered by the policy
because the individual is diagnosed with autism spectrum disorder.  Such
coverage  may  be  subject to annual deductibles, copayments and coinsu-
rance as may be deemed appropriate by the superintendent  and  shall  be
consistent with those imposed on other benefits under the group or blan-
ket policy. Coverage for applied behavior analysis shall be subject to a
maximum  benefit  of six hundred eighty hours of treatment per policy or
calendar year per  covered  individual.  This  paragraph  shall  not  be
construed  as  limiting  the benefits that are otherwise available to an
individual under the group or blanket policy, provided however that such
policy shall not contain any  limitations  on  visits  that  are  solely
applied  to  the treatment of autism spectrum disorder. No insurer shall
terminate coverage or refuse to deliver, execute, issue, amend,  adjust,
or  renew  coverage  to  an  individual solely because the individual is
diagnosed with autism spectrum disorder or has  received  treatment  for
autism  spectrum  disorder.  Coverage  shall  be  subject to utilization
review and external appeals of health care services pursuant to  article
forty-nine  of  this  chapter  as  well  as,  case management, and other
managed care provisions.
  S 4. Subsection (ee) of section 4303 of the insurance law, as  amended
by chapter 596 of the laws of 2011 and paragraph 2 as amended by section
40  of  part  D of chapter 56 of the laws of 2013, 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 or surgical care coverage  shall  [not  exclude]  INCLUDE  FULL
coverage  for  THE PREVENTION, EARLY DETECTION, screening, diagnosis and

S. 2707--A                          4

treatment of medical conditions otherwise covered by the contract solely
because the treatment is provided to diagnose or treat  autism  spectrum
disorder.
  (2)  Every  contract  that provides physician services, medical, major
medical or similar comprehensive-type coverage  shall  provide  coverage
for  the  screening, diagnosis and treatment of autism spectrum disorder
in accordance with this paragraph and shall not  exclude  FULL  coverage
for  the  PREVENTION, EARLY DETECTION, screening, diagnosis or treatment
of medical conditions otherwise covered  by  the  contract  because  the
individual is diagnosed with 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. Coverage for applied
behavior  analysis  shall be subject to a maximum benefit of six hundred
eighty hours of treatment per contract  or  calendar  year  per  covered
individual.  This paragraph shall not be construed as limiting the bene-
fits that are otherwise available to an individual under  the  contract,
provided however that such contract shall not contain any limitations on
visits  that  are  solely  applied  to  the treatment of autism spectrum
disorder. No insurer shall terminate  coverage  or  refuse  to  deliver,
execute, issue, amend, adjust, or renew coverage to an individual solely
because the individual is diagnosed with autism spectrum disorder or has
received  treatment  for  autism  spectrum  disorder.  Coverage shall be
subject to utilization  review  and  external  appeals  of  health  care
services pursuant to article forty-nine of this chapter as well as, case
management, and other managed care provisions.
  S  5.  This  act shall take effect on the thirtieth day after it shall
have become a law.

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Senate Bill S2707A

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Sponsored By

Kevin S. Parker

Archive: Last Bill Status - In Senate Committee Insurance Committee

Actions

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2013-S2707 - Details

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