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

                                  3664

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            February 13, 2015
                               ___________

Introduced  by  Sen.  ORTT  --  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  coverage  for  the
  screening, 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. Subparagraph (B) of  paragraph  25  of  subsection  (i)  of
section 3216 of the insurance law, as amended by section 38 of part D of
chapter 56 of the laws of 2013, is amended to read as follows:
  (B)  Every  policy  [that] WHICH 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  cover-
age  for  the  screening,  diagnosis  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 deduct-
ibles, copayments and coinsurance as may be deemed  appropriate  by  the
superintendent and shall be consistent with those imposed on other bene-
fits  under the 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 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09014-01-5

              

S. 3664                             2

forty-nine  of  this  chapter  as  well  as,  case management, and other
managed care provisions.
  S  2.  Subparagraph  (B)  of paragraph 17 of subsection (l) of section
3221 of the insurance law, as amended by section 39 of part D of chapter
56 of the laws of 2013, is amended to read as follows:
  (B) Every group or blanket  policy  [that]  WHICH  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  coverage  for  the screening, diagnosis 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 coinsurance as may be deemed appro-
priate by the superintendent and shall be consistent with those  imposed
on  other  benefits  under  the  group  or blanket 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 treat-
ment 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  disor-
der.  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.  Paragraph 2 of subsection (ee) of section 4303 of the insurance
law, as amended by section 40 of part D of chapter 56  of  the  laws  of
2013, is amended to read as follows:
  (2)  Every contract [that] WHICH 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  cover-
age  for  the  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 benefits that are
otherwise available to an individual under the contract, provided howev-
er 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 4. This act shall take effect immediately.