S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7913
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              August 4, 2023
                                ___________
 
 Introduced  by  M.  of A. SIMON, JENSEN -- read once and referred 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.  Subparagraphs (B) and (C) of paragraph  25  of  subsection
 (i) of section 3216 of the insurance law, subparagraph (B) as amended by
 section  2  of  subpart  A of part BB of chapter 57 of the laws of 2019,
 subparagraph (C) as amended by chapter 596 of the laws  of  2011,  items
 (i)  and  (iii) of subparagraph (C) as amended by section 3 of subpart A
 of part BB of chapter 57 of the laws of 2019, are  amended  to  read  as
 follows:
   (B)  Every  policy  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 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 appropriate by the super-
 intendent and shall be consistent with those imposed on  other  benefits
 under  the policy.   COVERAGE FOR APPLIED BEHAVIOR ANALYSIS AND DEVELOP-
 MENTAL, INDIVIDUAL-DIFFERENCES, RELATIONSHIP-BASED  TREATMENT  SHALL  BE
 SUBJECT  TO  A  MAXIMUM BENEFIT OF SIX HUNDRED EIGHTY HOURS OF TREATMENT
 PER POLICY DURING A 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, EXCEPT AS PROVIDED
 IN  THIS  SUBPARAGRAPH  FOR  COVERAGE  FOR APPLIED BEHAVIOR ANALYSIS AND
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09798-01-3
              

 A. 7913                             2
 
 DEVELOPMENTAL, INDIVIDUAL DIFFERENCES, RELATIONSHIP-BASED TREATMENT.  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.
   (C) For purposes of this paragraph:
   (i) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 statistical manual of mental disorders, INCLUDING, BUT NOT  LIMITED  TO,
 AUTISTIC SPECTRUM DISORDER.
   (ii) "applied behavior analysis" means the design, implementation, and
 evaluation  of environmental modifications, using behavioral stimuli and
 consequences, to  produce  socially  significant  improvement  in  human
 behavior,  including  the  use  of  direct observation, measurement, and
 functional analysis of the relationship between environment  and  behav-
 ior.
   (iii)  "behavioral  health  treatment"  means counseling and treatment
 programs, INCLUDING DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES AND  RELATION-
 SHIP-BASED  TREATMENT,  when  provided  by  a  licensed  provider WITH A
 PROFESSIONAL CERTIFICATE IN DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELA-
 TIONSHIP-BASED TREATMENT FROM THE INTERDISCIPLINARY COUNCIL ON  DEVELOP-
 MENT  AND  LEARNING,  and  applied behavior analysis, when provided by a
 person licensed, certified or otherwise authorized  to  provide  applied
 behavior  analysis, that are necessary to develop, maintain, or restore,
 to the maximum extent practicable, the  functioning  of  an  individual.
 INDIVIDUALS  THAT  PROVIDE  BEHAVIORAL HEALTH TREATMENT UNDER THE SUPER-
 VISION OF A LICENSED  PROVIDER  PURSUANT  TO  THIS  PARAGRAPH  SHALL  BE
 SUBJECT  TO STANDARDS OF PROFESSIONALISM, SUPERVISION AND RELEVANT EXPE-
 RIENCE PURSUANT TO REGULATIONS  PROMULGATED  BY  THE  SUPERINTENDENT  IN
 CONSULTATION WITH THE COMMISSIONERS OF HEALTH AND EDUCATION.
   (iv) "diagnosis of autism spectrum disorder" means assessments, evalu-
 ations,  or  tests to diagnose whether an individual has autism spectrum
 disorder.
   (v) "pharmacy care" means medications prescribed by a licensed  health
 care  provider  legally authorized to prescribe under title eight of the
 education law.
   (vi) "psychiatric care" means direct or consultative services provided
 by a psychiatrist licensed in the state in which the psychiatrist  prac-
 tices.
   (vii)  "psychological  care"  means  direct  or  consultative services
 provided by a psychologist licensed in the state in which  the  psychol-
 ogist practices.
   (viii)  "therapeutic  care"  means  services  provided  by licensed or
 certified [speech therapists, occupational therapists,  social  workers,
 or  physical  therapists] PROVIDERS IN THE FIELDS OF COUNSELING, OCCUPA-
 TIONAL THERAPY, PHYSICAL THERAPY, SOCIAL WORK, OR  SPEECH  AND  LANGUAGE
 PATHOLOGY.
   (ix) "treatment of autism spectrum disorder" shall include the follow-
 ing  care  and assistive communication devices prescribed or ordered for
 an individual diagnosed with autism  spectrum  disorder  by  a  licensed
 physician or a licensed psychologist:
   (1) behavioral health treatment;
   (2) psychiatric care;
 A. 7913                             3

   (3) psychological care;
   (4) medical care provided by a licensed health care provider;
   (5) therapeutic care, including therapeutic care which is deemed habi-
 litative or nonrestorative, in the event that the policy provides cover-
 age for therapeutic care; and
   (6)  pharmacy  care in the event that the policy provides coverage for
 prescription drugs.
   (X) "DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELATIONSHIP-BASED  TREAT-
 MENT" MEANS THE IMPLEMENTATION OF A FLOORTIME INTERVENTION THAT IS BASED
 ON  AN  ASSESSMENT  OF FUNCTIONAL-EMOTIONAL DEVELOPMENT AND THE PERSON'S
 INDIVIDUAL  PROFILE,  WHILE  UNDERSTANDING  THAT  HUMAN  DEVELOPMENT  IS
 FOSTERED  IN THE CONTEXT OF RELATIONSHIPS WITH OTHERS.  THE PRIMARY GOAL
 IS TO PROMOTE DEVELOPMENT AND ADDRESS DEVELOPMENTAL CHALLENGES AND DEFI-
 CITS THAT OFTEN ACCOMPANY AUTISM AND OTHER NEURODEVELOPMENTAL DISORDERS.
   § 2. Subparagraphs (B) and (C) of paragraph 17 of  subsection  (l)  of
 section  3221  of  the  insurance  law,  subparagraph  (B) as amended by
 section 19 of subpart A of part BB of chapter 57 of the  laws  of  2019,
 subparagraph  (C)  as  amended by chapter 596 of the laws of 2011, items
 (i) and (iii) of subparagraph (C) as amended by section 20 of subpart  A
 of  part  BB  of  chapter 57 of the laws of 2019, are amended to read as
 follows:
   (B) Every group or blanket policy 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 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  AND  DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES,
 RELATIONSHIP-BASED TREATMENT SHALL BE SUBJECT TO A  MAXIMUM  BENEFIT  OF
 SIX  HUNDRED EIGHTY HOURS OF TREATMENT PER POLICY DURING A CALENDAR YEAR
 PER COVERED INDIVIDUAL. This paragraph shall not be construed as  limit-
 ing 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, EXCEPT AS PROVIDED IN THIS SUBPARA-
 GRAPH FOR COVERAGE FOR  APPLIED  BEHAVIOR  ANALYSIS  AND  DEVELOPMENTAL,
 INDIVIDUAL  DIFFERENCES,  RELATIONSHIP-BASED TREATMENT. 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.
   (C) For purposes of this paragraph:
   (i) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 statistical manual of mental disorders, INCLUDING, BUT NOT  LIMITED  TO,
 AUTISTIC SPECTRUM DISORDER.
   (ii) "applied behavior analysis" means the design, implementation, and
 evaluation  of environmental modifications, using behavioral stimuli and
 consequences, to  produce  socially  significant  improvement  in  human
 A. 7913                             4
 
 behavior,  including  the  use  of  direct observation, measurement, and
 functional analysis of the relationship between environment  and  behav-
 ior.
   (iii)  "behavioral  health  treatment"  means counseling and treatment
 programs,  INCLUDING  DEVELOPMENTAL,  INDIVIDUAL-DIFFERENCES,  RELATION-
 SHIP-BASED  TREATMENT,  when  provided  by  a  licensed  provider WITH A
 PROFESSIONAL CERTIFICATE IN DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELA-
 TIONSHIP-BASED TREATMENT FROM THE INTERDISCIPLINARY COUNCIL ON  DEVELOP-
 MENT  AND  LEARNING,  and  applied behavior analysis, when provided by a
 person licensed, certified or otherwise authorized  to  provide  applied
 behavior  analysis, that are necessary to develop, maintain, or restore,
 to the maximum extent practicable, the  functioning  of  an  individual.
 INDIVIDUALS  THAT  PROVIDE  BEHAVIORAL HEALTH TREATMENT UNDER THE SUPER-
 VISION OF A LICENSED  PROVIDER  PURSUANT  TO  THIS  PARAGRAPH  SHALL  BE
 SUBJECT  TO STANDARDS OF PROFESSIONALISM, SUPERVISION AND RELEVANT EXPE-
 RIENCE PURSUANT TO REGULATIONS  PROMULGATED  BY  THE  SUPERINTENDENT  IN
 CONSULTATION WITH THE COMMISSIONERS OF HEALTH AND EDUCATION.
   (iv) "diagnosis of autism spectrum disorder" means assessments, evalu-
 ations,  or  tests to diagnose whether an individual has autism spectrum
 disorder.
   (v) "pharmacy care" means medications prescribed by a licensed  health
 care  provider  legally authorized to prescribe under title eight of the
 education law.
   (vi) "psychiatric care" means direct or consultative services provided
 by a psychiatrist licensed in the state in which the psychiatrist  prac-
 tices.
   (vii)  "psychological  care"  means  direct  or  consultative services
 provided by a psychologist licensed in the state in which  the  psychol-
 ogist practices.
   (viii)  "therapeutic  care"  means  services  provided  by licensed or
 certified [speech therapists, occupational therapists,  social  workers,
 or  physical  therapists] PROVIDERS IN THE FIELDS OF COUNSELING, OCCUPA-
 TIONAL THERAPY, PHYSICAL THERAPY, SOCIAL WORK, OR  SPEECH  AND  LANGUAGE
 PATHOLOGY.
   (ix) "treatment of autism spectrum disorder" shall include the follow-
 ing  care  and assistive communication devices prescribed or ordered for
 an individual diagnosed with autism  spectrum  disorder  by  a  licensed
 physician or a licensed psychologist:
   (1) behavioral health treatment;
   (2) psychiatric care;
   (3) psychological care;
   (4) medical care provided by a licensed health care provider;
   (5) therapeutic care, including therapeutic care which is deemed habi-
 litative or nonrestorative, in the event that the policy provides cover-
 age for therapeutic care; and
   (6)  pharmacy  care in the event that the policy provides coverage for
 prescription drugs.
   (X) "DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELATIONSHIP-BASED  TREAT-
 MENT" MEANS THE IMPLEMENTATION OF A FLOORTIME INTERVENTION THAT IS BASED
 ON  AN  ASSESSMENT  OF FUNCTIONAL-EMOTIONAL DEVELOPMENT AND THE PERSON'S
 INDIVIDUAL  PROFILE,  WHILE  UNDERSTANDING  THAT  HUMAN  DEVELOPMENT  IS
 FOSTERED  IN  THE CONTEXT OF RELATIONSHIPS WITH OTHERS. THE PRIMARY GOAL
 IS TO PROMOTE DEVELOPMENT AND ADDRESS DEVELOPMENTAL CHALLENGES AND DEFI-
 CITS THAT OFTEN ACCOMPANY AUTISM AND OTHER NEURODEVELOPMENTAL DISORDERS.
   § 3. Paragraphs 2 and 3 of subsection (ee)  of  section  4303  of  the
 insurance law, paragraph 2 as amended by section 31 of subpart A of part
 A. 7913                             5
 
 BB  of chapter 57 of the laws of 2019, paragraph 3 as amended by chapter
 596 of the laws of 2011, subparagraphs (A) and (C)  of  paragraph  3  as
 amended  by section 32 of subpart A of part BB of chapter 57 of the laws
 of 2019, are amended to read as follows:
   (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 coverage 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 super-
 intendent and shall be consistent with those imposed on  other  benefits
 under the contract.  COVERAGE FOR APPLIED BEHAVIOR ANALYSIS AND DEVELOP-
 MENTAL,  INDIVIDUAL-DIFFERENCES,  RELATIONSHIP-BASED  TREATMENT SHALL BE
 SUBJECT TO A MAXIMUM BENEFIT OF SIX HUNDRED EIGHTY  HOURS  OF  TREATMENT
 PER POLICY DURING A 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  however  that
 such contract shall not contain any limitations on visits that are sole-
 ly  applied  to  the  treatment  of  autism spectrum disorder, EXCEPT AS
 PROVIDED IN THIS SUBPARAGRAPH FOR COVERAGE FOR APPLIED BEHAVIOR ANALYSIS
 AND DEVELOPMENTAL, INDIVIDUAL DIFFERENCES, RELATIONSHIP-BASED TREATMENT.
 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.
   (3) For purposes of this subsection:
   (A) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 statistical manual of mental disorders, INCLUDING, BUT NOT  LIMITED  TO,
 AUTISTIC SPECTRUM DISORDER.
   (B)  "applied behavior analysis" means the design, implementation, and
 evaluation of environmental modifications, using behavioral stimuli  and
 consequences,  to  produce  socially  significant  improvement  in human
 behavior, including the use  of  direct  observation,  measurement,  and
 functional  analysis  of the relationship between environment and behav-
 ior.
   (C) "behavioral  health  treatment"  means  counseling  and  treatment
 programs,  INCLUDING  DEVELOPMENTAL,  INDIVIDUAL-DIFFERENCES,  RELATION-
 SHIP-BASED TREATMENT, when  provided  by  a  licensed  provider  WITH  A
 PROFESSIONAL CERTIFICATE IN DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELA-
 TIONSHIP-BASED  TREATMENT FROM THE INTERDISCIPLINARY COUNCIL ON DEVELOP-
 MENT AND LEARNING, and applied behavior analysis,  when  provided  by  a
 person  that  is  licensed, certified or otherwise authorized to provide
 applied behavior analysis, that are necessary to develop,  maintain,  or
 restore,  to the maximum extent practicable, the functioning of an indi-
 vidual.  INDIVIDUALS THAT PROVIDE BEHAVIORAL HEALTH TREATMENT UNDER  THE
 SUPERVISION  OF A LICENSED PROVIDER PURSUANT TO THIS SUBSECTION SHALL BE
 SUBJECT TO STANDARDS OF PROFESSIONALISM, SUPERVISION AND RELEVANT  EXPE-
 RIENCE  PURSUANT  TO  REGULATIONS  PROMULGATED  BY THE SUPERINTENDENT IN
 CONSULTATION WITH THE COMMISSIONERS OF HEALTH AND EDUCATION.
 A. 7913                             6

   (D) "diagnosis of autism spectrum disorder" means assessments,  evalu-
 ations,  or  tests to diagnose whether an individual has autism spectrum
 disorder.
   (E)  "pharmacy care" means medications prescribed by a licensed health
 care provider legally authorized to prescribe under title eight  of  the
 education law.
   (F)  "psychiatric care" means direct or consultative services provided
 by a psychiatrist licensed in the state in which the psychiatrist  prac-
 tices.
   (G)   "psychological  care"  means  direct  or  consultative  services
 provided by a psychologist licensed in the state in which  the  psychol-
 ogist practices.
   (H)  "therapeutic  care" means services provided by licensed or certi-
 fied [speech therapists, occupational  therapists,  social  workers,  or
 physical therapists] PROVIDERS IN THE FIELDS OF COUNSELING, OCCUPATIONAL
 THERAPY,   PHYSICAL   THERAPY,  SOCIAL  WORK,  OR  SPEECH  AND  LANGUAGE
 PATHOLOGY.
   (I) "treatment of autism spectrum disorder" shall include the  follow-
 ing  care  and assistive communication devices prescribed or ordered for
 an individual diagnosed with autism  spectrum  disorder  by  a  licensed
 physician or a licensed psychologist:
   (i) behavioral health treatment;
   (ii) psychiatric care;
   (iii) psychological care;
   (iv) medical care provided by a licensed health care provider;
   (v) therapeutic care, including therapeutic care which is deemed habi-
 litative or nonrestorative, in the event that the policy provides cover-
 age for therapeutic care; and
   (vi)  pharmacy  care  in the event that the contract provides coverage
 for prescription drugs.
   § 4. This act shall take effect on the ninetieth day  after  it  shall
 have become a law.