S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9073
 
                           I N  A S S E M B L Y
 
                             February 6, 2024
                                ___________
 
 Introduced  by M. of A. SOLAGES -- read once and referred to the Commit-
   tee on Health
 
 AN ACT to amend the social services law, in  relation  to  studying  the
   adequacy of applied behavioral analysis provider networks
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Paragraph (jj) of subdivision 2 of  section  365-a  of  the
 social  services  law,  as  added by chapter 733 of the laws of 2022, is
 amended to read as follows:
   [(jj)] (NN) applied  behavior  analysis,  under  article  one  hundred
 sixty-seven  of the education law, provided by a person licensed, certi-
 fied, or otherwise authorized to provide applied behavior analysis under
 that article. BY DECEMBER FIRST OF EACH YEAR, THE COMMISSIONER OF HEALTH
 SHALL MAKE PUBLICLY AVAILABLE ON THE DEPARTMENT OF  HEALTH'S  WEBSITE  A
 REPORT CONCERNING ACCESS TO APPLIED BEHAVIOR ANALYSIS FOR ENROLLED CHIL-
 DREN  DIAGNOSED  WITH  AUTISM  SPECTRUM  DISORDER  MEETING THE FOLLOWING
 REQUIREMENTS:
   (I) THE DATA IN THE REPORT SHALL BE ORGANIZED  BY  CURRENT  PROCEDURAL
 TERMINOLOGY (CPT) CODE;
   (II) THE REPORT SHALL INCLUDE THE FOLLOWING INFORMATION FROM THE IMME-
 DIATELY PRECEDING FISCAL YEAR REGARDING THE MEDICAID PROGRAM:
   (A)  THE  NUMBER  OF LICENSED BEHAVIOR ANALYSTS AND CERTIFIED BEHAVIOR
 ANALYST ASSISTANTS PRACTICING IN THIS STATE WHO ARE MEDICAID PROVIDERS;
   (B) THE NUMBER OF MEDICAID ENROLLEES WHO ARE CHILDREN WITH  AN  AUTISM
 SPECTRUM DISORDER DIAGNOSIS;
   (C)  THE  NUMBER OF MEDICAID ENROLLEES WHO ARE CHILDREN WITH AN AUTISM
 SPECTRUM DISORDER DIAGNOSIS WHO RECEIVED APPLIED BEHAVIOR ANALYSIS;
   (D) THE NUMBER OF LICENSED BEHAVIOR ANALYSTS  AND  CERTIFIED  BEHAVIOR
 ANALYST  ASSISTANTS  WITH  WHOM  EACH  MEDICAID MANAGED CARE PLAN IN THE
 STATE HAS CONTRACTED, BY COUNTY;
   (E) THE MEDIAN NUMBER OF DAYS BETWEEN DIAGNOSIS OF  A  CHILD  WITH  AN
 AUTISM  SPECTRUM  DISORDER  AND  THE  TIME AT WHICH SUCH CHILD BEGINS TO
 RECEIVE APPLIED BEHAVIOR ANALYSIS;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD14099-01-4
              

 A. 9073                             2
 
   (F) THE NUMBER OF MEDICAID ENROLLEES WHO ARE CHILDREN WITH  AN  AUTISM
 SPECTRUM  DISORDER DIAGNOSIS WHO DID NOT RECEIVE APPLIED BEHAVIOR ANALY-
 SIS, DESPITE IT BEING RECOMMENDED BY THE CHILD'S HEALTH  CARE  PROVIDER,
 IF ASCERTAINABLE;
   (G)  THE  NUMBER  OF PRIOR AUTHORIZATION REQUESTS FOR APPLIED BEHAVIOR
 ANALYSIS THAT WERE DENIED AND THE NUMBER OF APPEALS RESULTING FROM THOSE
 DENIALS AND PARTIAL DENIALS;
   (H) THE MEDIAN OF RECOMMENDED HOURS AND THE MEDIAN OF  RECEIVED  HOURS
 OF  APPLIED  BEHAVIOR  ANALYSIS  FOR MEDICAID ENROLLEES WHO ARE CHILDREN
 WITH AN AUTISM SPECTRUM DISORDER DIAGNOSIS WHO  WERE  APPROVED  FOR  AND
 RECEIVED  APPLIED  BEHAVIOR  ANALYSIS  BUT DID NOT RECEIVE THE NUMBER OF
 HOURS OF TREATMENT RECOMMENDED BY THE CHILD'S HEALTH CARE  PROVIDER,  IF
 ASCERTAINABLE;
   (I) THE MEDIAN OF RECOMMENDED HOURS AND THE MEDIAN OF COVERED HOURS OF
 APPLIED  BEHAVIOR  ANALYSIS FOR MEDICAID ENROLLEES WHO ARE CHILDREN WITH
 AN AUTISM SPECTRUM DISORDER DIAGNOSIS  FOR  WHOM  THE  MEDICAID  PROGRAM
 COVERED  FEWER  BEHAVIOR  ANALYSIS  HOURS  THAN  WERE RECOMMENDED BY THE
 CHILD'S HEALTH CARE PROVIDER, IF ASCERTAINABLE;
   (J) RECOMMENDATIONS TO IMPROVE THE ADEQUACY OF THE NETWORK OF  APPLIED
 BEHAVIOR ANALYSIS PROVIDERS WHO ARE MEDICAID PROVIDERS; AND
   (K) OTHER RECOMMENDATIONS TO IMPROVE ACCESS TO APPLIED BEHAVIOR ANALY-
 SIS;
   (III)  THE  DEPARTMENT SHALL MAKE EVERY EFFORT TO COLLECT FROM APPLIED
 BEHAVIOR ANALYSIS PROVIDERS AND ENROLLEES ANY INFORMATION  NECESSARY  TO
 COMPILE THE REPORT REQUIRED BY THIS SECTION; AND
   (IV)  THE  DEPARTMENT  SHALL  DEVELOP EDUCATION AND OUTREACH MATERIALS
 THAT DO BOTH OF THE FOLLOWING:
   (A) INFORM AND EDUCATE PARENTS AND LEGAL GUARDIANS OF  ENROLLED  CHIL-
 DREN  WITH AN AUTISM SPECTRUM DISORDER DIAGNOSIS ABOUT RELEVANT SERVICES
 FOR WHICH THOSE CHILDREN ARE ELIGIBLE; AND
   (B) EXPLAIN HOW TO ACCESS THOSE SERVICES.
   § 2. This act shall take effect immediately.