Senate Bill S4174

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4174
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 3, 2025
                                ___________
 
 Introduced  by  Sens. PARKER, ADDABBO, BAILEY, PERSAUD -- 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 346 to
 read as follows:
   §  346. 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 SUCH GOVERNOR'S  APPOINTEES.  VACANCIES  IN  THE
 MEMBERSHIP  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.
                                                            LBD07771-01-5
              

 S. 4174                             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.
   §  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
 2 of subpart A of part BB of chapter 57 of the laws of 2019, 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. 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
 S. 4174                             3
 
 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 spec-
 trum 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.  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 19
 of subpart A of part BB of chapter 57 of the laws of 2019,  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  screening, diagnosis and treatment of
 autism spectrum disorder in accordance with this paragraph and shall not
 exclude coverage for the PREVENTION, EARLY DETECTION, 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. This paragraph shall not be construed as limiting the  bene-
 fits  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 individ-
 ual solely because the individual  is  diagnosed  with  autism  spectrum
 disorder  or has received treatment for autism spectrum disorder. Cover-
 age 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.
   § 4. Paragraphs 1 and 2 of subsection (ee)  of  section  4303  of  the
 insurance law, paragraph 1 as amended by chapter 596 of the laws of 2011
 and  paragraph  2  as  amended  by section 31 of subpart A of part BB of
 chapter 57 of the laws of 2019, are amended to read as follows:
   (1) A medical expense indemnity corporation, a hospital service corpo-
 ration 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
 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 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
 S. 4174                             4
 
 the  PREVENTION,  EARLY  DETECTION, 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. 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 spec-
 trum 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.
   §  5.  This  act shall take effect on the thirtieth day after it shall
 have become a law.