Senate Bill S8138

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8138
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               May 15, 2025
                                ___________
 
 Introduced  by  Sen. PERSAUD -- read twice and ordered printed, and when
   printed to be committed to the Committee 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;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10105-01-5
 S. 8138                             2
              

 
   (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;
   (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.