Charles J. Fuschillo Jr.

May 15, 2009

Photo caption: Senator Fuschillo (right) speaks with Merrick resident Michael Giangregorio about his legislation requiring insurance companies to cover treatment costs for children with autism. Mr. Giangreogrio, who has an eight year old son with autism, joined with Senator Fuschillo in calling on the State to enact the legislation into law.

State Senator Charles J. Fuschillo, Jr. today joined with Merrick residents Michael and Alison Giangregorio, whose eight year old son Nicholas has autism, in calling on New York State to enact a law requiring private insurers to cover the costs of treatment and therapy for children with autism.

Currently, children with autism throughout New York State are routinely denied insurance benefits for treatment of their disorder, forcing their parents to pay the costs out of their own pockets. Therapy costs for children with autism typically run between $20,000 - $50,000 per year.

"Many parents who have children with autism face a choice that no parent should ever have to make; face financial ruin or stop getting treatments for their child. Requiring insurance coverage for medically prescribed treatments and care for children with autism will ensure that parents can get their children the healthcare they need without having to lose everything they own in order to do it," said Senator Fuschillo (R-Merrick).

"Over the years, my family has spent well over $85,000, which has depleted savings and reduced retirement savings to pay for supplemental treatment for our son which exceeded what is mandated through our school district and not covered by our insurance. Far too many other families have been forced to do the same thing. Some could not even get treatment for their child because their finances were exhausted. In the case of a child with autism, doing without care or diluting care could mean the loss of critical opportunities. New York State needs to act to stop this. This law would help ensure that my son, my family, and all of the other families like ours all across the State will have equal access through their insurance company to obtain treatment for autism spectrum disorders while not affecting services mandated under their child's education plan. The passage of the legislation will undoubtedly ease the financial burden for many of the families who, by accepting a certain placement, are forced to forgo equally necessary treatments or make sacrifices due to financial restrictions and I thank Senator Fuschillo for fighting for us," said Michael Giangregorio.  

Under the legislation being sponsored by Senator Fuschillo, private insurance companies would be required to offer coverage for Applied Behavior Analysis (ABA) for children with autism ages 21 and under. ABA, an evidence-based behavioral intervention, is the treatment of choice for many children with autism. The American Academy of Pediatrics has noted its decades-long record of efficacy as has the Surgeon General of the United States.

Treatments that would be covered under the proposed law include medications, speech therapy, occupational therapy, physical therapy, applied behavioral analysis, counseling, psychiatric and psychological care and any other care determined by the State Department of Health to be medically necessary.

The maximum coverage benefit would be $36,000 through December 31, 2010, after which the benefit would be adjusted annually for inflation by the New York State Superintendent of Insurance. There would be no limits on the number of visits an individual may make to an autism provider (up to the $36,000 limit). Payments made by an insurer for treatment or care unrelated to autism spectrum disorders would not be applied towards the maximum benefit.

Ten states require health insurers to provide autism services, including, Indiana, South Carolina, Texas, Arizona, Florida, Louisiana, Pennsylvania, Illinois, New Mexico and Montana. Bills requiring the coverage are pending in more than twenty other states, including Connecticut, New Jersey, Massachusetts, New Hampshire and Maine.

Autism is a complex neurobiological disorder that typically lasts throughout a person’s lifetime. It is the fastest growing developmental disability in the United States, and is more common than pediatric cancer, AIDS, and diabetes combined. It is part of a group of disorders known as autism spectrum disorders (ASD). According to the Center for Disease Control, 1 in 150 children are diagnosed with ASD. It occurs in all racial, ethnic, and social groups and is four times more likely to strike boys than girls. Autism impairs a person’s ability to communicate and relate to others. Symptoms can range from very mild to quite severe.

Early intervention is critical for children with autism. ABA has been proven extremely effective in helping children struggling with autism. Several studies have shown that as many as 47 percent of the children that undergo early intensive behavioral therapies achieve higher education placement and increased IQs. Many of the children who receive ABA are placed into mainstream educational settings.