Legislature approves expanded coverage for treatment of autism

Thomas F. O'Mara

June 17, 2011

Albany, N.Y., June 17—The New York State Legislature approved today landmark health care legislation co-sponsored by Senator Tom O’Mara (R-C, Big Flats) that would  require expanded health insurance coverage for the screening, diagnosis and treatment of autism spectrum disorder.

The legislation (S.4005/A.6305) was approved by both the Senate and Assembly earlier today. It will now be delivered to Governor Andrew  Cuomo to be signed into law.

“This important and landmark legislation seeks to ensure that families caring for an autistic child can get all of the medical care that meets their needs and circumstances.  It makes it clear that health insurance companies must consider autism as a condition like any other developmental disorder,” said O’Mara, noting Center for Disease Control (CDC) estimates that the number of children with autism is 1 in 110 nationwide.

Supporters of today’s legislation have argued that current law fails to require health insurance companies to provide coverage that adequately covers all of the costs related to autism treatments.  The new legislation would require insurance companies to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorders, including behavioral health treatments, speech therapy, occupational therapy, and physical therapy. Insurance companies would be prohibited from terminating coverage or refusing to renew, adjust, amend, issue, or execute a policy solely because the individual has been diagnosed with or received treatment for autism spectrum disorders.

Under existing law, parents of an autistic child are often faced with significant gaps in treatments covered by their insurance plan.  These families are often faced with having to pay significant out-of-pocket expenses for services.

The legislation builds upon an existing law which prevents insurance companies from denying treatment coverage otherwise covered by the policy solely because the treatment is provided to diagnose or treat an autism spectrum disorder.

If enacted into law, New York would join 25 other states which have already enacted similar autism insurance reform laws. It is supported by a number of different organizations, including Autism Speaks, the Medical Society of the State of New York, New York State Association for Behavior Analysis, and Families Together in New York State.

In a memo supporting the legislation, the Medical Society of the State of New York stated that the legislation “would expedite diagnosis and treatment by providing insurance parity for autism sufferers by requiring equitable coverage of the disorder by insurance companies.” Additionally, the Society noted that “treatment of autism spectrum disorders will result in better long-term health outcomes for those afflicted with this condition and should, therefore, lessen costs which are borne by taxpayers.”