Sen. Fuschillo Calls For New Law To Ensure Children With Autism Get Health Insurance Coverage

June 03, 2009

State Senators Charles J. Fuschillo, Jr., Craig Johnson and Roy J. McDonald and Assemblyman Harvey Weisenberg today joined with advocates for children with autism to call on New York State to enact a law requiring private insurers to cover the costs of autism treatment and therapy.  A total of 47 State Senators and 41 State Assembly Members have signed on as sponsors of the legislation.

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).

             "This is vitally important legislation that will help thousands of families who have a loved one on the Autism Spectum. Good policy is neither democratic policy, nor republican policy, and I am proud to be partnering with Senator Fuschillo on this issue," said Senator Johnson (D-Port Washington).

             “Autism and similar type disabilities have become a nightmare for those affected and their family structure when it comes to the costs associated with services, something needs to be done now to ease their financial concerns. I know firsthand from the experiences with my grandsons, both 4 and 6 who suffer from autism, how costly and difficult coverage can be. Now is the time for action,” said Senator McDonald (R-Saratoga), Chair of the Senate Minority Task Force on Autism and Similar Disabilities.

"There is no doubt that early and consistent treatment is essential to children with autism if they are to reach their full potential. As the Assembly sponsor of this bill, it is my goal to ensure that children and their families have access to the coverage they need," said Assemblyman Weisenberg (D-Long Beach).

Diane Cahill, New York State Advocacy Chair for Autism Speaks, said “Families across the state are proud of the bi-partisan support this legislation has received, and we are compelling our leaders in the Senate and the Assembly to support this legislation, get it through committees, and onto the floor of the Senate and the Assembly for votes this Session.  Families across the state can no longer go without insurance coverage for autism. ”

Under the legislation (S. 2366/A. 6001), 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.