Holding Health Insurers Accountable
The Senate Democratic Majority passed groundbreaking legislation to protect children with autism, setting the bar for a new national standard for treatment and services. The legislation (S7000B/Breslin) requires early intervention screening, diagnosis and treatment for autism spectrum disorders, saving families facing autism thousands of dollars a year.
Despite research demonstrating that early intervention and intensive behavioral therapies can yield significant improvement in the quality of life for those with autism, diagnosis and treatment have been excluded from coverage by health insurance carriers in New York.
The prior insurance law did not provide clarity to consumers or insurers as to the scope of the required coverage. This bill includes an updated definition of autism spectrum disorder, and tells insurers what must be covered. The Commissioner of Health would be responsible for publicizing regulations identifying treatment and therapy options for autism coverage.
Twenty states previously spoke up for those affected by autism by passing legislation to provide them with insurance coverage. The passage of this much needed legislation would make New York the 21st state to require such coverage. This bill is one of the strongest in the nation, not only requiring policies to cover autism, but does so without a financial cap. Furthermore, the coverage is extended for the entire life span of the individual.
The bill would only allow evidence-based and clinically proven treatments to be covered.
Senator Neil D. Breslin (D-Albany), Chair of the Insurance Committee and sponsor of the bill said, “This law would restore the voice of those indirectly affected by autism. Many families paying out-of-pocket for autism treatments risk their homes and the educations of their unaffected children, mortgaging their entire futures for something that should be covered by basic health insurance.”
Senator Shirley L. Huntley (D-Queens) said, “Autism is a developmental disorder that effects many children and families across New York State and the nation. The rates of children with Autism has been increasing over the decades, and more and more parents are having to find ways to pay for varied types of treatment and therapy for their autistic children. This bill gives parents and families increased options and access to treatments and decreases out of pocket costs. The availability of extra resources will enable parents to be more proactive and involved with understanding the disorder and how to effectively take action. A bill like this is long overdue, and will benefit the lives of many New Yorkers.”
Senator Brian X. Foley (D-Blue Point) said, "Families of children with autism spectrum disorders are constantly looking for ways to help their children to better experience the world and to receive the treatment necessary to improve their quality of life. Too often, these families have difficulty accessing these services and treatment programs because they cannot afford to pay for it out of their own pockets. Requiring insurance companies to cover the cost of these treatments will help to ease the burden on many of the families who are living with this disease."
Senator Andrea Stewart-Cousins (D-Westchester) said, “For years, due to vague State requirements, the people across State of New York have not been able to receive full or even partial coverage for autism spectrum disorder. I am pleased to stand with my colleagues in support of legislation that both clarifies the required scope of coverage to consumers and insurers, and will allow individuals with autism to receive coverage they deserve for the screening, diagnosis and treatment of this disorder. As a result, these New Yorkers will no longer be forced to choose between an impossible financial burden and the proper health care for a family member.”
The Centers for Disease Control have now estimated that the number of children with autism is 1 in 110 nationwide, up from previous estimates of 1 in 150. The numbers are even more stark in New York, with the autism rate for children increasing by about 15-percent per year. Recent studies have shown that close to 1 in 90 children are affected by autism. Currently, there are 17,000 students ages 4 to 21 classified by New York schools as having autism.
Senate President Pro Tempore Malcolm A. Smith said, “There are many challenges facing the parents of autistic children and this simple fix will greatly help to alleviate the financial burden on them. I commend Senator Breslin for his dedication to making sure that children with autism are able to receive the coverage that will allow them to be diagnosed earlier and treated for as long as necessary.”
Senator Thomas K. Duane (D-Manhattan), chair of the Health Committee said, "This bill is an enormous first step forward. By requiring that insurers cover services that have passed a level of evidence-based clinical scrutiny, those who are living with autism will receive better coverage and, at the same time, insurers will not be required to cover clinically unproven treatments. Today's passage of S7000B is a proud moment for this legislative body."
Senator Suzi Oppenheimer (D-Mamaroneck) said, “This legislation is an important step in providing insurance parity for thousands of New Yorkers who are affected by autism spectrum disorders. I applaud Senator Breslin for his leadership in moving this vital health insurance initiative through the Senate.”
Senator Craig M. Johnson (D-Nassau) said, “Every day I hear the horror stories from families who have re-mortgaged their homes and taken second and third jobs in order to pay for the autism-related treatments that their children need. Insurance companies are supposed to be there to help families during times of crisis. Today, we are ensuring that these companies live up to their responsibility.”
Senator David J. Valesky (D-Oneida) said, “Often, families affected by autism are forced to pay for medical treatment on their own without the support of insurance agencies. This legislation gives families the ability to rely on their insurance to help alleviate some of that financial impact.”
"For the increasing number of families affected by this issue, the challenges presented by autism should not be compounded by a lack of treatment options and financial fears. As insurance chairman, it is my hope that this bill will bring peace of mind to parents and a higher degree of care and hope for children on the autism spectrum,” said Assemblyman Joseph Morelle (D- Irondequoit), Chair of the Assembly Insurance Committee.
“Providing care for a family member with autism should not result in a choice between financial hardship and access to medical assistance. Sadly, that has been the case for too long. This bill will ease some of those burdens. It is my hope that these changes will result in better outcomes, improved quality of life and better access to vital services for families,” said Assemblyman Harvey Weisenberg (D-Nassau).
Assemblyman Mark Schroeder (D-Buffalo) said, "Public awareness is growing about the prevalence of autism spectrum disorders, and with that awareness there is a rising demand that insurance companies recognize the obstacles presented by these disorders. Chairman Morelle's and Senator Breslin’s bill is an initial step toward the parity these children and their families deserve."
“People often lament the political gridlock in Albany, but this legislation is an important reminder of what our elected officials can and will do to help New York’s families,” said Bob Wright, co-founder of Autism Speaks. “Families here and around the country are literally going broke trying to give children the therapies they need and deserve to meet their full potential. It’s time that we eliminate this unfair burden and end insurers’ blatant discrimination against children with autism in every state in America.”
"The passage of S. 7000B is an important step toward coverage of evidence-based autism treatment for New York families who have historically been discriminated against by the very health plans to which they pay premiums," said Judith Ursitti, Autism Speaks regional director of state advocacy relations. "We thank Senator Breslin, in particular, for his commitment and leadership on this issue."
"The Autism Science Foundation is proud to support S. 7000B, which will enable thousands of New York families to receive the benefit of evidence based, clinically proven interventions and treatments for autism spectrum disorders, like Applied Behavior Analysis therapy (ABA), as well as screening and diagnostic services" said Alison Singer, Westchester County resident and President of the Autism Science Foundation. "Research has shown that evidence-based intensive behavioral therapies like ABA can result in significant improvement in the cognition, communication and well-being of people with autism spectrum disorder."
“We enthusiastically support Senator Breslin and his colleagues in their efforts to bring equity in insurance coverage to children and adults who are challenged by autism and autism spectrum disorder.” said Dr. Henry Schaeffer, Chair of the American Academy of Pediatrics, District II, New York State. “The more than 5,000 pediatricians across the state who provide health care to more than 4 million children stand with you in your work to assure that all children and families, no matter what their physical, psychological or intellectual challenges, can get the health care they need to live productive and healthy lives.”
“The Asperger Syndrome and High Functioning Autism Association celebrates the New York State Senate’s actions in passing S. 7000B and affording autistic individuals access to quality health care,” said Patricia R. Schissel, LMSW, President, AHA Asperger Syndrome and High Functioning Autism Association (AHA) Inc. “We welcome the Senate’s willingness to stand with us in our undying support of those whose lives have been touched by autism.”
To view the press conference announcing this legislation prior to the vote visit