Bill Text: NY S03974 | 2013-2014 | General Assembly | Introduced
Bill Title: Relates to coverage for the screening, diagnosis and treatment of autism spectrum disorder; removes provisions of the monetary limit for coverage of applied behavior analysis.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2014-01-08 - REFERRED TO INSURANCE [S03974 Detail]
Download: New_York-2013-S03974-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
3974
2013-2014 Regular Sessions
I N S E N A T E
March 1, 2013
___________
Introduced by Sen. CARLUCCI -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to coverage for the
screening, diagnosis and treatment of autism spectrum disorder
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Subparagraph (B) of paragraph 25 of subsection (i) of
2 section 3216 of the insurance law, as amended by chapter 596 of the laws
3 of 2011, is amended to read as follows:
4 (B) Every policy which provides physician services, medical, major
5 medical or similar comprehensive-type coverage shall provide coverage
6 for the screening, diagnosis and treatment of autism spectrum disorder
7 in accordance with this paragraph and shall not exclude coverage for the
8 screening, diagnosis or treatment of medical conditions otherwise
9 covered by the policy because the individual is diagnosed with autism
10 spectrum disorder. Such coverage may be subject to annual deductibles,
11 copayments and coinsurance as may be deemed appropriate by the super-
12 intendent and shall be consistent with those imposed on other benefits
13 under the policy. [Coverage for applied behavior analysis shall be
14 subject to a maximum benefit of forty-five thousand dollars per year per
15 covered individual and such maximum annual benefit will increase by the
16 amount calculated from the average ten year rolling average increase of
17 the medical component of the consumer price index.] This paragraph shall
18 not be construed as limiting the benefits that are otherwise available
19 to an individual under the policy, provided however that such policy
20 shall not contain any limitations on visits that are solely applied to
21 the treatment of autism spectrum disorder. No insurer shall terminate
22 coverage or refuse to deliver, execute, issue, amend, adjust, or renew
23 coverage to an individual solely because the individual is diagnosed
24 with autism spectrum disorder or has received treatment for autism spec-
25 trum disorder. Coverage shall be subject to utilization review and
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03639-01-3
S. 3974 2
1 external appeals of health care services pursuant to article forty-nine
2 of this chapter as well as, case management, and other managed care
3 provisions.
4 S 2. Subparagraph (B) of paragraph 17 of subsection (l) of section
5 3221 of the insurance law, as amended by chapter 596 of the laws of
6 2011, is amended to read as follows:
7 (B) Every group or blanket policy which provides physician services,
8 medical, major medical or similar comprehensive-type coverage shall
9 provide coverage for the screening, diagnosis and treatment of autism
10 spectrum disorder in accordance with this paragraph and shall not
11 exclude coverage for the screening, diagnosis or treatment of medical
12 conditions otherwise covered by the policy because the individual is
13 diagnosed with autism spectrum disorder. Such coverage may be subject to
14 annual deductibles, copayments and coinsurance as may be deemed appro-
15 priate by the superintendent and shall be consistent with those imposed
16 on other benefits under the group or blanket policy. [Coverage for
17 applied behavior analysis shall be subject to a maximum benefit of
18 forty-five thousand dollars per year per covered individual and such
19 maximum annual benefit will increase by the amount calculated from the
20 average ten year rolling average increase of the medical component of
21 the consumer price index.] This paragraph shall not be construed as
22 limiting the benefits that are otherwise available to an individual
23 under the group or blanket policy, provided however that such policy
24 shall not contain any limitations on visits that are solely applied to
25 the treatment of autism spectrum disorder. No insurer shall terminate
26 coverage or refuse to deliver, execute, issue, amend, adjust, or renew
27 coverage to an individual solely because the individual is diagnosed
28 with autism spectrum disorder or has received treatment for autism spec-
29 trum disorder. Coverage shall be subject to utilization review and
30 external appeals of health care services pursuant to article forty-nine
31 of this chapter as well as, case management, and other managed care
32 provisions.
33 S 3. Paragraph 2 of subsection (ee) of section 4303 of the insurance
34 law, as amended by chapter 596 of the laws of 2011, is amended to read
35 as follows:
36 (2) Every contract which provides physician services, medical, major
37 medical or similar comprehensive-type coverage shall provide coverage
38 for the screening, diagnosis and treatment of autism spectrum disorder
39 in accordance with this subsection and shall not exclude coverage for
40 the screening, diagnosis or treatment of medical conditions otherwise
41 covered by the contract because the individual is diagnosed with autism
42 spectrum disorder. Such coverage may be subject to annual deductibles,
43 copayments and coinsurance as may be deemed appropriate by the super-
44 intendent and shall be consistent with those imposed on other benefits
45 under the contract. [Coverage for applied behavior analysis shall be
46 subject to a maximum benefit of forty-five thousand dollars per year per
47 covered individual and such maximum annual benefit will increase by the
48 amount calculated from the average ten year rolling average increase of
49 the medical component of the consumer price index.] This paragraph shall
50 not be construed as limiting the benefits that are otherwise available
51 to an individual under the contract, provided however that such contract
52 shall not contain any limitations on visits that are solely applied to
53 the treatment of autism spectrum disorder. No insurer shall terminate
54 coverage or refuse to deliver, execute, issue, amend, adjust, or renew
55 coverage to an individual solely because the individual is diagnosed
56 with autism spectrum disorder or has received treatment for autism spec-
S. 3974 3
1 trum disorder. Coverage shall be subject to utilization review and
2 external appeals of health care services pursuant to article forty-nine
3 of this chapter as well as, case management, and other managed care
4 provisions.
5 S 4. This act shall take effect immediately.
