Bill Text: NY S05481 | 2023-2024 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Requires insurance policies to cover neuropsychological exams for dyslexia under certain circumstances; caps coverage amount.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced) 2024-06-07 - SUBSTITUTED BY A2898A [S05481 Detail]

Download: New_York-2023-S05481-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          5481

                               2023-2024 Regular Sessions

                    IN SENATE

                                      March 6, 2023
                                       ___________

        Introduced  by Sen. HOYLMAN-SIGAL -- 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  requiring  certain
          insurance policies to cover neuropsychological exams for dyslexia

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. This act shall be known and may be cited as  the  "dyslexia
     2  diagnosis access act".
     3    § 2. Legislative findings and intent. The legislature hereby finds and
     4  declares the following:
     5    a.  Dyslexia is a specific learning disability that is neurobiological
     6  in origin. It is characterized  by  difficulties  with  accurate  and/or
     7  fluent  word  recognition  and impaired spelling and decoding abilities.
     8  These difficulties typically result from a deficit in  the  phonological
     9  component of language within the brain that is often discordant with the
    10  person's  intelligence and other cognitive abilities. Secondary  effects
    11  of undetected and unaddressed dyslexia  include    anxiety,  depression,
    12  worsened  health,  decreased  life  expectancy, lower   education rates,
    13  lower employment and income rates, and increased  poverty and incarcera-
    14  tion rates.
    15     b. Studies indicate that as many as one in  five  children  may  have
    16  dyslexia or another phonemic awareness issue. However, lack of access to
    17  appropriate  screening and diagnostic testing poses a barrier to compre-
    18  hensively tracking the incidence of dyslexia and students  are  unlikely
    19  to  receive  the  intervention  required  to overcome dyslexia without a
    20  positive diagnosis. Comprehensive neuropsychological  exams  are  recog-
    21  nized  as  the most effective way to positively diagnose dyslexia.  Such
    22  exams are often administered over the course of two days  and  currently
    23  may  cost  in  excess of six thousand dollars but are typically not paid
    24  for by health insurance, making them unaffordable to many families.
    25    § 3. Subsection (i) of section 3216 of the insurance law is amended by
    26  adding a new paragraph 39 to read as follows:
    27    (39) (A) Every policy that provides coverage for  physician  services,
    28  medical,  major  medical  or  similar  comprehensive-type coverage shall

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01994-01-3
        S. 5481                             2

     1  provide coverage for testing for suspected dyslexia in  accordance  with
     2  this paragraph and shall not exclude coverage for the screening, diagno-
     3  sis or treatment of medical conditions otherwise covered by the policy.
     4    (i)  Coverage  shall include comprehensive neuropsychological examina-
     5  tions for the purposes of diagnosing dyslexia, pursuant  to  this  para-
     6  graph.
     7    (ii)  Clinicians'  neuropsychological reports shall include comprehen-
     8  sive recommendations regardless of diagnosis, including a psychological,
     9  emotional, and educational wellness plan for the individual evaluated.
    10    (B) Coverage under this paragraph is only required if one or  more  of
    11  the following criteria are met:
    12    (i)  the insured is at an increased hereditary risk for dyslexia owing
    13  to a family history of dyslexia; or
    14    (ii) the individual is a student who has failed two (if in  kindergar-
    15  ten  or first grade) or one (if in second grade or above) readily avail-
    16  able literacy screening benchmark(s) of proven psychometric  value;  and
    17  is deemed at risk according to their instructor, school, or other super-
    18  vising educational body; or
    19    (iii)  the  individual's  pediatrician identifies the individual as at
    20  risk for dyslexia as indicated by findings from  a  valid  and  reliable
    21  screener and recommends a neuropsychological examination; or
    22    (iv)  the  individual  is  a  student with a history of risk factor(s)
    23  known to impact learning and educational  outcomes,  including  but  not
    24  limited to: fetal toxin exposure, prematurity, and history of neurologi-
    25  cal disorder, such as epilepsy.
    26    (C)  Coverage  required by this paragraph shall be capped at six thou-
    27  sand dollars, indexed to  inflation  to  be  adjusted  every  two  years
    28  according  to  consumer  price  index  for  all  urban consumers for the
    29  nation, as prepared by the United States department of  labor,  for  the
    30  calendar year preceding the calendar year in which the adjustment to the
    31  maximum benefit amount is promulgated.
    32    §  4.  Section  3221  of  the insurance law is amended by adding a new
    33  subsection (u) to read as follows:
    34    (u)  (1)  (A)  Every  policy  that  provides  coverage  for  physician
    35  services,  medical, major medical or similar comprehensive-type coverage
    36  shall provide coverage for testing for suspected dyslexia in  accordance
    37  with  this  subsection and shall not exclude coverage for the screening,
    38  diagnosis or treatment of medical conditions otherwise  covered  by  the
    39  policy.
    40    (B)  Coverage  shall include comprehensive neuropsychological examina-
    41  tions  for  the  purposes  of  diagnosing  dyslexia,  pursuant  to  this
    42  subsection.
    43    (C) Clinicians' neuropsychological reports shall include comprehensive
    44  recommendations  regardless  of  diagnosis,  including  a psychological,
    45  emotional, and educational wellness plan for the individual evaluated.
    46    (2) Coverage under this subsection is only required if one or more  of
    47  the following criteria are met:
    48    (A)  the insured is at an increased hereditary risk for dyslexia owing
    49  to a family history of dyslexia; or
    50    (B) the individual is a student who has failed two (if in kindergarten
    51  or first grade) or one (if in second grade or above)  readily  available
    52  literacy  screening  benchmark(s)  of  proven psychometric value; and is
    53  deemed at risk according to their instructor, school, or other supervis-
    54  ing educational body; or
        S. 5481                             3

     1    (C) the individual's pediatrician identifies the individual as at risk
     2  for dyslexia as indicated by findings from a valid and reliable screener
     3  and recommends a neuropsychological examination; or
     4    (D) the individual is a student with a history of risk factor(s) known
     5  to  impact  learning and educational outcomes, including but not limited
     6  to: fetal toxin  exposure,  prematurity,  and  history  of  neurological
     7  disorder, such as epilepsy.
     8    (3)  Coverage required by this subsection shall be capped at six thou-
     9  sand dollars, indexed to  inflation  to  be  adjusted  every  two  years
    10  according  to  consumer  price  index  for  all  urban consumers for the
    11  nation, as prepared by the United States department of  labor,  for  the
    12  calendar year preceding the calendar year in which the adjustment to the
    13  maximum benefit amount is promulgated.
    14    §  5.  Section  4303  of  the insurance law is amended by adding a new
    15  subsection (uu) to read as follows:
    16    (uu) (1)  (A)  Every  policy  that  provides  coverage  for  physician
    17  services,  medical, major medical or similar comprehensive-type coverage
    18  shall provide coverage for testing for suspected dyslexia in  accordance
    19  with  this  subsection and shall not exclude coverage for the screening,
    20  diagnosis or treatment of medical conditions otherwise  covered  by  the
    21  policy.
    22    (B)  Coverage  shall include comprehensive neuropsychological examina-
    23  tions  for  the  purposes  of  diagnosing  dyslexia,  pursuant  to  this
    24  subsection.
    25    (C) Clinicians' neuropsychological reports shall include comprehensive
    26  recommendations  regardless  of  diagnosis,  including  a psychological,
    27  emotional, and educational wellness plan for the individual evaluated.
    28    (2) Coverage under this subsection is only required if one or more  of
    29  the following criteria are met:
    30    (A)  the insured is at an increased hereditary risk for dyslexia owing
    31  to a family history of dyslexia; or
    32    (B) the individual is a student who has failed two (if in kindergarten
    33  or first grade) or one (if in second grade or above)  readily  available
    34  literacy  screening  benchmark(s)  of  proven psychometric value; and is
    35  deemed at risk according to their instructor, school, or other supervis-
    36  ing educational body; or
    37    (C) the individual's pediatrician identifies the individual as at risk
    38  for dyslexia as indicated by findings from a valid and reliable screener
    39  and recommends a neuropsychological examination; or
    40    (D) the individual is a student with a history of risk factor(s) known
    41  to impact learning and educational outcomes including, but  not  limited
    42  to:  fetal  toxin  exposure,  prematurity,  and  history of neurological
    43  disorder, such as epilepsy.
    44    (3) Coverage required by this subsection shall be capped at six  thou-
    45  sand  dollars,  indexed  to  inflation  to  be  adjusted every two years
    46  according to consumer price  index  for  all  urban  consumers  for  the
    47  nation,  as  prepared  by the United States department of labor, for the
    48  calendar year preceding the calendar year in which the adjustment to the
    49  maximum benefit amount is promulgated.
    50    § 6. This act shall take effect on the first of January next  succeed-
    51  ing  the date on which it shall have become a law and shall apply to all
    52  policies and contracts issued, renewed, modified, altered, or amended on
    53  or after such  date.  Effective  immediately,  the  addition,  amendment
    54  and/or repeal of any rule or regulation necessary for the implementation
    55  of  this  act  on  its  effective  date  are  authorized  to be made and
    56  completed on or before such date.