Bill Text: NY A08548 | 2021-2022 | General Assembly | Amended
Bill Title: Relates to coverage for applied behavior analysis and for developmental, individual-differences, relationship-based treatment of autism spectrum disorder.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Introduced - Dead) 2022-04-07 - print number 8548a [A08548 Detail]
Download: New_York-2021-A08548-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 8548--A 2021-2022 Regular Sessions IN ASSEMBLY December 13, 2021 ___________ Introduced by M. of A. ABINANTI, SIMON, JENSEN -- read once and referred to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee 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. Subparagraphs (B) and (C) of paragraph 25 of subsection 2 (i) of section 3216 of the insurance law, subparagraph (B) as amended by 3 section 2 of subpart A of part BB of chapter 57 of the laws of 2019, 4 subparagraph (C) as amended by chapter 596 of the laws of 2011, items 5 (i) and (iii) of subparagraph (C) as amended by section 3 of subpart A 6 of part BB of chapter 57 of the laws of 2019, are amended to read as 7 follows: 8 (B) Every policy that provides physician services, medical, major 9 medical or similar comprehensive-type coverage shall provide coverage 10 for the screening, diagnosis and treatment of autism spectrum disorder 11 in accordance with this paragraph and shall not exclude coverage for the 12 screening, diagnosis or treatment of medical conditions otherwise 13 covered by the policy because the individual is diagnosed with autism 14 spectrum disorder. Such coverage may be subject to annual deductibles, 15 copayments and coinsurance as may be deemed appropriate by the super- 16 intendent and shall be consistent with those imposed on other benefits 17 under the policy. Coverage for applied behavior analysis and develop- 18 mental, individual-differences, relationship-based treatment shall be 19 subject to a maximum benefit of six hundred eighty hours of treatment 20 per policy during a calendar year per covered individual. This paragraph 21 shall not be construed as limiting the benefits that are otherwise 22 available to an individual under the policy, provided however that such EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD13801-02-2A. 8548--A 2 1 policy shall not contain any limitations on visits that are solely 2 applied to the treatment of autism spectrum disorder, except as provided 3 in this subparagraph for coverage for applied behavior analysis and 4 developmental, individual differences, relationship-based treatment. No 5 insurer shall terminate coverage or refuse to deliver, execute, issue, 6 amend, adjust, or renew coverage to an individual solely because the 7 individual is diagnosed with autism spectrum disorder or has received 8 treatment for autism spectrum disorder. Coverage shall be subject to 9 utilization review and external appeals of health care services pursuant 10 to article forty-nine of this chapter as well as case management and 11 other managed care provisions. 12 (C) For purposes of this paragraph: 13 (i) "autism spectrum disorder" means any pervasive developmental 14 disorder as defined in the most recent edition of the diagnostic and 15 statistical manual of mental disorders, including, but not limited to, 16 autistic spectrum disorder. 17 (ii) "applied behavior analysis" means the design, implementation, and 18 evaluation of environmental modifications, using behavioral stimuli and 19 consequences, to produce socially significant improvement in human 20 behavior, including the use of direct observation, measurement, and 21 functional analysis of the relationship between environment and behav- 22 ior. 23 (iii) "behavioral health treatment" means counseling and treatment 24 programs, including developmental, individual-differences and relation- 25 ship-based treatment, when provided by a licensed provider with a 26 professional certificate in developmental, individual-differences, rela- 27 tionship-based treatment from the interdisciplinary council on develop- 28 ment and learning, and applied behavior analysis, when provided by a 29 person licensed, certified or otherwise authorized to provide applied 30 behavior analysis, that are necessary to develop, maintain, or restore, 31 to the maximum extent practicable, the functioning of an individual. 32 Individuals that provide behavioral health treatment under the super- 33 vision of a licensed provider pursuant to this paragraph shall be 34 subject to standards of professionalism, supervision and relevant expe- 35 rience pursuant to regulations promulgated by the superintendent in 36 consultation with the commissioners of health and education. 37 (iv) "diagnosis of autism spectrum disorder" means assessments, evalu- 38 ations, or tests to diagnose whether an individual has autism spectrum 39 disorder. 40 (v) "pharmacy care" means medications prescribed by a licensed health 41 care provider legally authorized to prescribe under title eight of the 42 education law. 43 (vi) "psychiatric care" means direct or consultative services provided 44 by a psychiatrist licensed in the state in which the psychiatrist prac- 45 tices. 46 (vii) "psychological care" means direct or consultative services 47 provided by a psychologist licensed in the state in which the psychol- 48 ogist practices. 49 (viii) "therapeutic care" means services provided by licensed or 50 certified [speech therapists, occupational therapists, social workers,51or physical therapists] providers in the fields of counseling, occupa- 52 tional therapy, physical therapy, social work, or speech and language 53 pathology. 54 (ix) "treatment of autism spectrum disorder" shall include the follow- 55 ing care and assistive communication devices prescribed or ordered forA. 8548--A 3 1 an individual diagnosed with autism spectrum disorder by a licensed 2 physician or a licensed psychologist: 3 (1) behavioral health treatment; 4 (2) psychiatric care; 5 (3) psychological care; 6 (4) medical care provided by a licensed health care provider; 7 (5) therapeutic care, including therapeutic care which is deemed habi- 8 litative or nonrestorative, in the event that the policy provides cover- 9 age for therapeutic care; and 10 (6) pharmacy care in the event that the policy provides coverage for 11 prescription drugs. 12 (x) "developmental, individual-differences, relationship-based treat- 13 ment" means the implementation of a floortime intervention that is based 14 on an assessment of functional-emotional development and the person's 15 individual profile, while understanding that human development is 16 fostered in the context of relationships with others. The primary goal 17 is to promote development and address developmental challenges and defi- 18 cits that often accompany autism and other neurodevelopmental disorders. 19 § 2. Subparagraphs (B) and (C) of paragraph 17 of subsection (l) of 20 section 3221 of the insurance law, subparagraph (B) as amended by 21 section 19 of subpart A of part BB of chapter 57 of the laws of 2019, 22 subparagraph (C) as amended by chapter 596 of the laws of 2011, items 23 (i) and (iii) of subparagraph (C) as amended by section 20 of subpart A 24 of part BB of chapter 57 of the laws of 2019, are amended to read as 25 follows: 26 (B) Every group or blanket policy that provides physician services, 27 medical, major medical or similar comprehensive-type coverage shall 28 provide coverage for the screening, diagnosis and treatment of autism 29 spectrum disorder in accordance with this paragraph and shall not 30 exclude coverage for the screening, diagnosis or treatment of medical 31 conditions otherwise covered by the policy because the individual is 32 diagnosed with autism spectrum disorder. Such coverage may be subject to 33 annual deductibles, copayments and coinsurance as may be deemed appro- 34 priate by the superintendent and shall be consistent with those imposed 35 on other benefits under the group or blanket policy. Coverage for 36 applied behavior analysis and developmental, individual-differences, 37 relationship-based treatment shall be subject to a maximum benefit of 38 six hundred eighty hours of treatment per policy during a calendar year 39 per covered individual. This paragraph shall not be construed as limit- 40 ing the benefits that are otherwise available to an individual under the 41 group or blanket policy, provided however that such policy shall not 42 contain any limitations on visits that are solely applied to the treat- 43 ment of autism spectrum disorder, except as provided in this subpara- 44 graph for coverage for applied behavior analysis and developmental, 45 individual differences, relationship-based treatment. No insurer shall 46 terminate coverage or refuse to deliver, execute, issue, amend, adjust, 47 or renew coverage to an individual solely because the individual is 48 diagnosed with autism spectrum disorder or has received treatment for 49 autism spectrum disorder. Coverage shall be subject to utilization 50 review and external appeals of health care services pursuant to article 51 forty-nine of this chapter as well as case management and other managed 52 care provisions. 53 (C) For purposes of this paragraph: 54 (i) "autism spectrum disorder" means any pervasive developmental 55 disorder as defined in the most recent edition of the diagnostic andA. 8548--A 4 1 statistical manual of mental disorders, including, but not limited to, 2 autistic spectrum disorder. 3 (ii) "applied behavior analysis" means the design, implementation, and 4 evaluation of environmental modifications, using behavioral stimuli and 5 consequences, to produce socially significant improvement in human 6 behavior, including the use of direct observation, measurement, and 7 functional analysis of the relationship between environment and behav- 8 ior. 9 (iii) "behavioral health treatment" means counseling and treatment 10 programs, including developmental, individual-differences, relation- 11 ship-based treatment, when provided by a licensed provider with a 12 professional certificate in developmental, individual-differences, rela- 13 tionship-based treatment from the interdisciplinary council on develop- 14 ment and learning, and applied behavior analysis, when provided by a 15 person licensed, certified or otherwise authorized to provide applied 16 behavior analysis, that are necessary to develop, maintain, or restore, 17 to the maximum extent practicable, the functioning of an individual. 18 Individuals that provide behavioral health treatment under the super- 19 vision of a licensed provider pursuant to this paragraph shall be 20 subject to standards of professionalism, supervision and relevant expe- 21 rience pursuant to regulations promulgated by the superintendent in 22 consultation with the commissioners of health and education. 23 (iv) "diagnosis of autism spectrum disorder" means assessments, evalu- 24 ations, or tests to diagnose whether an individual has autism spectrum 25 disorder. 26 (v) "pharmacy care" means medications prescribed by a licensed health 27 care provider legally authorized to prescribe under title eight of the 28 education law. 29 (vi) "psychiatric care" means direct or consultative services provided 30 by a psychiatrist licensed in the state in which the psychiatrist prac- 31 tices. 32 (vii) "psychological care" means direct or consultative services 33 provided by a psychologist licensed in the state in which the psychol- 34 ogist practices. 35 (viii) "therapeutic care" means services provided by licensed or 36 certified [speech therapists, occupational therapists, social workers,37or physical therapists] providers in the fields of counseling, occupa- 38 tional therapy, physical therapy, social work, or speech and language 39 pathology. 40 (ix) "treatment of autism spectrum disorder" shall include the follow- 41 ing care and assistive communication devices prescribed or ordered for 42 an individual diagnosed with autism spectrum disorder by a licensed 43 physician or a licensed psychologist: 44 (1) behavioral health treatment; 45 (2) psychiatric care; 46 (3) psychological care; 47 (4) medical care provided by a licensed health care provider; 48 (5) therapeutic care, including therapeutic care which is deemed habi- 49 litative or nonrestorative, in the event that the policy provides cover- 50 age for therapeutic care; and 51 (6) pharmacy care in the event that the policy provides coverage for 52 prescription drugs. 53 (x) "developmental, individual-differences, relationship-based treat- 54 ment" means the implementation of a floortime intervention that is based 55 on an assessment of functional-emotional development and the person's 56 individual profile, while understanding that human development isA. 8548--A 5 1 fostered in the context of relationships with others. The primary goal 2 is to promote development and address developmental challenges and defi- 3 cits that often accompany autism and other neurodevelopmental disorders. 4 § 3. Paragraphs 2 and 3 of subsection (ee) of section 4303 of the 5 insurance law, paragraph 2 as amended by section 31 of subpart A of part 6 BB of chapter 57 of the laws of 2019, paragraph 3 as amended by chapter 7 596 of the laws of 2011, subparagraphs (A) and (C) of paragraph 3 as 8 amended by section 32 of subpart A of part BB of chapter 57 of the laws 9 of 2019, are amended to read as follows: 10 (2) Every contract that provides physician services, medical, major 11 medical or similar comprehensive-type coverage shall provide coverage 12 for the screening, diagnosis and treatment of autism spectrum disorder 13 in accordance with this paragraph and shall not exclude coverage for the 14 screening, diagnosis or treatment of medical conditions otherwise 15 covered by the contract because the individual is diagnosed with autism 16 spectrum disorder. Such coverage may be subject to annual deductibles, 17 copayments and coinsurance as may be deemed appropriate by the super- 18 intendent and shall be consistent with those imposed on other benefits 19 under the contract. Coverage for applied behavior analysis and develop- 20 mental, individual-differences, relationship-based treatment shall be 21 subject to a maximum benefit of six hundred eighty hours of treatment 22 per policy during a calendar year per covered individual. This paragraph 23 shall not be construed as limiting the benefits that are otherwise 24 available to an individual under the contract, provided however that 25 such contract shall not contain any limitations on visits that are sole- 26 ly applied to the treatment of autism spectrum disorder, except as 27 provided in this subparagraph for coverage for applied behavior analysis 28 and developmental, individual differences, relationship-based treatment. 29 No insurer shall terminate coverage or refuse to deliver, execute, 30 issue, amend, adjust, or renew coverage to an individual solely because 31 the individual is diagnosed with autism spectrum disorder or has 32 received treatment for autism spectrum disorder. Coverage shall be 33 subject to utilization review and external appeals of health care 34 services pursuant to article forty-nine of this chapter as well as case 35 management and other managed care provisions. 36 (3) For purposes of this subsection: 37 (A) "autism spectrum disorder" means any pervasive developmental 38 disorder as defined in the most recent edition of the diagnostic and 39 statistical manual of mental disorders, including, but not limited to, 40 autistic spectrum disorder. 41 (B) "applied behavior analysis" means the design, implementation, and 42 evaluation of environmental modifications, using behavioral stimuli and 43 consequences, to produce socially significant improvement in human 44 behavior, including the use of direct observation, measurement, and 45 functional analysis of the relationship between environment and behav- 46 ior. 47 (C) "behavioral health treatment" means counseling and treatment 48 programs, including developmental, individual-differences, relation- 49 ship-based treatment, when provided by a licensed provider with a 50 professional certificate in developmental, individual-differences, rela- 51 tionship-based treatment from the interdisciplinary council on develop- 52 ment and learning, and applied behavior analysis, when provided by a 53 person that is licensed, certified or otherwise authorized to provide 54 applied behavior analysis, that are necessary to develop, maintain, or 55 restore, to the maximum extent practicable, the functioning of an indi- 56 vidual. Individuals that provide behavioral health treatment under theA. 8548--A 6 1 supervision of a licensed provider pursuant to this subsection shall be 2 subject to standards of professionalism, supervision and relevant expe- 3 rience pursuant to regulations promulgated by the superintendent in 4 consultation with the commissioners of health and education. 5 (D) "diagnosis of autism spectrum disorder" means assessments, evalu- 6 ations, or tests to diagnose whether an individual has autism spectrum 7 disorder. 8 (E) "pharmacy care" means medications prescribed by a licensed health 9 care provider legally authorized to prescribe under title eight of the 10 education law. 11 (F) "psychiatric care" means direct or consultative services provided 12 by a psychiatrist licensed in the state in which the psychiatrist prac- 13 tices. 14 (G) "psychological care" means direct or consultative services 15 provided by a psychologist licensed in the state in which the psychol- 16 ogist practices. 17 (H) "therapeutic care" means services provided by licensed or certi- 18 fied [speech therapists, occupational therapists, social workers, or19physical therapists] providers in the fields of counseling, occupational 20 therapy, physical therapy, social work, or speech and language 21 pathology. 22 (I) "treatment of autism spectrum disorder" shall include the follow- 23 ing care and assistive communication devices prescribed or ordered for 24 an individual diagnosed with autism spectrum disorder by a licensed 25 physician or a licensed psychologist: 26 (i) behavioral health treatment; 27 (ii) psychiatric care; 28 (iii) psychological care; 29 (iv) medical care provided by a licensed health care provider; 30 (v) therapeutic care, including therapeutic care which is deemed habi- 31 litative or nonrestorative, in the event that the policy provides cover- 32 age for therapeutic care; and 33 (vi) pharmacy care in the event that the contract provides coverage 34 for prescription drugs. 35 § 4. This act shall take effect on the ninetieth day after it shall 36 have become a law.
