Bill Text: NY S04097 | 2011-2012 | General Assembly | Introduced
Bill Title: Requires that individual accident and health insurance policies shall provide coverage for screening, diagnosis and treatment of autism spectrum disorder.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2012-01-04 - REFERRED TO INSURANCE [S04097 Detail]
Download: New_York-2011-S04097-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
4097
2011-2012 Regular Sessions
I N S E N A T E
March 17, 2011
___________
Introduced by Sen. DUANE -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law and the public health law, in relation
to coverage for the screening, diagnosis and treatment of autism spec-
trum disorder
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Paragraph 25 of subsection (i) of section 3216 of the
2 insurance law, as added by chapter 557 of the laws of 2006, is amended
3 to read as follows:
4 (25) Every policy which provides coverage for hospital, surgical, or
5 medical care coverage shall [not exclude] PROVIDE coverage for THE
6 SCREENING, diagnosis and treatment of [medical conditions otherwise
7 covered by the policy solely because the treatment is provided to diag-
8 nose or treat] autism spectrum disorder IN ACCORDANCE WITH THIS PARA-
9 GRAPH AND SHALL NOT EXCLUDE COVERAGE FOR THE TREATMENT OF MEDICAL CONDI-
10 TIONS OTHERWISE COVERED BY THE POLICY BECAUSE THE INDIVIDUAL IS
11 DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER. SUCH COVERAGE MAY BE
12 SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE
13 DEEMED APPROPRIATE BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH
14 THOSE IMPOSED ON OTHER BENEFITS UNDER THE POLICY. THIS PARAGRAPH SHALL
15 NOT BE CONSTRUED AS LIMITING THE BENEFITS THAT ARE OTHERWISE AVAILABLE
16 TO AN INDIVIDUAL UNDER THE POLICY. COVERAGE MAY BE SUBJECT TO UTILIZA-
17 TION REVIEW OF HEALTH CARE SERVICES, INCLUDING THE REVIEW OF MEDICAL
18 NECESSITY, CASE MANAGEMENT, AND OTHER MANAGED CARE PROVISIONS.
19 (A) For purposes of this [section] PARAGRAPH, "autism spectrum disor-
20 der" means a GROUP OF neurobiological [condition that includes autism,
21 Asperger syndrome, Rett's syndrome, or pervasive developmental disorder]
22 CONDITIONS DEFINED IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
23 DISORDERS IV REVISED, OR ITS SUCCESSOR, AS PERVASIVE DEVELOPMENTAL
24 DISORDERS.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05243-01-1
S. 4097 2
1 (B) THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE SUPERINTEN-
2 DENT, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS-
3 SIONER OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL,
4 NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBPARA-
5 GRAPH, PROMULGATE AND THEREAFTER REGULARLY UPDATE, REGULATIONS WHICH
6 SHALL IDENTIFY TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE SHALL BE
7 REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM
8 DISORDER PURSUANT TO THIS PARAGRAPH. SUCH TREATMENT AND THERAPY OPTIONS
9 SHALL BE EVIDENCE-BASED, PEER-REVIEWED AND CLINICALLY PROVEN. COVERAGE
10 FOR BEHAVIORAL THERAPIES REQUIRED PURSUANT TO THIS SUBPARAGRAPH SHALL
11 NOT BE DENIED ON THE BASIS THAT SUCH THERAPIES ARE EDUCATIONAL OR HABI-
12 LITATIVE IN NATURE, UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE
13 COVERED PERSON PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTI-
14 CLE EIGHTY-NINE OF THE EDUCATION LAW. THE PROVISION OF SERVICES PURSU-
15 ANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND
16 FIVE HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED
17 EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE OF THE EDUCATION LAW OR AN
18 INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE OFFICE FOR
19 PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL NOT AFFECT COVERAGE UNDER
20 THE POLICY FOR SERVICES PROVIDED ON A SUPPLEMENTAL BASIS OUTSIDE OF AN
21 EDUCATIONAL SETTING IF SUCH SERVICES ARE DEEMED MEDICALLY NECESSARY.
22 (C) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI-
23 GATION TO PROVIDE SERVICES TO AN INDIVIDUAL UNDER AN INDIVIDUALIZED
24 FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE HUNDRED FORTY-FIVE
25 OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
26 EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED SERVICE PLAN
27 PURSUANT TO REGULATIONS OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL
28 DISABILITIES.
29 (D) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI-
30 GATION TO PROVIDE COVERAGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE
31 BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES
32 PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS
33 ARTICLE OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE
34 OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES.
35 (E) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT A POLICY
36 FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING PROVIDERS WHO
37 SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUDING PROVIDER
38 CREDENTIALING.
39 S 2. Paragraph 17 of subsection (l) of section 3221 of the insurance
40 law, as added by chapter 557 of the laws of 2006, is amended to read as
41 follows:
42 (17) [A] EVERY group or blanket accident [or] AND health insurance
43 policy [or issuing a group or blanket policy for delivery in this state]
44 DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE which provides coverage
45 for hospital, surgical, or medical care coverage shall [not exclude]
46 PROVIDE coverage for THE SCREENING, diagnosis and treatment of [medical
47 conditions otherwise covered by the policy because the treatment is
48 provided to diagnose or treat] autism spectrum disorder IN ACCORDANCE
49 WITH THIS PARAGRAPH AND SHALL NOT EXCLUDE COVERAGE FOR THE TREATMENT OF
50 MEDICAL CONDITIONS OTHERWISE COVERED BY THE POLICY BECAUSE THE INDIVID-
51 UAL IS DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER. SUCH COVERAGE MAY BE
52 SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE
53 DEEMED APPROPRIATE BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH
54 THOSE IMPOSED ON OTHER BENEFITS UNDER THE POLICY. THIS PARAGRAPH SHALL
55 NOT BE CONSTRUED AS LIMITING THE BENEFITS THAT ARE OTHERWISE AVAILABLE
56 TO AN INDIVIDUAL UNDER THE POLICY. COVERAGE MAY BE SUBJECT TO UTILIZA-
S. 4097 3
1 TION REVIEW OF HEALTH CARE SERVICES, INCLUDING THE REVIEW OF MEDICAL
2 NECESSITY, CASE MANAGEMENT, AND OTHER MANAGED CARE PROVISIONS.
3 (A) For purposes of this [section] PARAGRAPH, "autism spectrum disor-
4 der" means a GROUP OF neurobiological [condition that includes autism,
5 Asperger syndrome, Rett's syndrome, or pervasive developmental disorder]
6 CONDITIONS DEFINED IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
7 DISORDERS IV REVISED, OR ITS SUCCESSOR, AS PERVASIVE DEVELOPMENTAL
8 DISORDERS.
9 (B) THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE SUPERINTEN-
10 DENT, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS-
11 SIONER OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL,
12 NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBPARA-
13 GRAPH, PROMULGATE AND THEREAFTER REGULARLY UPDATE, REGULATIONS WHICH
14 SHALL IDENTIFY TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE SHALL BE
15 REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM
16 DISORDER PURSUANT TO THIS PARAGRAPH. SUCH TREATMENT AND THERAPY OPTIONS
17 SHALL BE EVIDENCE-BASED, PEER-REVIEWED AND CLINICALLY PROVEN. COVERAGE
18 FOR BEHAVIORAL THERAPIES REQUIRED PURSUANT TO THIS SUBPARAGRAPH SHALL
19 NOT BE DENIED ON THE BASIS THAT SUCH THERAPIES ARE EDUCATIONAL OR HABI-
20 LITATIVE IN NATURE, UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE
21 COVERED PERSON PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTI-
22 CLE EIGHTY-NINE OF THE EDUCATION LAW. THE PROVISION OF SERVICES PURSU-
23 ANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND
24 FIVE HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED
25 EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE OF THE EDUCATION LAW OR AN
26 INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE OFFICE FOR
27 PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL NOT AFFECT COVERAGE UNDER
28 THE POLICY FOR SERVICES PROVIDED ON A SUPPLEMENTAL BASIS OUTSIDE OF AN
29 EDUCATIONAL SETTING IF SUCH SERVICES ARE DEEMED MEDICALLY NECESSARY.
30 (C) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI-
31 GATION TO PROVIDE SERVICES TO AN INDIVIDUAL UNDER AN INDIVIDUALIZED
32 FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE HUNDRED FORTY-FIVE
33 OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
34 EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED SERVICE PLAN
35 PURSUANT TO REGULATIONS OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL
36 DISABILITIES.
37 (D) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI-
38 GATION TO PROVIDE COVERAGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE
39 BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES
40 PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS
41 ARTICLE OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE
42 OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES.
43 (E) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT A POLICY
44 FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING PROVIDERS WHO
45 SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUDING PROVIDER
46 CREDENTIALING.
47 S 3. Subsection (ee) of section 4303 of the insurance law, as added by
48 chapter 557 of the laws of 2006, is amended to read as follows:
49 (ee) A medical expense indemnity corporation, a hospital service
50 corporation or a health service corporation which provides coverage for
51 hospital, surgical, or medical care coverage shall [not exclude] PROVIDE
52 coverage for THE SCREENING, diagnosis and treatment of [medical condi-
53 tions otherwise covered by the policy solely because the treatment is
54 provided to diagnose or treat] autism spectrum disorder IN ACCORDANCE
55 WITH THIS SUBSECTION AND SHALL NOT EXCLUDE COVERAGE FOR THE TREATMENT OF
56 MEDICAL CONDITIONS OTHERWISE COVERED BY THE POLICY BECAUSE THE INDIVID-
S. 4097 4
1 UAL IS DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER. SUCH COVERAGE MAY BE
2 SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE
3 DEEMED APPROPRIATE BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH
4 THOSE IMPOSED ON OTHER BENEFITS UNDER THE CONTRACT. THIS SUBSECTION
5 SHALL NOT BE CONSTRUED AS LIMITING THE BENEFITS THAT ARE OTHERWISE
6 AVAILABLE TO AN INDIVIDUAL UNDER THE CONTRACT. COVERAGE MAY BE SUBJECT
7 TO UTILIZATION REVIEW OF HEALTH CARE SERVICES, INCLUDING THE REVIEW OF
8 MEDICAL NECESSITY, CASE MANAGEMENT, AND OTHER MANAGED CARE PROVISIONS.
9 (1) For purposes of this [section] SUBSECTION, "autism spectrum disor-
10 der" means a GROUP OF neurobiological [condition that includes autism,
11 Asperger syndrome, Rett's syndrome, or pervasive developmental disorder]
12 CONDITIONS DEFINED IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
13 DISORDERS IV REVISED, OR ITS SUCCESSOR, AS PERVASIVE DEVELOPMENTAL
14 DISORDERS.
15 (2) THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE SUPERINTEN-
16 DENT, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS-
17 SIONER OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL,
18 NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBPARA-
19 GRAPH, PROMULGATE AND THEREAFTER REGULARLY UPDATE, REGULATIONS WHICH
20 SHALL IDENTIFY TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE SHALL BE
21 REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM
22 DISORDER PURSUANT TO THIS SUBSECTION. SUCH TREATMENT AND THERAPY OPTIONS
23 SHALL BE EVIDENCE-BASED, PEER-REVIEWED AND CLINICALLY PROVEN. COVERAGE
24 FOR BEHAVIORAL THERAPIES REQUIRED PURSUANT TO THIS PARAGRAPH SHALL NOT
25 BE DENIED ON THE BASIS THAT SUCH THERAPIES ARE EDUCATIONAL OR HABILITA-
26 TIVE IN NATURE, UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE COVERED
27 PERSON PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE EIGHT-
28 Y-NINE OF THE EDUCATION LAW. THE PROVISION OF SERVICES PURSUANT TO AN
29 INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE
30 HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION
31 PLAN UNDER ARTICLE EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED
32 SERVICE PLAN PURSUANT TO REGULATIONS OF THE OFFICE FOR PEOPLE WITH
33 DEVELOPMENTAL DISABILITIES SHALL NOT AFFECT COVERAGE UNDER THE CONTRACT
34 FOR SERVICES PROVIDED ON A SUPPLEMENTAL BASIS OUTSIDE OF AN EDUCATIONAL
35 SETTING IF SUCH SERVICES ARE DEEMED MEDICALLY NECESSARY.
36 (3) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO AFFECT ANY OBLI-
37 GATION TO PROVIDE SERVICES TO AN INDIVIDUAL UNDER AN INDIVIDUALIZED
38 FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE HUNDRED FORTY-FIVE
39 OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
40 EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED SERVICE PLAN
41 PURSUANT TO REGULATIONS OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL
42 DISABILITIES.
43 (4) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO AFFECT ANY OBLI-
44 GATION TO PROVIDE COVERAGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE
45 BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES
46 PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS
47 CHAPTER OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE
48 OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES.
49 (5) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO PREVENT A
50 CONTRACT FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING
51 PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD-
52 ING PROVIDER CREDENTIALING.
53 S 4. Section 2500-j of the public health law is amended by adding a
54 new subdivision 4 to read as follows:
55 4. THE COMMISSIONER, IN CONSULTATION WITH THE SUPERINTENDENT OF INSUR-
56 ANCE, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS-
S. 4097 5
1 SIONER OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, SHALL
2 PROMULGATE NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS
3 SUBDIVISION, AND REGULARLY UPDATE, REGULATIONS WHICH SHALL IDENTIFY
4 TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE SHALL BE REQUIRED FOR
5 THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM DISORDER
6 PURSUANT TO SECTIONS THREE THOUSAND TWO HUNDRED SIXTEEN, THREE THOUSAND
7 TWO HUNDRED TWENTY-ONE AND FOUR THOUSAND THREE HUNDRED THREE OF THE
8 INSURANCE LAW.
9 S 5. Severability clause. If any clause, sentence, paragraph, subdivi-
10 sion, section or part of this act shall be adjudged by any court of
11 competent jurisdiction to be invalid, such judgment shall not affect,
12 impair, or invalidate the remainder thereof, but shall be confined in
13 its operation to the clause, sentence, paragraph, subdivision, section
14 or part thereof directly involved in the controversy in which such judg-
15 ment shall have been rendered. It is hereby declared to be the intent of
16 the legislature that this act would have been enacted even if such
17 invalid provisions had not been included herein.
18 S 6. This act shall take effect immediately, provided that sections
19 one, two and three of this act shall take effect upon the promulgation
20 of either emergency or permanent rules and regulations by the commis-
21 sioner of health outlining the treatment insurers are required to
22 provide to cover autism spectrum disorder as provided for in this act
23 and shall apply to all policies or contracts issued, renewed, modified,
24 altered or amended on and after such effective date; provided that the
25 commissioner of health shall notify the legislative bill drafting
26 commission upon the promulgation of such emergency or permanent rules
27 and regulations in order that the commission may maintain an accurate
28 and timely effective data base of the official text of the laws of the
29 state of New York in furtherance of effectuating the provisions of
30 section 44 of the legislative law and section 70-b of the public offi-
31 cers law.
