Bill Text: NY S07673 | 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: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2022-04-12 - PRINT NUMBER 7673A [S07673 Detail]
Download: New_York-2021-S07673-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 7673--A IN SENATE January 6, 2022 ___________ Introduced by Sens. HARCKHAM, CLEARE, KENNEDY, LIU -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- 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 23 policy shall not contain any limitations on visits that are solely 24 applied to the treatment of autism spectrum disorder, except as provided 25 in this subparagraph for coverage for applied behavior analysis and 26 developmental, individual differences, relationship-based treatment. No EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD13801-03-2S. 7673--A 2 1 insurer shall terminate coverage or refuse to deliver, execute, issue, 2 amend, adjust, or renew coverage to an individual solely because the 3 individual is diagnosed with autism spectrum disorder or has received 4 treatment for autism spectrum disorder. Coverage shall be subject to 5 utilization review and external appeals of health care services pursuant 6 to article forty-nine of this chapter as well as case management and 7 other managed care provisions. 8 (C) For purposes of this paragraph: 9 (i) "autism spectrum disorder" means any pervasive developmental 10 disorder as defined in the most recent edition of the diagnostic and 11 statistical manual of mental disorders, including, but not limited to, 12 autistic spectrum disorder. 13 (ii) "applied behavior analysis" means the design, implementation, and 14 evaluation of environmental modifications, using behavioral stimuli and 15 consequences, to produce socially significant improvement in human 16 behavior, including the use of direct observation, measurement, and 17 functional analysis of the relationship between environment and behav- 18 ior. 19 (iii) "behavioral health treatment" means counseling and treatment 20 programs, including developmental, individual-differences and relation- 21 ship-based treatment, when provided by a licensed provider with a 22 professional certificate in developmental, individual-differences, rela- 23 tionship-based treatment from the interdisciplinary council on develop- 24 ment and learning, and applied behavior analysis, when provided by a 25 person licensed, certified or otherwise authorized to provide applied 26 behavior analysis, that are necessary to develop, maintain, or restore, 27 to the maximum extent practicable, the functioning of an individual. 28 Individuals that provide behavioral health treatment under the super- 29 vision of a licensed provider pursuant to this paragraph shall be 30 subject to standards of professionalism, supervision and relevant expe- 31 rience pursuant to regulations promulgated by the superintendent in 32 consultation with the commissioners of health and education. 33 (iv) "diagnosis of autism spectrum disorder" means assessments, evalu- 34 ations, or tests to diagnose whether an individual has autism spectrum 35 disorder. 36 (v) "pharmacy care" means medications prescribed by a licensed health 37 care provider legally authorized to prescribe under title eight of the 38 education law. 39 (vi) "psychiatric care" means direct or consultative services provided 40 by a psychiatrist licensed in the state in which the psychiatrist prac- 41 tices. 42 (vii) "psychological care" means direct or consultative services 43 provided by a psychologist licensed in the state in which the psychol- 44 ogist practices. 45 (viii) "therapeutic care" means services provided by licensed or 46 certified [speech therapists, occupational therapists, social workers,47or physical therapists] providers in the fields of counseling, occupa- 48 tional therapy, physical therapy, social work, or speech and language 49 pathology. 50 (ix) "treatment of autism spectrum disorder" shall include the follow- 51 ing care and assistive communication devices prescribed or ordered for 52 an individual diagnosed with autism spectrum disorder by a licensed 53 physician or a licensed psychologist: 54 (1) behavioral health treatment; 55 (2) psychiatric care; 56 (3) psychological care;S. 7673--A 3 1 (4) medical care provided by a licensed health care provider; 2 (5) therapeutic care, including therapeutic care which is deemed habi- 3 litative or nonrestorative, in the event that the policy provides cover- 4 age for therapeutic care; and 5 (6) pharmacy care in the event that the policy provides coverage for 6 prescription drugs. 7 (x) "developmental, individual-differences, relationship-based treat- 8 ment" means the implementation of a floortime intervention that is based 9 on an assessment of functional-emotional development and the person's 10 individual profile, while understanding that human development is 11 fostered in the context of relationships with others. The primary goal 12 is to promote development and address developmental challenges and defi- 13 cits that often accompany autism and other neurodevelopmental disorders. 14 § 2. Subparagraphs (B) and (C) of paragraph 17 of subsection (l) of 15 section 3221 of the insurance law, subparagraph (B) as amended by 16 section 19 of subpart A of part BB of chapter 57 of the laws of 2019, 17 subparagraph (C) as amended by chapter 596 of the laws of 2011, items 18 (i) and (iii) of subparagraph (C) as amended by section 20 of subpart A 19 of part BB of chapter 57 of the laws of 2019, are amended to read as 20 follows: 21 (B) Every group or blanket policy that provides physician services, 22 medical, major medical or similar comprehensive-type coverage shall 23 provide coverage for the screening, diagnosis and treatment of autism 24 spectrum disorder in accordance with this paragraph and shall not 25 exclude coverage for the screening, diagnosis or treatment of medical 26 conditions otherwise covered by the policy because the individual is 27 diagnosed with autism spectrum disorder. Such coverage may be subject to 28 annual deductibles, copayments and coinsurance as may be deemed appro- 29 priate by the superintendent and shall be consistent with those imposed 30 on other benefits under the group or blanket policy. Coverage for 31 applied behavior analysis and developmental, individual-differences, 32 relationship-based treatment shall be subject to a maximum benefit of 33 six hundred eighty hours of treatment per policy during a calendar year 34 per covered individual. This paragraph shall not be construed as limit- 35 ing the benefits that are otherwise available to an individual under the 36 group or blanket policy, provided however that such policy shall not 37 contain any limitations on visits that are solely applied to the treat- 38 ment of autism spectrum disorder, except as provided in this subpara- 39 graph for coverage for applied behavior analysis and developmental, 40 individual differences, relationship-based treatment. No insurer shall 41 terminate coverage or refuse to deliver, execute, issue, amend, adjust, 42 or renew coverage to an individual solely because the individual is 43 diagnosed with autism spectrum disorder or has received treatment for 44 autism spectrum disorder. Coverage shall be subject to utilization 45 review and external appeals of health care services pursuant to article 46 forty-nine of this chapter as well as case management and other managed 47 care provisions. 48 (C) For purposes of this paragraph: 49 (i) "autism spectrum disorder" means any pervasive developmental 50 disorder as defined in the most recent edition of the diagnostic and 51 statistical manual of mental disorders, including, but not limited to, 52 autistic spectrum disorder. 53 (ii) "applied behavior analysis" means the design, implementation, and 54 evaluation of environmental modifications, using behavioral stimuli and 55 consequences, to produce socially significant improvement in human 56 behavior, including the use of direct observation, measurement, andS. 7673--A 4 1 functional analysis of the relationship between environment and behav- 2 ior. 3 (iii) "behavioral health treatment" means counseling and treatment 4 programs, including developmental, individual-differences, relation- 5 ship-based treatment, when provided by a licensed provider with a 6 professional certificate in developmental, individual-differences, rela- 7 tionship-based treatment from the interdisciplinary council on develop- 8 ment and learning, and applied behavior analysis, when provided by a 9 person licensed, certified or otherwise authorized to provide applied 10 behavior analysis, that are necessary to develop, maintain, or restore, 11 to the maximum extent practicable, the functioning of an individual. 12 Individuals that provide behavioral health treatment under the super- 13 vision of a licensed provider pursuant to this paragraph shall be 14 subject to standards of professionalism, supervision and relevant expe- 15 rience pursuant to regulations promulgated by the superintendent in 16 consultation with the commissioners of health and education. 17 (iv) "diagnosis of autism spectrum disorder" means assessments, evalu- 18 ations, or tests to diagnose whether an individual has autism spectrum 19 disorder. 20 (v) "pharmacy care" means medications prescribed by a licensed health 21 care provider legally authorized to prescribe under title eight of the 22 education law. 23 (vi) "psychiatric care" means direct or consultative services provided 24 by a psychiatrist licensed in the state in which the psychiatrist prac- 25 tices. 26 (vii) "psychological care" means direct or consultative services 27 provided by a psychologist licensed in the state in which the psychol- 28 ogist practices. 29 (viii) "therapeutic care" means services provided by licensed or 30 certified [speech therapists, occupational therapists, social workers,31or physical therapists] providers in the fields of counseling, occupa- 32 tional therapy, physical therapy, social work, or speech and language 33 pathology. 34 (ix) "treatment of autism spectrum disorder" shall include the follow- 35 ing care and assistive communication devices prescribed or ordered for 36 an individual diagnosed with autism spectrum disorder by a licensed 37 physician or a licensed psychologist: 38 (1) behavioral health treatment; 39 (2) psychiatric care; 40 (3) psychological care; 41 (4) medical care provided by a licensed health care provider; 42 (5) therapeutic care, including therapeutic care which is deemed habi- 43 litative or nonrestorative, in the event that the policy provides cover- 44 age for therapeutic care; and 45 (6) pharmacy care in the event that the policy provides coverage for 46 prescription drugs. 47 (x) "developmental, individual-differences, relationship-based treat- 48 ment" means the implementation of a floortime intervention that is based 49 on an assessment of functional-emotional development and the person's 50 individual profile, while understanding that human development is 51 fostered in the context of relationships with others. The primary goal 52 is to promote development and address developmental challenges and defi- 53 cits that often accompany autism and other neurodevelopmental disorders. 54 § 3. Paragraphs 2 and 3 of subsection (ee) of section 4303 of the 55 insurance law, paragraph 2 as amended by section 31 of subpart A of part 56 BB of chapter 57 of the laws of 2019, paragraph 3 as amended by chapterS. 7673--A 5 1 596 of the laws of 2011, subparagraphs (A) and (C) of paragraph 3 as 2 amended by section 32 of subpart A of part BB of chapter 57 of the laws 3 of 2019, are amended to read as follows: 4 (2) Every contract that 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 contract 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 contract. Coverage for applied behavior analysis and develop- 14 mental, individual-differences, relationship-based treatment shall be 15 subject to a maximum benefit of six hundred eighty hours of treatment 16 per policy during a calendar year per covered individual. This paragraph 17 shall not be construed as limiting the benefits that are otherwise 18 available to an individual under the contract, provided however that 19 such contract shall not contain any limitations on visits that are sole- 20 ly applied to the treatment of autism spectrum disorder, except as 21 provided in this subparagraph for coverage for applied behavior analysis 22 and developmental, individual differences, relationship-based treatment. 23 No insurer shall terminate coverage or refuse to deliver, execute, 24 issue, amend, adjust, or renew coverage to an individual solely because 25 the individual is diagnosed with autism spectrum disorder or has 26 received treatment for autism spectrum disorder. Coverage shall be 27 subject to utilization review and external appeals of health care 28 services pursuant to article forty-nine of this chapter as well as case 29 management and other managed care provisions. 30 (3) For purposes of this subsection: 31 (A) "autism spectrum disorder" means any pervasive developmental 32 disorder as defined in the most recent edition of the diagnostic and 33 statistical manual of mental disorders, including, but not limited to, 34 autistic spectrum disorder. 35 (B) "applied behavior analysis" means the design, implementation, and 36 evaluation of environmental modifications, using behavioral stimuli and 37 consequences, to produce socially significant improvement in human 38 behavior, including the use of direct observation, measurement, and 39 functional analysis of the relationship between environment and behav- 40 ior. 41 (C) "behavioral health treatment" means counseling and treatment 42 programs, including developmental, individual-differences, relation- 43 ship-based treatment, when provided by a licensed provider with a 44 professional certificate in developmental, individual-differences, rela- 45 tionship-based treatment from the interdisciplinary council on develop- 46 ment and learning, and applied behavior analysis, when provided by a 47 person that is licensed, certified or otherwise authorized to provide 48 applied behavior analysis, that are necessary to develop, maintain, or 49 restore, to the maximum extent practicable, the functioning of an indi- 50 vidual. Individuals that provide behavioral health treatment under the 51 supervision of a licensed provider pursuant to this subsection shall be 52 subject to standards of professionalism, supervision and relevant expe- 53 rience pursuant to regulations promulgated by the superintendent in 54 consultation with the commissioners of health and education.S. 7673--A 6 1 (D) "diagnosis of autism spectrum disorder" means assessments, evalu- 2 ations, or tests to diagnose whether an individual has autism spectrum 3 disorder. 4 (E) "pharmacy care" means medications prescribed by a licensed health 5 care provider legally authorized to prescribe under title eight of the 6 education law. 7 (F) "psychiatric care" means direct or consultative services provided 8 by a psychiatrist licensed in the state in which the psychiatrist prac- 9 tices. 10 (G) "psychological care" means direct or consultative services 11 provided by a psychologist licensed in the state in which the psychol- 12 ogist practices. 13 (H) "therapeutic care" means services provided by licensed or certi- 14 fied [speech therapists, occupational therapists, social workers, or15physical therapists] providers in the fields of counseling, occupational 16 therapy, physical therapy, social work, or speech and language 17 pathology. 18 (I) "treatment of autism spectrum disorder" shall include the follow- 19 ing care and assistive communication devices prescribed or ordered for 20 an individual diagnosed with autism spectrum disorder by a licensed 21 physician or a licensed psychologist: 22 (i) behavioral health treatment; 23 (ii) psychiatric care; 24 (iii) psychological care; 25 (iv) medical care provided by a licensed health care provider; 26 (v) therapeutic care, including therapeutic care which is deemed habi- 27 litative or nonrestorative, in the event that the policy provides cover- 28 age for therapeutic care; and 29 (vi) pharmacy care in the event that the contract provides coverage 30 for prescription drugs. 31 § 4. This act shall take effect on the ninetieth day after it shall 32 have become a law.
