NY State Senate Bill 2009-S1175

Senate Bill S1175

2009-2010 Legislative Session

Expands required health insurance coverage for the treatment and diagnosis of autism spectrum disorders

download bill text pdf

Archive: Last Bill Status - Stricken

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

Please enter your contact information

First Name

Last Name

Email Address

A valid email address is required.

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.

Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 20, 2010	recommit, enacting clause stricken
Jan 06, 2010	referred to insurance
Jan 27, 2009	referred to insurance

co-Sponsors

2009-S1175 (ACTIVE) - Details

Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L

2009-S1175 (ACTIVE) - Summary

Expands required health insurance coverage for the treatment and diagnosis of autism spectrum disorders.

2009-S1175 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S1175

 TITLE OF BILL :
An act to amend the insurance law, in relation to requiring health
insurance coverage of the diagnosis and treatment of autism spectrum
disorders in persons under twenty-one years of age


 PURPOSE OR GENERAL IDEA OF BILL :
To expand required health insurance coverage for the treatment and
diagnosis of autism spectrum disorders.

 SUMMARY OF SPECIFIC PROVISIONS :
Section 1: Amends Insurance §32l6-i(25), §3221-i(17) and §4303(ee) to
provide coverage in every policy, group policy, and/or medical
indemnity, hospital service or health service corporation for the
diagnosis and treatment of autism spectrum disorders rendered to
covered persons under the age of twenty-one years.

Defines autism spectrum disorder (including neurobiological conditions
that include autism, Asperger syndrome, Rett's syndrome, or pervasive
developmental disorder) in accordance with the most recent edition of
the Diagnostic and Statistical Manual of Mental Disorders.

Defines diagnosis of autism spectrum disorder as one or more tests,
evaluations or assessments to diagnose whether an individual has

autism spectrum disorders; which are performed or ordered by a
physician or psychologist licensed to practice medicine in the state
and having expertise in the diagnosis of autism spectrum disorders.

Defines medically necessary as any care, treatment, intervention,
service or item which would reasonably prevent the onset of an
illness, condition, injury, disease, or disability; reduce or
ameliorate the physical, mental or development effects of said
illness; achieve or maintain maximum functional activity in performing
daily activities.

Treatment for autism spectrum disorders shall include psychiatric
care, including direct, consultative, and diagnostic services;
psychological care; habilitative or rehabilitative care; therapeutic
care, including behavioral, speech, occupational and physical
therapies; providing coverage not to exceed thirty-six thousand
dollars per year.

 JUSTIFICATION :
Insurance companies would be required to cover autism diagnosis and
treatment up to $36,000. The action would mark a victory for advocates
who say early intervention and therapy is key to helping children with
autism gain communication and social skills.  The underlying cause of
autism is not known.

On the national level, the number of children diagnosed with autism
has increased by 500 percent over the past ten years. In New York
State alone, the Office of Mental Retardation and Developmental
Disabilities serves 16,000 individuals with autism In many cases,
families of children with autism are forced to cover treatment costs
with personal funds, at costs that can range from $2,000 to $4,000
out-of-pocket per month. The Autism Society of America estimates that
the lifetime cost of caring for a child with autism ranges .from $3.5
million to $5 million.

Insurance companies and health maintenance organizations are in a much
better position to negotiate lower rates and better quality service.
Eventually, coverage costs will decrease as more professionals are
trained to work with autism. Coverage will assume the cost of
treatment at a lower rate. Children who go without the essential
treatment may never have the ability to master basic life skills and
they may become a danger to themselves and to the community. For every
$1 we spend before the age of 5 we save $7 on lifelong care.

 PRIOR LEGISLATIVE HISTORY :
New bill.

 FISCAL IMPLICATIONS :
To be determined.

 EFFECTIVE DATE :
This act shall take effect on the first January next succeeding the
date on which it shall have become law and shall apply to all policies
or contracts issued, renewed, modified, altered or amended on and
after such effective date.

2009-S1175 (ACTIVE) - Bill Text download pdf

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

    S. 1175                                                  A. 3332

                       2009-2010 Regular Sessions

                      S E N A T E - A S S E M B L Y

                            January 27, 2009
                               ___________

IN  SENATE  --  Introduced by Sens. HUNTLEY, MONSERRATE, ONORATO -- read
  twice and ordered printed, and when printed to  be  committed  to  the
  Committee on Insurance

IN  ASSEMBLY  --  Introduced  by M. of A. BALL, ALFANO, BURLING, CASTRO,
  DUPREY, ERRIGO, KOLB, MOLINARO, QUINN,  SCOZZAFAVA,  THIELE,  TOBACCO,
  WALKER, WEISENBERG -- Multi-Sponsored by -- M. of A. RABBITT, RUSSELL,
  WRIGHT -- read once and referred to the Committee on Insurance

AN  ACT  to  amend  the  insurance  law, in relation to requiring health
  insurance coverage of the diagnosis and treatment of  autism  spectrum
  disorders in persons under twenty-one years of age

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph 25 of subsection  (i)  of  section  3216  of  the
insurance  law,  as added by chapter 557 of the laws of 2006, is amended
to read as follows:
  (25) (A) Every policy which provides coverage for hospital,  surgical,
or  medical  care  coverage shall [not exclude] PROVIDE coverage for THE
diagnosis and treatment of [medical conditions otherwise covered by  the
policy  solely  because  the treatment is provided to diagnose or treat]
autism spectrum [disorder] DISORDERS RENDERED TO COVERED  PERSONS  UNDER
THE AGE OF TWENTY-ONE YEARS.
  (B) For purposes of this [section, "autism] PARAGRAPH:
  (I) "AUTISM spectrum [disorder" means a neurobiological condition that
includes autism, Asperger syndrome, Rett's syndrome, or pervasive devel-
opmental disorder] DISORDERS" MEANS PERVASIVE DEVELOPMENTAL DISORDERS AS
DEFINED  IN  THE  MOST  RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL
MANUAL OF MENTAL DISORDERS, INCLUDING AUTISM,  ASPERGER'S  DISORDER  AND
PERVASIVE DEVELOPMENTAL DISORDERS NOT OTHERWISE SPECIFIED.
  (II) "DIAGNOSIS OF AUTISM SPECTRUM DISORDERS" MEANS ONE OR MORE TESTS,
EVALUATIONS OR ASSESSMENTS TO DIAGNOSE, WHETHER AN INDIVIDUAL HAS AUTISM

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05668-01-9

S. 1175                             2                            A. 3332

SPECTRUM  DISORDERS  THAT  ARE PRESCRIBED, PERFORMED OR ORDERED BY (I) A
PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE OR (II) A PSYCHOL-
OGIST LICENSED TO PRACTICE IN THIS STATE AND HAVING EXPERTISE  IN  DIAG-
NOSING AUTISM SPECTRUM DISORDERS.
  (III)  "MEDICALLY  NECESSARY" MEANS ANY CARE, TREATMENT, INTERVENTION,
SERVICE OR ITEM WHICH WILL OR IS REASONABLY EXPECTED TO DO  ANY  OF  THE
FOLLOWING:
  (I)  PREVENT  THE  ONSET  OF AN ILLNESS, CONDITION, INJURY, DISEASE OR
DISABILITY;
  (II) REDUCE  OR  AMELIORATE  THE  PHYSICAL,  MENTAL  OR  DEVELOPMENTAL
EFFECTS OF AN ILLNESS, CONDITION, INJURY, DISEASE OR DISABILITY; OR
  (III)  ASSIST  TO  ACHIEVE  OR MAINTAIN MAXIMUM FUNCTIONAL ACTIVITY IN
PERFORMING DAILY ACTIVITIES.
  (IV) "TREATMENT FOR  AUTISM  SPECTRUM  DISORDERS"  SHALL  INCLUDE  THE
FOLLOWING  CARE  PRESCRIBED, PROVIDED OR ORDERED FOR AN INDIVIDUAL DIAG-
NOSED WITH AUTISM SPECTRUM DISORDERS:
  (I) PSYCHIATRIC CARE, INCLUDING  DIRECT,  CONSULTATIVE  OR  DIAGNOSTIC
SERVICES PROVIDED BY A LICENSED PHYSICIAN SPECIALIZING IN PSYCHIATRY;
  (II)  PSYCHOLOGICAL  CARE,  INCLUDING  DIRECT OR CONSULTATIVE SERVICES
PROVIDED BY A LICENSED PSYCHOLOGIST;
  (III) HABILITATIVE OR  REHABILITATIVE  CARE,  INCLUDING  PROFESSIONAL,
COUNSELING  AND  GUIDANCE  SERVICES  AND  TREATMENT  PROGRAMS  THAT  ARE
INTENDED TO DEVELOP, MAINTAIN AND RESTORE THE FUNCTIONING OF AN INDIVID-
UAL;
  (IV) THERAPEUTIC CARE, INCLUDING BEHAVIORAL, SPEECH, OCCUPATIONAL  AND
PHYSICAL THERAPIES THAT PROVIDE TREATMENT IN THE FOLLOWING AREAS:
  1. SELF CARE AND FEEDING,
  2. PRAGMATIC, RECEPTIVE AND EXPRESSIVE LANGUAGE,
  3. COGNITIVE FUNCTIONING,
  4. APPLIED BEHAVIOR ANALYSIS, INTERVENTION AND MODIFICATION,
  5. MOTOR PLANNING, AND
  6. SENSORY PROCESSING.
  (C) UPON REQUEST OF THE COVERAGE PROVIDER, A PROVIDER OF TREATMENT FOR
AUTISM  SPECTRUM DISORDERS SHALL FURNISH MEDICAL RECORDS, CLINICAL NOTES
OR OTHER NECESSARY DATA THAT SUBSTANTIATE THAT THE INITIAL AND CONTINUED
MEDICAL TREATMENT IS MEDICALLY NECESSARY AND RESULTING IN IMPROVED CLIN-
ICAL STATUS. WHEN TREATMENT IS ANTICIPATED TO REQUIRE CONTINUED SERVICES
TO ACHIEVE DEMONSTRABLE PROGRESS, THE COVERAGE PROVIDER  MAY  REQUEST  A
TREATMENT  PLAN  CONSISTING  OF  DIAGNOSIS,  PROPOSED TREATMENT BY TYPE,
FREQUENCY, ANTICIPATED DURATION OF TREATMENT, THE  ANTICIPATED  OUTCOMES
STATED  AS  GOALS, AND THE FREQUENCY BY WHICH THE TREATMENT PLAN WILL BE
UPDATED.
  (D) COVERAGE PURSUANT TO THIS PARAGRAPH SHALL  NOT  EXCEED  THIRTY-SIX
THOUSAND  DOLLARS  PER  YEAR,  PROVIDED  THAT  SUCH COVERAGE SHALL IN NO
MANNER LIMIT OR BE APPLIED AGAINST ANY  OTHER  COVERAGE  LIMIT  FOR  ANY
OTHER HEALTH CONDITION COVERED UNDER THE INSURANCE POLICY.  ANNUALLY, ON
OR  BEFORE  JANUARY  FIRST, SUCH COVERAGE LIMIT SHALL BE ADJUSTED BY THE
SUPERINTENDENT TO REFLECT INFLATION USING THE MEDICAL CARE COMPONENT  OF
THE UNITED STATES DEPARTMENT OF LABOR CONSUMER PRICE INDEX FOR ALL URBAN
CONSUMERS.   SUCH COVERAGE SHALL IN NO MANNER LIMIT THE NUMBER OF VISITS
FOR THE TREATMENT AND DIAGNOSIS OF AUTISM SPECTRUM DISORDERS.
  (E) THE DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM  DISORDERS  MAY  BE
SUBJECT TO REASONABLE DEDUCTIBLE, CO-PAYMENT AND CO-INSURANCE AMOUNTS TO
THE EXTENT THAT OTHER MEDICAL SERVICES ARE SUBJECT TO SUCH PROVISIONS.

S. 1175                             3                            A. 3332

  S  2.  Paragraph 17 of subsection (l) of section 3221 of the insurance
law, as added by chapter 557 of the laws of 2006, is amended to read  as
follows:
  (17)  (A)  A  group  or blanket accident or health insurance policy or
issuing a group or blanket policy  for  delivery  in  this  state  which
provides coverage for hospital, surgical, or medical care coverage shall
[not  exclude]  PROVIDE  coverage  for  THE  diagnosis  and treatment of
[medical conditions otherwise covered by the policy because  the  treat-
ment is provided to diagnose or treat] autism spectrum [disorder] DISOR-
DERS RENDERED TO COVERED PERSONS UNDER THE AGE OF TWENTY-ONE YEARS.
  (B) For purposes of this [section, "autism] PARAGRAPH:
  (I) "AUTISM spectrum [disorder" means a neurobiological condition that
includes autism, Asperger syndrome, Rett's syndrome, or pervasive devel-
opmental disorder] DISORDERS" MEANS PERVASIVE DEVELOPMENTAL DISORDERS AS
DEFINED  IN  THE  MOST  RECENT EDITION OF THE DIAGNOSTIC AND STATISTICAL
MANUAL OF MENTAL DISORDERS, INCLUDING AUTISM,  ASPERGER'S  DISORDER  AND
PERVASIVE DEVELOPMENTAL DISORDERS NOT OTHERWISE SPECIFIED.
  (II) "DIAGNOSIS OF AUTISM SPECTRUM DISORDERS" MEANS ONE OR MORE TESTS,
EVALUATIONS OR ASSESSMENTS TO DIAGNOSE, WHETHER AN INDIVIDUAL HAS AUTISM
SPECTRUM  DISORDERS  THAT  ARE PRESCRIBED, PERFORMED OR ORDERED BY (I) A
PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE OR (II) A PSYCHOL-
OGIST LICENSED TO PRACTICE IN THIS STATE AND HAVING EXPERTISE  IN  DIAG-
NOSING AUTISM SPECTRUM DISORDERS.
  (III)  "MEDICALLY  NECESSARY" MEANS ANY CARE, TREATMENT, INTERVENTION,
SERVICE OR ITEM WHICH WILL OR IS REASONABLY EXPECTED TO DO  ANY  OF  THE
FOLLOWING:
  (I)  PREVENT  THE  ONSET  OF AN ILLNESS, CONDITION, INJURY, DISEASE OR
DISABILITY;
  (II) REDUCE  OR  AMELIORATE  THE  PHYSICAL,  MENTAL  OR  DEVELOPMENTAL
EFFECTS OF AN ILLNESS, CONDITION, INJURY, DISEASE OR DISABILITY; OR
  (III)  ASSIST  TO  ACHIEVE  OR MAINTAIN MAXIMUM FUNCTIONAL ACTIVITY IN
PERFORMING DAILY ACTIVITIES.
  (IV) "TREATMENT FOR  AUTISM  SPECTRUM  DISORDERS"  SHALL  INCLUDE  THE
FOLLOWING  CARE  PRESCRIBED, PROVIDED OR ORDERED FOR AN INDIVIDUAL DIAG-
NOSED WITH AUTISM SPECTRUM DISORDERS:
  (I) PSYCHIATRIC CARE, INCLUDING  DIRECT,  CONSULTATIVE  OR  DIAGNOSTIC
SERVICES PROVIDED BY A LICENSED PHYSICIAN SPECIALIZING IN PSYCHIATRY;
  (II)  PSYCHOLOGICAL  CARE,  INCLUDING  DIRECT OR CONSULTATIVE SERVICES
PROVIDED BY A LICENSED PSYCHOLOGIST;
  (III) HABILITATIVE OR  REHABILITATIVE  CARE,  INCLUDING  PROFESSIONAL,
COUNSELING  AND  GUIDANCE  SERVICES  AND  TREATMENT  PROGRAMS  THAT  ARE
INTENDED TO DEVELOP, MAINTAIN AND RESTORE THE FUNCTIONING OF AN INDIVID-
UAL;
  (IV) THERAPEUTIC CARE, INCLUDING BEHAVIORAL, SPEECH, OCCUPATIONAL  AND
PHYSICAL THERAPIES THAT PROVIDE TREATMENT IN THE FOLLOWING AREAS:
  1. SELF CARE AND FEEDING,
  2. PRAGMATIC, RECEPTIVE AND EXPRESSIVE LANGUAGE,
  3. COGNITIVE FUNCTIONING,
  4. APPLIED BEHAVIOR ANALYSIS, INTERVENTION AND MODIFICATION,
  5. MOTOR PLANNING, AND
  6. SENSORY PROCESSING.
  (C) UPON REQUEST OF THE COVERAGE PROVIDER, A PROVIDER OF TREATMENT FOR
AUTISM  SPECTRUM DISORDERS SHALL FURNISH MEDICAL RECORDS, CLINICAL NOTES
OR OTHER NECESSARY DATA THAT SUBSTANTIATE THAT THE INITIAL AND CONTINUED
MEDICAL TREATMENT IS MEDICALLY NECESSARY AND RESULTING IN IMPROVED CLIN-
ICAL STATUS. WHEN TREATMENT IS ANTICIPATED TO REQUIRE CONTINUED SERVICES

S. 1175                             4                            A. 3332

TO ACHIEVE DEMONSTRABLE PROGRESS, THE COVERAGE PROVIDER  MAY  REQUEST  A
TREATMENT  PLAN  CONSISTING  OF  DIAGNOSIS,  PROPOSED TREATMENT BY TYPE,
FREQUENCY, ANTICIPATED DURATION OF TREATMENT, THE  ANTICIPATED  OUTCOMES
STATED  AS  GOALS, AND THE FREQUENCY BY WHICH THE TREATMENT PLAN WILL BE
UPDATED.
  (D) COVERAGE PURSUANT TO THIS PARAGRAPH SHALL  NOT  EXCEED  THIRTY-SIX
THOUSAND  DOLLARS  PER  YEAR,  PROVIDED  THAT  SUCH COVERAGE SHALL IN NO
MANNER LIMIT OR BE APPLIED AGAINST ANY  OTHER  COVERAGE  LIMIT  FOR  ANY
OTHER HEALTH CONDITION COVERED UNDER THE INSURANCE POLICY.  ANNUALLY, ON
OR  BEFORE  JANUARY  FIRST, SUCH COVERAGE LIMIT SHALL BE ADJUSTED BY THE
SUPERINTENDENT TO REFLECT INFLATION USING THE MEDICAL CARE COMPONENT  OF
THE UNITED STATES DEPARTMENT OF LABOR CONSUMER PRICE INDEX FOR ALL URBAN
CONSUMERS.   SUCH COVERAGE SHALL IN NO MANNER LIMIT THE NUMBER OF VISITS
FOR THE TREATMENT AND DIAGNOSIS OF AUTISM SPECTRUM DISORDERS.
  (E) THE DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM  DISORDERS  MAY  BE
SUBJECT TO REASONABLE DEDUCTIBLE, CO-PAYMENT AND CO-INSURANCE AMOUNTS TO
THE EXTENT THAT OTHER MEDICAL SERVICES ARE SUBJECT TO SUCH PROVISIONS.
  S 3. Subsection (ee) of section 4303 of the insurance law, as added by
chapter 557 of the laws of 2006, is amended to read as follows:
  (ee)  (1)  A medical expense indemnity corporation, a hospital service
corporation or a health service corporation which provides coverage  for
hospital, surgical, or medical care coverage shall [not exclude] INCLUDE
coverage  for  THE diagnosis and treatment of [medical conditions other-
wise covered by the policy solely because the treatment is  provided  to
diagnose  or  treat]  autism  spectrum  [disorder] DISORDERS RENDERED TO
COVERED PERSONS UNDER THE AGE OF TWENTY-ONE YEARS.
  (2) For purposes of this [section, "autism] SUBSECTION:
  (A) "AUTISM spectrum [disorder" means a neurobiological condition that
includes autism, Asperger syndrome, Rett's syndrome, or pervasive devel-
opmental disorder] DISORDERS" MEANS PERVASIVE DEVELOPMENTAL DISORDERS AS
DEFINED IN THE MOST RECENT EDITION OF  THE  DIAGNOSTIC  AND  STATISTICAL
MANUAL  OF  MENTAL  DISORDERS, INCLUDING AUTISM, ASPERGER'S DISORDER AND
PERVASIVE DEVELOPMENTAL DISORDERS NOT OTHERWISE SPECIFIED.
  (B) "DIAGNOSIS OF AUTISM SPECTRUM DISORDERS" MEANS ONE OR MORE  TESTS,
EVALUATIONS OR ASSESSMENTS TO DIAGNOSE, WHETHER AN INDIVIDUAL HAS AUTISM
SPECTRUM  DISORDERS  THAT  ARE PRESCRIBED, PERFORMED OR ORDERED BY (I) A
PHYSICIAN LICENSED TO PRACTICE MEDICINE IN THIS STATE OR (II) A PSYCHOL-
OGIST LICENSED TO PRACTICE IN THIS STATE AND HAVING EXPERTISE  IN  DIAG-
NOSING AUTISM SPECTRUM DISORDERS.
  (C)  "MEDICALLY  NECESSARY"  MEANS  ANY CARE, TREATMENT, INTERVENTION,
SERVICE OR ITEM WHICH WILL OR IS REASONABLY EXPECTED TO DO  ANY  OF  THE
FOLLOWING:
  (I)  PREVENT  THE  ONSET  OF AN ILLNESS, CONDITION, INJURY, DISEASE OR
DISABILITY;
  (II) REDUCE  OR  AMELIORATE  THE  PHYSICAL,  MENTAL  OR  DEVELOPMENTAL
EFFECTS OF AN ILLNESS, CONDITION, INJURY, DISEASE OR DISABILITY; OR
  (III)  ASSIST  TO  ACHIEVE  OR MAINTAIN MAXIMUM FUNCTIONAL ACTIVITY IN
PERFORMING DAILY ACTIVITIES.
  (D) "TREATMENT  FOR  AUTISM  SPECTRUM  DISORDERS"  SHALL  INCLUDE  THE
FOLLOWING  CARE  PRESCRIBED, PROVIDED OR ORDERED FOR AN INDIVIDUAL DIAG-
NOSED WITH AUTISM SPECTRUM DISORDERS:
  (I) PSYCHIATRIC CARE, INCLUDING   DIRECT, CONSULTATIVE  OR  DIAGNOSTIC
SERVICES PROVIDED BY A LICENSED PHYSICIAN SPECIALIZING IN PSYCHIATRY;
  (II)  PSYCHOLOGICAL  CARE,  INCLUDING  DIRECT OR CONSULTATIVE SERVICES
PROVIDED BY A LICENSED PSYCHOLOGIST;

S. 1175                             5                            A. 3332

  (III) HABILITATIVE OR  REHABILITATIVE  CARE,  INCLUDING  PROFESSIONAL,
COUNSELING  AND  GUIDANCE  SERVICES  AND  TREATMENT  PROGRAMS  THAT  ARE
INTENDED TO DEVELOP, MAINTAIN AND RESTORE THE FUNCTIONING OF AN INDIVID-
UAL.
  (IV)  THERAPEUTIC CARE, INCLUDING BEHAVIORAL, SPEECH, OCCUPATIONAL AND
PHYSICAL THERAPIES THAT PROVIDE TREATMENT IN THE FOLLOWING AREAS:
  (I) SELF CARE AND FEEDING,
  (II) PRAGMATIC, RECEPTIVE AND EXPRESSIVE LANGUAGE,
  (III) COGNITIVE FUNCTIONING,
  (IV) APPLIED BEHAVIOR ANALYSIS, INTERVENTION AND MODIFICATION,
  (V) MOTOR PLANNING, AND
  (VI) SENSORY PROCESSING.
  (3) UPON REQUEST OF THE COVERAGE PROVIDER, A PROVIDER OF TREATMENT FOR
AUTISM SPECTRUM DISORDERS SHALL FURNISH MEDICAL RECORDS, CLINICAL  NOTES
OR OTHER NECESSARY DATA THAT SUBSTANTIATE THAT THE INITIAL AND CONTINUED
MEDICAL TREATMENT IS MEDICALLY NECESSARY AND RESULTING IN IMPROVED CLIN-
ICAL STATUS. WHEN TREATMENT IS ANTICIPATED TO REQUIRE CONTINUED SERVICES
TO  ACHIEVE  DEMONSTRABLE  PROGRESS, THE COVERAGE PROVIDER MAY REQUEST A
TREATMENT PLAN CONSISTING OF  DIAGNOSIS,  PROPOSED  TREATMENT  BY  TYPE,
FREQUENCY,  ANTICIPATED  DURATION OF TREATMENT, THE ANTICIPATED OUTCOMES
STATED AS GOALS, AND THE FREQUENCY BY WHICH THE TREATMENT PLAN  WILL  BE
UPDATED.
  (4)  COVERAGE  PURSUANT TO THIS SUBSECTION SHALL NOT EXCEED THIRTY-SIX
THOUSAND DOLLARS PER YEAR, PROVIDED  THAT  SUCH  COVERAGE  SHALL  IN  NO
MANNER  LIMIT  OR  BE  APPLIED  AGAINST ANY OTHER COVERAGE LIMIT FOR ANY
OTHER HEALTH CONDITION COVERED UNDER THE INSURANCE POLICY.  ANNUALLY, ON
OR BEFORE JANUARY FIRST, SUCH COVERAGE LIMIT SHALL BE  ADJUSTED  BY  THE
SUPERINTENDENT  TO REFLECT INFLATION USING THE MEDICAL CARE COMPONENT OF
THE UNITED STATES DEPARTMENT OF LABOR CONSUMER PRICE INDEX FOR ALL URBAN
CONSUMERS.  SUCH COVERAGE SHALL IN NO MANNER LIMIT THE NUMBER OF  VISITS
FOR THE TREATMENT AND DIAGNOSIS OF AUTISM SPECTRUM DISORDERS.
  (5)  THE  DIAGNOSIS  AND TREATMENT OF AUTISM SPECTRUM DISORDERS MAY BE
SUBJECT TO REASONABLE DEDUCTIBLE, CO-PAYMENT AND CO-INSURANCE AMOUNTS TO
THE EXTENT THAT OTHER MEDICAL SERVICES ARE SUBJECT TO SUCH PROVISIONS.
  S 4. This act shall take effect on the first of January next  succeed-
ing  the date on which it shall have become a law and shall apply to all
policies or contracts issued, renewed, modified, altered or  amended  on
and after such effective date.

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Senate Bill S1175

Share this bill

Sponsored By

Shirley L. Huntley