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

                                   537

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  M. of A. ABINANTI, STEVENSON, TITONE, COOK, ENGLEBRIGHT,
  ROBINSON, BENEDETTO -- Multi-Sponsored by -- M. of A.  FINCH,  GIBSON,
  GRAF,  RAIA,  THIELE  --  read  once  and referred to the Committee on
  Insurance

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:

  Section 1. Subparagraph (B) of  paragraph  25  of  subsection  (i)  of
section 3216 of the insurance law, as amended by chapter 596 of the laws
of 2011, is amended to read as follows:
  (B)  Every  policy  which  provides physician services, medical, major
medical or similar comprehensive-type coverage  shall  provide  coverage
for  the  screening, diagnosis and treatment of autism spectrum disorder
in accordance with this paragraph and shall not exclude coverage for the
screening,  diagnosis  or  treatment  of  medical  conditions  otherwise
covered  by  the  policy because the individual is diagnosed with autism
spectrum disorder. Such coverage may be subject to  annual  deductibles,
copayments  and  coinsurance  as may be deemed appropriate by the super-
intendent and shall be consistent with those imposed on  other  benefits
under  the  policy.  [Coverage  for  applied  behavior analysis shall be
subject to a maximum benefit of forty-five thousand dollars per year per
covered individual and such maximum annual benefit will increase by  the
amount  calculated from the average ten year rolling average increase of
the medical component of the consumer price index.] This paragraph shall
not be construed as limiting the benefits that are  otherwise  available
to  an  individual  under  the policy, provided however that such policy
shall not contain any limitations on visits that are solely  applied  to
the  treatment  of  autism spectrum disorder. No insurer shall terminate
coverage or refuse to deliver, execute, issue, amend, adjust,  or  renew

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

                                                           LBD03639-01-3

A. 537                              2

coverage  to  an  individual  solely because the individual is diagnosed
with autism spectrum disorder or has received treatment for autism spec-
trum disorder. Coverage shall  be  subject  to  utilization  review  and
external  appeals of health care services pursuant to article forty-nine
of this chapter as well as, case  management,  and  other  managed  care
provisions.
  S  2.  Subparagraph  (B)  of paragraph 17 of subsection (l) of section
3221 of the insurance law, as amended by chapter  596  of  the  laws  of
2011, is amended to read as follows:
  (B)  Every  group or blanket policy which provides physician services,
medical, major medical  or  similar  comprehensive-type  coverage  shall
provide  coverage  for  the screening, diagnosis and treatment of autism
spectrum disorder in  accordance  with  this  paragraph  and  shall  not
exclude  coverage  for  the screening, diagnosis or treatment of medical
conditions otherwise covered by the policy  because  the  individual  is
diagnosed with autism spectrum disorder. Such coverage may be subject to
annual  deductibles,  copayments and coinsurance as may be deemed appro-
priate by the superintendent and shall be consistent with those  imposed
on  other  benefits  under  the  group  or blanket policy. [Coverage for
applied behavior analysis shall be  subject  to  a  maximum  benefit  of
forty-five  thousand  dollars  per  year per covered individual and such
maximum annual benefit will increase by the amount calculated  from  the
average  ten  year  rolling average increase of the medical component of
the consumer price index.] This paragraph  shall  not  be  construed  as
limiting  the  benefits  that  are  otherwise available to an individual
under the group or blanket policy, provided  however  that  such  policy
shall  not  contain any limitations on visits that are solely applied to
the treatment of autism spectrum disorder. No  insurer  shall  terminate
coverage  or  refuse to deliver, execute, issue, amend, adjust, or renew
coverage to an individual solely because  the  individual  is  diagnosed
with autism spectrum disorder or has received treatment for autism spec-
trum  disorder.  Coverage  shall  be  subject  to utilization review and
external appeals of health care services pursuant to article  forty-nine
of  this  chapter  as  well  as, case management, and other managed care
provisions.
  S 3. Paragraph 2 of subsection (ee) of section 4303 of  the  insurance
law,  as  amended by chapter 596 of the laws of 2011, is amended to read
as follows:
  (2) Every contract which provides physician services,  medical,  major
medical  or  similar  comprehensive-type coverage shall provide coverage
for the screening, diagnosis and treatment of autism  spectrum  disorder
in  accordance  with  this subsection and shall not exclude coverage for
the screening, diagnosis or treatment of  medical  conditions  otherwise
covered  by the contract because the individual is diagnosed with autism
spectrum disorder. Such coverage may be subject to  annual  deductibles,
copayments  and  coinsurance  as may be deemed appropriate by the super-
intendent and shall be consistent with those imposed on  other  benefits
under  the  contract.  [Coverage  for applied behavior analysis shall be
subject to a maximum benefit of forty-five thousand dollars per year per
covered individual and such maximum annual benefit will increase by  the
amount  calculated from the average ten year rolling average increase of
the medical component of the consumer price index.] This paragraph shall
not be construed as limiting the benefits that are  otherwise  available
to an individual under the contract, provided however that such contract
shall  not  contain any limitations on visits that are solely applied to
the treatment of autism spectrum disorder. No  insurer  shall  terminate

A. 537                              3

coverage  or  refuse to deliver, execute, issue, amend, adjust, or renew
coverage to an individual solely because  the  individual  is  diagnosed
with autism spectrum disorder or has received treatment for autism spec-
trum  disorder.  Coverage  shall  be  subject  to utilization review and
external appeals of health care services pursuant to article  forty-nine
of  this  chapter  as  well  as, case management, and other managed care
provisions.
  S 4. This act shall take effect immediately.