NY State Senate Bill 2019-S3251

Senate Bill S3251

2019-2020 Legislative Session

Requires health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder

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Archive: Last Bill Status - In Senate Committee Insurance Committee

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

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 08, 2020	referred to insurance
Feb 05, 2019	referred to insurance

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2019-S3251 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Add §343, amd §§3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S385
2011-2012: S3405
2013-2014: S2707
2015-2016: S2751
2017-2018: S2222
2021-2022: S3301
2023-2024: S5762

2019-S3251 (ACTIVE) - Summary

Requires health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder; establishes an advisory panel on health insurance coverage for autism spectrum disorder to annually compile a list of treatments and therapy options for which health insurers will be required to provide coverage; establishes a toll-free, 24 hour a day, autism and health insurance coverage hotline to receive and act upon complaints and questions from families with autistic children, relating to insurance coverage for autism spectrum disorder.

2019-S3251 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S3251

SPONSOR: PARKER
 
TITLE OF BILL:

An act to amend the insurance law, in relation to establishing an advi-
sory panel on health insurance coverage for autism spectrum disorder

 
PURPOSE:

To establish an advisory panel to report to the superintendent regarding
successful treatment options for autism spectrum disorder that will be
required to be covered by insurance.

 
SUMMARY OF PROVISIONS:

Section 1 adds section 343 to the insurance law to establish an advisory
panel on health insurance coverage to be composed of health profes-
sionals from the department of health, office of mental health, and/or
the office of people with developmental disabilities and representatives
of autism advocacy groups. These individuals will be appointed by the

governor, the temporary president of the senate, and the speaker of the
assembly. Additionally, this section requires the panel to submit an
annual report on treatment efficacy that will be covered by insurance,
as well as, establish a hotline to assist healthcare providers with the
insurance process.

Section 2 amends the insurance law as added by chapter 56 of the laws of
2013, to include full coverage for diagnosis and treatment of autism
spectrum disorder.

Section 3 amends the insurance law, to include full coverage for screen-
ing, diagnosis and treatment of autism spectrum disorder.

Section 4 amends the insurance law, to include full coverage for diagno-
sis and treatment of autism spectrum disorder

Section 5 Effective Date

 
JUSTIFICATION:

According to the National Centers for Disease Control and Prevention it
is estimated that an average of 1 in 110 children in the United States
has an autism spectrum disorder (ASD). Research indicates that early
detection of ASD, when paired with proper intervention, can lead to
better outcomes for children. These outcomes include improved language,
social, and adaptive functioning, and a reduction in inappropriate
behaviors.

Consequently, it is critical to identify and refer children with ASD as
early as possible.

Unfortunately, many children with autism are not properly diagnosed
until years after the first symptoms appear. Until the passage of Chap-
ter 596 of the laws of New York 2011, most health insurance plans in the
state of New York did not cover autism treatment.  Now that ASD is
included in the list of neurological disorders covered by insurance it
is imperative that we establish an advisory panel to report on the
successful treatment and therapy options which will be required under
the new law. It is also necessary to establish a hotline for personnel
to streamline insurance coverage questions that will likely occur due to
changes in the insurance law.

The passage of Chapter 596 of the Laws of New York 2011 (S.5845) is
major accomplishment in terms of decreasing exclusions in health insur-
ance based solely on the fact that an individual is diagnosed with
autism spectrum disorder. This bill takes this recently enacted law one
step further by including the prevention, diagnosis and treatment of
autism spectrum disorder, just as any other neurobiological condition
that would be included in hospital, surgical or medical care coverage.

 
LEGISLATIVE HISTORY:

2017-18: S.2222 - Referred to Insurance
2015-16: S.2751 - Referred to Insurance
2013-14: S.2707A - Referred to Insurance
2011-12: S.3405A - Referred to Insurance
2011 2009-10: S.385/A.2759 - Referred to Insurance
2007-08:  S.3121/A.539 - Referred to Insurance

 
FISCAL IMPLICATION:

Minimal.

 
EFFECTIVE DATE:
This act shall take effect on the thirtieth day after it becomes a law.

2019-S3251 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3251
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                             February 5, 2019
                                ___________
 
 Introduced  by  Sens.  PARKER,  ADDABBO,  BAILEY,  KENNEDY,  MONTGOMERY,
   PERSAUD -- read twice and ordered printed,  and  when  printed  to  be
   committed to the Committee on Insurance
 
 AN  ACT to amend the insurance law, in relation to establishing an advi-
   sory panel on health insurance coverage for autism spectrum disorder

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.   The insurance law is amended by adding a new section 343
 to read as follows:
   § 343. COVERAGE FOR AUTISM SPECTRUM DISORDER. (A) (1) THERE IS  HEREBY
 ESTABLISHED  WITHIN THE DEPARTMENT AN ADVISORY PANEL ON HEALTH INSURANCE
 COVERAGE FOR AUTISM SPECTRUM DISORDER. SUCH PANEL SHALL BE  COMPOSED  OF
 NINE  MEMBERS  WHO  ARE EXPERTS IN HEALTH CARE AND APPOINTED AS FOLLOWS:
 SEVEN MEMBERS WHO ARE OFFICERS OR EMPLOYEES OF THE DEPARTMENT OF HEALTH,
 OFFICE OF MENTAL HEALTH OR THE  OFFICE  FOR  PEOPLE  WITH  DEVELOPMENTAL
 DISABILITIES SHALL BE APPOINTED BY THE GOVERNOR; AND THE TEMPORARY PRES-
 IDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY SHALL EACH APPOINT A
 MEMBER  WHO IS A REPRESENTATIVE OF AN AUTISM ADVOCACY GROUP. EACH MEMBER
 SHALL SERVE A TERM OF TWO YEARS. THE GOVERNOR SHALL DESIGNATE THE  CHAIR
 OF  THE PANEL FROM AMONG HIS OR HER APPOINTEES. VACANCIES IN THE MEMBER-
 SHIP OF THE PANEL SHALL BE FILLED IN THE MANNER  PROVIDED  FOR  ORIGINAL
 APPOINTMENTS.
   (2)  THE  MEMBERS OF THE PANEL SHALL RECEIVE NO COMPENSATION FOR THEIR
 SERVICES BUT SHALL  BE  ALLOWED  THEIR  ACTUAL  AND  NECESSARY  EXPENSES
 INCURRED IN THE PERFORMANCE OF THEIR DUTIES PURSUANT TO THIS SUBSECTION.
   (3)  THE  ADVISORY PANEL ON HEALTH INSURANCE COVERAGE FOR AUTISM SPEC-
 TRUM DISORDER SHALL ANNUALLY, ON OR BEFORE SEPTEMBER FIRST, COMPILE  AND
 SUBMIT  TO THE SUPERINTENDENT A LIST OF SUCCESSFUL TREATMENT AND THERAPY
 OPTIONS FOR AUTISM SPECTRUM DISORDER THAT WILL BE REQUIRED TO BE COVERED
 PURSUANT TO PARAGRAPH TWENTY-FIVE OF SUBSECTION  (I)  OF  SECTION  THREE
 THOUSAND  TWO  HUNDRED SIXTEEN, PARAGRAPH SEVENTEEN OF SUBSECTION (1) OF
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD08342-01-9

 S. 3251                             2
 
 SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE  AND  SUBSECTION  (EE)  OF
 SECTION FOUR THOUSAND THREE HUNDRED THREE OF THIS CHAPTER.
   (4)  WITHIN FORTY-FIVE DAYS OF RECEIPT OF EACH LIST SUBMITTED PURSUANT
 TO PARAGRAPH THREE OF THIS SUBSECTION, THE SUPERINTENDENT SHALL,  ON  AN
 EMERGENCY  BASIS, PROMULGATE AND IMPLEMENT RULES AND REGULATIONS REQUIR-
 ING COVERAGE FOR THE TREATMENT AND THERAPY OPTIONS INCLUDED IN EACH SUCH
 LIST.
   (B) (1) WITHIN ONE HUNDRED  EIGHTY  DAYS  OF  THE  SUBMISSION  OF  THE
 INITIAL  LIST  TO  THE  SUPERINTENDENT  PURSUANT  TO  PARAGRAPH THREE OF
 SUBSECTION (A) OF THIS SECTION, THE DEPARTMENT SHALL ESTABLISH AND OPER-
 ATE AN AUTISM AND HEALTH INSURANCE COVERAGE HOTLINE. THE  HOTLINE  SHALL
 BE A TOLL-FREE, TWENTY-FOUR HOUR A DAY CONSUMER CALL CENTER FOR FAMILIES
 WITH  AUTISTIC CHILDREN WHO HAVE COMPLAINTS ABOUT OR QUESTIONS ON INSUR-
 ERS AND COVERAGE FOR AUTISM SPECTRUM DISORDER. ALL  COMPLAINTS  RECEIVED
 BY  SUCH  HOTLINE  SHALL  BE  DOCUMENTED AND REFERRED TO THE APPROPRIATE
 OFFICIAL IN THE DEPARTMENT FOR CORRECTIVE ACTION.
   (2) THE DEPARTMENT MAY CONTRACT WITH A QUALIFIED NOT-FOR-PROFIT CORPO-
 RATION FOR THE PROVISION AND OPERATION OF THE HOTLINE REQUIRED  BY  THIS
 SUBSECTION. ANY SUCH CONTRACT SHALL ONLY BE AWARDED AFTER THE DEPARTMENT
 HAS  CONDUCTED  A  REQUEST  FOR  PROPOSALS PROCESS. THE DEPARTMENT SHALL
 SELECT A NOT-FOR-PROFIT CORPORATION WHICH HAS THE RESOURCES AND  ABILITY
 TO  OPERATE  A  STATEWIDE  HOTLINE,  AND  IS STAFFED BY EMPLOYEES AND/OR
 VOLUNTEERS WITH STRONG EXPERIENCE IN AUTISM SPECTRUM DISORDER.
   (3) IF THE DEPARTMENT ELECTS TO  ESTABLISH  AND  OPERATE  THE  HOTLINE
 USING  ITS OWN PERSONNEL AND RESOURCES, SUCH HOTLINE SHALL BE STAFFED BY
 OFFICERS AND EMPLOYEES WITH STRONG EXPERIENCE IN AUTISM SPECTRUM  DISOR-
 DER.  UNTIL  THE  STATE  CIVIL SERVICE COMMISSION SHALL HAVE ESTABLISHED
 CIVIL SERVICE TITLES  AND  COMPETITIVE  EXAMINATIONS  FOR  POSITIONS  AS
 EMPLOYEES  OF THE HOTLINE, THE SUPERINTENDENT IS AUTHORIZED AND DIRECTED
 TO APPOINT AND EMPLOY SUCH QUALIFIED OFFICERS AND EMPLOYEES AS SHALL  BE
 NECESSARY TO OPERATE THE AUTISM AND HEALTH INSURANCE COVERAGE HOTLINE.
   (4)  THE  SUPERINTENDENT IS AUTHORIZED TO PROMULGATE AND IMPLEMENT ANY
 RULES AND REGULATIONS NECESSARY TO CARRY  OUT  THE  PROVISIONS  OF  THIS
 SUBSECTION.
   §  2.  Subparagraphs  (A) and (B) of paragraph 25 of subsection (i) of
 section 3216 of the insurance law, subparagraph (A) as amended by  chap-
 ter  595 of the laws of 2011, and subparagraph (B) as amended by section
 38 of part D of chapter 56 of the laws of 2013, are amended to  read  as
 follows:
   (A)  Every  policy  which  provides  coverage for hospital or surgical
 coverage shall [not exclude] INCLUDE FULL coverage for  THE  PREVENTION,
 EARLY  DETECTION,  screening, diagnosis and treatment of [medical condi-
 tions otherwise covered by the policy solely because  the  treatment  is
 provided to diagnose or treat] autism spectrum disorder.
   (B)  Every  policy  that  provides  physician services, medical, major
 medical or similar comprehensive-type coverage shall provide FULL cover-
 age for the screening, diagnosis and treatment of autism spectrum disor-
 der in accordance with this paragraph and shall not exclude coverage for
 the PREVENTION, EARLY DETECTION, screening, diagnosis  or  treatment  of
 medical  conditions otherwise covered by the policy because the individ-
 ual is diagnosed with autism spectrum disorder.  Such  coverage  may  be
 subject  to  annual  deductibles,  copayments  and coinsurance as may be
 deemed appropriate by the superintendent 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  six  hundred
 eighty  hours of treatment per policy or calendar year per covered indi-

 S. 3251                             3
 
 vidual. 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 coverage to an  individual  solely  because  the
 individual  is  diagnosed  with autism spectrum disorder or has received
 treatment for autism spectrum 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.
   § 3. Subparagraphs (A) and (B) of paragraph 17 of  subsection  (l)  of
 section  3221 of the insurance law, subparagraph (A) as amended by chap-
 ter 595 of the laws of 2011, subparagraph (B) as amended by  section  39
 of  part  D  of  chapter  56 of the laws of 2013, are amended to read as
 follows:
   (A) Every group or blanket accident and health insurance policy deliv-
 ered or issued for delivery in this state which  provides  coverage  for
 hospital  or  surgical  care  coverage  shall [not exclude] INCLUDE FULL
 coverage for THE PREVENTION, EARLY DETECTION, screening,  diagnosis  and
 treatment  of medical conditions otherwise covered by the policy because
 the treatment is provided to diagnose or treat autism spectrum disorder.
   (B) Every group or blanket policy that  provides  physician  services,
 medical,  major  medical  or  similar  comprehensive-type coverage shall
 provide FULL coverage for the PREVENTION,  EARLY  DETECTION,  screening,
 diagnosis  and  treatment of autism spectrum disorder in accordance with
 this paragraph and shall not exclude coverage for the screening, diagno-
 sis 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  coinsu-
 rance  as  may  be deemed appropriate by the superintendent and shall be
 consistent with those imposed on other benefits under the group or blan-
 ket policy. Coverage for applied behavior analysis shall be subject to a
 maximum benefit of six hundred eighty hours of treatment per  policy  or
 calendar  year  per  covered  individual.  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 spectrum 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.
   §  4. Subsection (ee) of section 4303 of the insurance law, as amended
 by chapter 596 of the laws of 2011 and paragraph 2 as amended by section
 40 of part D of chapter 56 of the laws of 2013, 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  or  surgical  care  coverage  shall [not exclude] INCLUDE FULL
 coverage for THE PREVENTION, EARLY DETECTION, screening,  diagnosis  and
 treatment of medical conditions otherwise covered by the contract solely

 S. 3251                             4
 
 because  the  treatment is provided to diagnose or treat autism spectrum
 disorder.
   (2)  Every  contract  that 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  FULL  coverage
 for  the  PREVENTION, EARLY DETECTION, 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 superintendent 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 six hundred
 eighty hours of treatment per contract  or  calendar  year  per  covered
 individual.  This paragraph shall not be construed as limiting the bene-
 fits 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  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  spectrum  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.
   §  5.  This  act shall take effect on the thirtieth day after it shall
 have become a law.

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Senate Bill S3251

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Sponsored By

Kevin S. Parker

Archive: Last Bill Status - In Senate Committee Insurance Committee

co-Sponsors

Joseph P. Addabbo Jr.

Jamaal T. Bailey

Timothy M. Kennedy

Velmanette Montgomery

2019-S3251 (ACTIVE) - Details

2019-S3251 (ACTIVE) - Summary

2019-S3251 (ACTIVE) - Sponsor Memo

2019-S3251 (ACTIVE) - Bill Text download pdf

Comments