NY State Assembly Bill 2021-A8548A

Assembly Bill A8548A

2021-2022 Legislative Session

Relates to coverage for the screening, diagnosis and treatment of autism spectrum disorder

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Archive: Last Bill Status - In Assembly 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
Apr 07, 2022	print number 8548a
Apr 07, 2022	amend and recommit to insurance
Jan 05, 2022	referred to insurance
Dec 13, 2021	referred to insurance

Bill Amendments

Original

A (Active)

co-Sponsors

2021-A8548 - Details

See Senate Version of this Bill:: S7673
Current Committee:: Assembly Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2023-2024 Legislative Session:: A7913, S5393

2021-A8548 - Summary

Relates to coverage for applied behavior analysis and for developmental, individual-differences, relationship-based treatment of autism spectrum disorder.

2021-A8548 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8548
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             December 13, 2021
                                ___________
 
 Introduced by M. of A. ABINANTI -- read once and referred to the Commit-
   tee 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.    Subparagraphs (B) and (C) of paragraph 25 of subsection
 (i) of section 3216 of the insurance law, subparagraph (B) as amended by
 section 2 of subpart A of part BB of chapter 57 of  the  laws  of  2019,
 subparagraph  (C)  as  amended by chapter 596 of the laws of 2011, items
 (i) and (iii) of subparagraph (C) as amended by section 3 of  subpart  A
 of  part  BB  of  chapter 57 of the laws of 2019, are amended to read as
 follows:
   (B) Every policy 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 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  AND  DEVELOP-
 MENTAL,  INDIVIDUAL-DIFFERENCES,  RELATIONSHIP-BASED  TREATMENT 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 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.
                                                            LBD13801-01-1

 A. 8548                             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.
   (C) For purposes of this paragraph:
   (i)  "autism  spectrum  disorder"  means  any  pervasive developmental
 disorder as defined in the most recent edition  of  the  diagnostic  and
 statistical  manual  of  mental  disorders, INCLUDING AUTISTIC DISORDER,
 ASPERGER'S DISORDER, RETT'S DISORDER, CHILDHOOD DISINTEGRATIVE DISORDER,
 OR PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED.
   (ii) "applied behavior analysis" means the design, implementation, and
 evaluation of environmental modifications, using behavioral stimuli  and
 consequences,  to  produce  socially  significant  improvement  in human
 behavior, including the use  of  direct  observation,  measurement,  and
 functional  analysis  of the relationship between environment and behav-
 ior.
   (iii) "behavioral health treatment"  means  counseling  and  treatment
 programs,  INCLUDING  DEVELOPMENTAL,  INDIVIDUAL-DIFFERENCES,  RELATION-
 SHIP-BASED TREATMENT AND APPLIED BEHAVIORAL ANALYSIS, when provided by a
 licensed provider WITH  A  PROFESSIONAL  CERTIFICATE  IN  DEVELOPMENTAL,
 INDIVIDUAL-DIFFERENCES,  RELATIONSHIP-BASED TREATMENT FROM THE INTERDIS-
 CIPLINARY COUNCIL ON DEVELOPMENT  AND  LEARNING,  and  applied  behavior
 analysis,  when  provided OR SUPERVISED by a [person licensed, certified
 or otherwise authorized to provide applied behavior analysis,]  BEHAVIOR
 ANALYST  CERTIFIED PURSUANT TO THE BEHAVIOR ANALYST CERTIFICATION BOARD,
 that are necessary to develop, maintain,  or  restore,  to  the  maximum
 extent  practicable, the functioning of an individual.  INDIVIDUALS THAT
 PROVIDE BEHAVIORAL HEALTH TREATMENT UNDER THE SUPERVISION OF A  LICENSED
 PROVIDER  OR  A  CERTIFIED  BEHAVIOR  ANALYST PURSUANT TO THIS PARAGRAPH
 SHALL BE SUBJECT TO STANDARDS OF PROFESSIONALISM, SUPERVISION AND  RELE-
 VANT  EXPERIENCE  PURSUANT TO REGULATIONS PROMULGATED BY THE SUPERINTEN-
 DENT IN CONSULTATION WITH THE COMMISSIONERS OF HEALTH AND EDUCATION.
   (iv) "diagnosis of autism spectrum disorder" means assessments, evalu-
 ations, or tests to diagnose whether an individual has  autism  spectrum
 disorder.
   (v)  "pharmacy care" means medications prescribed by a licensed health
 care provider legally authorized to prescribe under title eight  of  the
 education law.
   (vi) "psychiatric care" means direct or consultative services provided
 by  a psychiatrist licensed in the state in which the psychiatrist prac-
 tices.
   (vii) "psychological  care"  means  direct  or  consultative  services
 provided  by  a psychologist licensed in the state in which the psychol-
 ogist practices.
   (viii) "therapeutic care"  means  services  provided  by  licensed  or
 certified speech therapists, occupational therapists, social workers, or
 physical therapists.
   (ix) "treatment of autism spectrum disorder" shall include the follow-
 ing  care  and assistive communication devices prescribed or ordered for
 an individual diagnosed with autism  spectrum  disorder  by  a  licensed
 physician or a licensed psychologist:
   (1) behavioral health treatment;
   (2) psychiatric care;
   (3) psychological care;
 A. 8548                             3
 
   (4) medical care provided by a licensed health care provider;
   (5) therapeutic care, including therapeutic care which is deemed habi-
 litative or nonrestorative, in the event that the policy provides cover-
 age for therapeutic care; and
   (6)  pharmacy  care in the event that the policy provides coverage for
 prescription drugs.
   (X) "DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELATIONSHIP-BASED  TREAT-
 MENT" MEANS THE IMPLEMENTATION OF A FLOORTIME INTERVENTION THAT IS BASED
 ON  AN  ASSESSMENT  OF FUNCTIONAL-EMOTIONAL DEVELOPMENT AND THE PERSON'S
 INDIVIDUAL  PROFILE,  WHILE  UNDERSTANDING  THAT  HUMAN  DEVELOPMENT  IS
 FOSTERED  IN THE CONTEXT OF RELATIONSHIPS WITH OTHERS.  THE PRIMARY GOAL
 IS TO PROMOTE DEVELOPMENT AND ADDRESS DEVELOPMENTAL CHALLENGES AND DEFI-
 CITS THAT OFTEN ACCOMPANY AUTISM AND OTHER NEURODEVELOPMENTAL DISORDERS.
   § 2. Subparagraphs (B) and (C) of paragraph 17 of  subsection  (l)  of
 section  3221  of  the  insurance  law,  subparagraph  (B) as amended by
 section 19 of subpart A of part BB of chapter 57 of the  laws  of  2019,
 subparagraph  (C)  as  amended by chapter 596 of the laws of 2011, items
 (i) and (iii) of subparagraph (C) as amended by section 20 of subpart  A
 of  part  BB  of  chapter 57 of the laws of 2019, are amended to read as
 follows:
   (B) Every group or blanket policy 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 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  AND  DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES,
 RELATIONSHIP-BASED TREATMENT 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 treat-
 ment 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  disor-
 der.  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.
   (C) For purposes of this paragraph:
   (i)  "autism  spectrum  disorder"  means  any  pervasive developmental
 disorder as defined in the most recent edition  of  the  diagnostic  and
 statistical  manual  of  mental  disorders, INCLUDING AUTISTIC DISORDER,
 ASPERGER'S DISORDER, RETT'S DISORDER, CHILDHOOD DISINTEGRATIVE DISORDER,
 OR PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED.
   (ii) "applied behavior analysis" means the design, implementation, and
 evaluation of environmental modifications, using behavioral stimuli  and
 consequences,  to  produce  socially  significant  improvement  in human
 behavior, including the use  of  direct  observation,  measurement,  and
 functional  analysis  of the relationship between environment and behav-
 ior.
 A. 8548                             4
 
   (iii) "behavioral health treatment"  means  counseling  and  treatment
 programs,  INCLUDING  DEVELOPMENTAL,  INDIVIDUAL-DIFFERENCES,  RELATION-
 SHIP-BASED TREATMENT AND APPLIED BEHAVIORAL ANALYSIS, when provided by a
 licensed provider WITH  A  PROFESSIONAL  CERTIFICATE  IN  DEVELOPMENTAL,
 INDIVIDUAL-DIFFERENCES,  RELATIONSHIP-BASED TREATMENT FROM THE INTERDIS-
 CIPLINARY COUNCIL ON DEVELOPMENT  AND  LEARNING,  and  applied  behavior
 analysis,  when  provided OR SUPERVISED by a [person licensed, certified
 or otherwise authorized to provide applied behavior  analysis]  BEHAVIOR
 ANALYST  CERTIFIED PURSUANT TO THE BEHAVIOR ANALYST CERTIFICATION BOARD,
 that are necessary to develop, maintain,  or  restore,  to  the  maximum
 extent  practicable, the functioning of an individual.  INDIVIDUALS THAT
 PROVIDE BEHAVIORAL HEALTH TREATMENT UNDER THE SUPERVISION OF A  LICENSED
 PROVIDER  OR  A  CERTIFIED  BEHAVIOR  ANALYST PURSUANT TO THIS PARAGRAPH
 SHALL BE SUBJECT TO STANDARDS OF PROFESSIONALISM, SUPERVISION AND  RELE-
 VANT  EXPERIENCE  PURSUANT TO REGULATIONS PROMULGATED BY THE SUPERINTEN-
 DENT IN CONSULTATION WITH THE COMMISSIONERS OF HEALTH AND EDUCATION.
   (iv) "diagnosis of autism spectrum disorder" means assessments, evalu-
 ations, or tests to diagnose whether an individual has  autism  spectrum
 disorder.
   (v)  "pharmacy care" means medications prescribed by a licensed health
 care provider legally authorized to prescribe under title eight  of  the
 education law.
   (vi) "psychiatric care" means direct or consultative services provided
 by  a psychiatrist licensed in the state in which the psychiatrist prac-
 tices.
   (vii) "psychological  care"  means  direct  or  consultative  services
 provided  by  a psychologist licensed in the state in which the psychol-
 ogist practices.
   (viii) "therapeutic care"  means  services  provided  by  licensed  or
 certified speech therapists, occupational therapists, social workers, or
 physical therapists.
   (ix) "treatment of autism spectrum disorder" shall include the follow-
 ing  care  and assistive communication devices prescribed or ordered for
 an individual diagnosed with autism  spectrum  disorder  by  a  licensed
 physician or a licensed psychologist:
   (1) behavioral health treatment;
   (2) psychiatric care;
   (3) psychological care;
   (4) medical care provided by a licensed health care provider;
   (5) therapeutic care, including therapeutic care which is deemed habi-
 litative or nonrestorative, in the event that the policy provides cover-
 age for therapeutic care; and
   (6)  pharmacy  care in the event that the policy provides coverage for
 prescription drugs.
   (X) "DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELATIONSHIP-BASED  TREAT-
 MENT" MEANS THE IMPLEMENTATION OF A FLOORTIME INTERVENTION THAT IS BASED
 ON  AN  ASSESSMENT  OF FUNCTIONAL-EMOTIONAL DEVELOPMENT AND THE PERSON'S
 INDIVIDUAL  PROFILE,  WHILE  UNDERSTANDING  THAT  HUMAN  DEVELOPMENT  IS
 FOSTERED  IN  THE CONTEXT OF RELATIONSHIPS WITH OTHERS. THE PRIMARY GOAL
 IS TO PROMOTE DEVELOPMENT AND ADDRESS DEVELOPMENTAL CHALLENGES AND DEFI-
 CITS THAT OFTEN ACCOMPANY AUTISM AND OTHER NEURODEVELOPMENTAL DISORDERS.
   § 3. Paragraphs 2 and 3 of subsection (ee)  of  section  4303  of  the
 insurance law, paragraph 2 as amended by section 31 of subpart A of part
 BB  of chapter 57 of the laws of 2019, paragraph 3 as amended by chapter
 596 of the laws of 2011, subparagraphs (A) and (C)  of  paragraph  3  as
 A. 8548                             5
 
 amended  by section 32 of subpart A of part BB of chapter 57 of the laws
 of 2019, are amended to read as follows:
   (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 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 AND DEVELOP-
 MENTAL,  INDIVIDUAL-DIFFERENCES,  RELATIONSHIP-BASED  TREATMENT 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 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 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.
   (3) For purposes of this subsection:
   (A)  "autism  spectrum  disorder"  means  any  pervasive developmental
 disorder as defined in the most recent edition  of  the  diagnostic  and
 statistical  manual  of  mental  disorders, INCLUDING AUTISTIC DISORDER,
 ASPERGER'S DISORDER, RETT'S DISORDER, CHILDHOOD DISINTEGRATIVE DISORDER,
 OR PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED.
   (B) "applied behavior analysis" means the design, implementation,  and
 evaluation  of environmental modifications, using behavioral stimuli and
 consequences, to  produce  socially  significant  improvement  in  human
 behavior,  including  the  use  of  direct observation, measurement, and
 functional analysis of the relationship between environment  and  behav-
 ior.
   (C)  "behavioral  health  treatment"  means  counseling  and treatment
 programs,  INCLUDING  DEVELOPMENTAL,  INDIVIDUAL-DIFFERENCES,  RELATION-
 SHIP-BASED TREATMENT AND APPLIED BEHAVIORAL ANALYSIS, when provided by a
 licensed  provider  WITH  A  PROFESSIONAL  CERTIFICATE IN DEVELOPMENTAL,
 INDIVIDUAL-DIFFERENCES, RELATIONSHIP-BASED TREATMENT FROM THE  INTERDIS-
 CIPLINARY  COUNCIL  ON  DEVELOPMENT  AND  LEARNING, and applied behavior
 analysis, when provided OR SUPERVISED by a  [person  that  is  licensed,
 certified  or otherwise authorized to provide applied behavior analysis]
 BEHAVIOR ANALYST CERTIFIED PURSUANT  TO  THE  BEHAVIOR  ANALYST  CERTIF-
 ICATION  BOARD,  that are necessary to develop, maintain, or restore, to
 the maximum extent practicable, the functioning of an individual.  INDI-
 VIDUALS THAT PROVIDE BEHAVIORAL HEALTH TREATMENT UNDER  THE  SUPERVISION
 OF  A LICENSED PROVIDER OR A CERTIFIED BEHAVIOR ANALYST PURSUANT TO THIS
 SUBSECTION SHALL BE SUBJECT TO STANDARDS OF PROFESSIONALISM, SUPERVISION
 AND RELEVANT EXPERIENCE  PURSUANT  TO  REGULATIONS  PROMULGATED  BY  THE
 SUPERINTENDENT  IN  CONSULTATION  WITH  THE  COMMISSIONERS OF HEALTH AND
 EDUCATION.
 A. 8548                             6
 
   (D) "diagnosis of autism spectrum disorder" means assessments,  evalu-
 ations,  or  tests to diagnose whether an individual has autism spectrum
 disorder.
   (E)  "pharmacy care" means medications prescribed by a licensed health
 care provider legally authorized to prescribe under title eight  of  the
 education law.
   (F)  "psychiatric care" means direct or consultative services provided
 by a psychiatrist licensed in the state in which the psychiatrist  prac-
 tices.
   (G)   "psychological  care"  means  direct  or  consultative  services
 provided by a psychologist licensed in the state in which  the  psychol-
 ogist practices.
   (H)  "therapeutic  care" means services provided by licensed or certi-
 fied speech therapists,  occupational  therapists,  social  workers,  or
 physical therapists.
   (I)  "treatment of autism spectrum disorder" shall include the follow-
 ing care and assistive communication devices prescribed or  ordered  for
 an  individual  diagnosed  with  autism  spectrum disorder by a licensed
 physician or a licensed psychologist:
   (i) behavioral health treatment;
   (ii) psychiatric care;
   (iii) psychological care;
   (iv) medical care provided by a licensed health care provider;
   (v) therapeutic care, including therapeutic care which is deemed habi-
 litative or nonrestorative, in the event that the policy provides cover-
 age for therapeutic care; and
   (vi) pharmacy care in the event that the  contract  provides  coverage
 for prescription drugs.
   §  4.  This  act shall take effect on the ninetieth day after it shall
 have become a law.

co-Sponsors

2021-A8548A (ACTIVE) - Details

See Senate Version of this Bill:: S7673
Current Committee:: Assembly Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2023-2024 Legislative Session:: A7913, S5393

2021-A8548A (ACTIVE) - Summary

Relates to coverage for applied behavior analysis and for developmental, individual-differences, relationship-based treatment of autism spectrum disorder.

2021-A8548A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  8548--A
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             December 13, 2021
                                ___________
 
 Introduced by M. of A. ABINANTI, SIMON, JENSEN -- read once and referred
   to  the  Committee  on  Insurance  --  recommitted to the Committee on
   Insurance in accordance with Assembly Rule  3,  sec.  2  --  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:
 
   Section  1.    Subparagraphs (B) and (C) of paragraph 25 of subsection
 (i) of section 3216 of the insurance law, subparagraph (B) as amended by
 section 2 of subpart A of part BB of chapter 57 of  the  laws  of  2019,
 subparagraph  (C)  as  amended by chapter 596 of the laws of 2011, items
 (i) and (iii) of subparagraph (C) as amended by section 3 of  subpart  A
 of  part  BB  of  chapter 57 of the laws of 2019, are amended to read as
 follows:
   (B) Every policy 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 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  AND  DEVELOP-
 MENTAL,  INDIVIDUAL-DIFFERENCES,  RELATIONSHIP-BASED  TREATMENT SHALL BE
 SUBJECT TO A MAXIMUM BENEFIT OF SIX HUNDRED EIGHTY  HOURS  OF  TREATMENT
 PER POLICY DURING A CALENDAR YEAR PER COVERED INDIVIDUAL. This paragraph
 shall  not  be  construed  as  limiting  the benefits that are otherwise
 available to an individual under the policy, provided however that  such
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13801-02-2

 A. 8548--A                          2
 
 policy  shall  not  contain  any  limitations  on visits that are solely
 applied to the treatment of autism spectrum disorder, EXCEPT AS PROVIDED
 IN THIS SUBPARAGRAPH FOR COVERAGE  FOR  APPLIED  BEHAVIOR  ANALYSIS  AND
 DEVELOPMENTAL,  INDIVIDUAL DIFFERENCES, RELATIONSHIP-BASED TREATMENT. 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.
   (C) For purposes of this paragraph:
   (i)  "autism  spectrum  disorder"  means  any  pervasive developmental
 disorder as defined in the most recent edition  of  the  diagnostic  and
 statistical  manual  of mental disorders, INCLUDING, BUT NOT LIMITED TO,
 AUTISTIC SPECTRUM DISORDER.
   (ii) "applied behavior analysis" means the design, implementation, and
 evaluation of environmental modifications, using behavioral stimuli  and
 consequences,  to  produce  socially  significant  improvement  in human
 behavior, including the use  of  direct  observation,  measurement,  and
 functional  analysis  of the relationship between environment and behav-
 ior.
   (iii) "behavioral health treatment"  means  counseling  and  treatment
 programs,  INCLUDING DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES AND RELATION-
 SHIP-BASED TREATMENT, when  provided  by  a  licensed  provider  WITH  A
 PROFESSIONAL CERTIFICATE IN DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELA-
 TIONSHIP-BASED  TREATMENT FROM THE INTERDISCIPLINARY COUNCIL ON DEVELOP-
 MENT AND LEARNING, and applied behavior analysis,  when  provided  by  a
 person  licensed,  certified  or otherwise authorized to provide applied
 behavior analysis, that are necessary to develop, maintain, or  restore,
 to  the  maximum  extent  practicable, the functioning of an individual.
 INDIVIDUALS THAT PROVIDE BEHAVIORAL HEALTH TREATMENT  UNDER  THE  SUPER-
 VISION  OF  A  LICENSED  PROVIDER  PURSUANT  TO  THIS PARAGRAPH SHALL BE
 SUBJECT TO STANDARDS OF PROFESSIONALISM, SUPERVISION AND RELEVANT  EXPE-
 RIENCE  PURSUANT  TO  REGULATIONS  PROMULGATED  BY THE SUPERINTENDENT IN
 CONSULTATION WITH THE COMMISSIONERS OF HEALTH AND EDUCATION.
   (iv) "diagnosis of autism spectrum disorder" means assessments, evalu-
 ations, or tests to diagnose whether an individual has  autism  spectrum
 disorder.
   (v)  "pharmacy care" means medications prescribed by a licensed health
 care provider legally authorized to prescribe under title eight  of  the
 education law.
   (vi) "psychiatric care" means direct or consultative services provided
 by  a psychiatrist licensed in the state in which the psychiatrist prac-
 tices.
   (vii) "psychological  care"  means  direct  or  consultative  services
 provided  by  a psychologist licensed in the state in which the psychol-
 ogist practices.
   (viii) "therapeutic care"  means  services  provided  by  licensed  or
 certified  [speech  therapists, occupational therapists, social workers,
 or physical therapists] PROVIDERS IN THE FIELDS OF  COUNSELING,  OCCUPA-
 TIONAL  THERAPY,  PHYSICAL  THERAPY, SOCIAL WORK, OR SPEECH AND LANGUAGE
 PATHOLOGY.
   (ix) "treatment of autism spectrum disorder" shall include the follow-
 ing care and assistive communication devices prescribed or  ordered  for
 A. 8548--A                          3

 an  individual  diagnosed  with  autism  spectrum disorder by a licensed
 physician or a licensed psychologist:
   (1) behavioral health treatment;
   (2) psychiatric care;
   (3) psychological care;
   (4) medical care provided by a licensed health care provider;
   (5) therapeutic care, including therapeutic care which is deemed habi-
 litative or nonrestorative, in the event that the policy provides cover-
 age for therapeutic care; and
   (6)  pharmacy  care in the event that the policy provides coverage for
 prescription drugs.
   (X) "DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELATIONSHIP-BASED  TREAT-
 MENT" MEANS THE IMPLEMENTATION OF A FLOORTIME INTERVENTION THAT IS BASED
 ON  AN  ASSESSMENT  OF FUNCTIONAL-EMOTIONAL DEVELOPMENT AND THE PERSON'S
 INDIVIDUAL  PROFILE,  WHILE  UNDERSTANDING  THAT  HUMAN  DEVELOPMENT  IS
 FOSTERED  IN THE CONTEXT OF RELATIONSHIPS WITH OTHERS.  THE PRIMARY GOAL
 IS TO PROMOTE DEVELOPMENT AND ADDRESS DEVELOPMENTAL CHALLENGES AND DEFI-
 CITS THAT OFTEN ACCOMPANY AUTISM AND OTHER NEURODEVELOPMENTAL DISORDERS.
   § 2. Subparagraphs (B) and (C) of paragraph 17 of  subsection  (l)  of
 section  3221  of  the  insurance  law,  subparagraph  (B) as amended by
 section 19 of subpart A of part BB of chapter 57 of the  laws  of  2019,
 subparagraph  (C)  as  amended by chapter 596 of the laws of 2011, items
 (i) and (iii) of subparagraph (C) as amended by section 20 of subpart  A
 of  part  BB  of  chapter 57 of the laws of 2019, are amended to read as
 follows:
   (B) Every group or blanket policy 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 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  AND  DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES,
 RELATIONSHIP-BASED TREATMENT SHALL BE SUBJECT TO A  MAXIMUM  BENEFIT  OF
 SIX  HUNDRED EIGHTY HOURS OF TREATMENT PER POLICY DURING A CALENDAR YEAR
 PER COVERED INDIVIDUAL. This paragraph shall not be construed as  limit-
 ing 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  treat-
 ment  of  autism  spectrum disorder, EXCEPT AS PROVIDED IN THIS SUBPARA-
 GRAPH FOR COVERAGE FOR  APPLIED  BEHAVIOR  ANALYSIS  AND  DEVELOPMENTAL,
 INDIVIDUAL  DIFFERENCES,  RELATIONSHIP-BASED TREATMENT. 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.
   (C) For purposes of this paragraph:
   (i) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 A. 8548--A                          4
 
 statistical manual of mental disorders, INCLUDING, BUT NOT  LIMITED  TO,
 AUTISTIC SPECTRUM DISORDER.
   (ii) "applied behavior analysis" means the design, implementation, and
 evaluation  of environmental modifications, using behavioral stimuli and
 consequences, to  produce  socially  significant  improvement  in  human
 behavior,  including  the  use  of  direct observation, measurement, and
 functional analysis of the relationship between environment  and  behav-
 ior.
   (iii)  "behavioral  health  treatment"  means counseling and treatment
 programs,  INCLUDING  DEVELOPMENTAL,  INDIVIDUAL-DIFFERENCES,  RELATION-
 SHIP-BASED  TREATMENT,  when  provided  by  a  licensed  provider WITH A
 PROFESSIONAL CERTIFICATE IN DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELA-
 TIONSHIP-BASED TREATMENT FROM THE INTERDISCIPLINARY COUNCIL ON  DEVELOP-
 MENT  AND  LEARNING,  and  applied behavior analysis, when provided by a
 person licensed, certified or otherwise authorized  to  provide  applied
 behavior  analysis, that are necessary to develop, maintain, or restore,
 to the maximum extent practicable, the  functioning  of  an  individual.
 INDIVIDUALS  THAT  PROVIDE  BEHAVIORAL HEALTH TREATMENT UNDER THE SUPER-
 VISION OF A LICENSED  PROVIDER  PURSUANT  TO  THIS  PARAGRAPH  SHALL  BE
 SUBJECT  TO STANDARDS OF PROFESSIONALISM, SUPERVISION AND RELEVANT EXPE-
 RIENCE PURSUANT TO REGULATIONS  PROMULGATED  BY  THE  SUPERINTENDENT  IN
 CONSULTATION WITH THE COMMISSIONERS OF HEALTH AND EDUCATION.
   (iv) "diagnosis of autism spectrum disorder" means assessments, evalu-
 ations,  or  tests to diagnose whether an individual has autism spectrum
 disorder.
   (v) "pharmacy care" means medications prescribed by a licensed  health
 care  provider  legally authorized to prescribe under title eight of the
 education law.
   (vi) "psychiatric care" means direct or consultative services provided
 by a psychiatrist licensed in the state in which the psychiatrist  prac-
 tices.
   (vii)  "psychological  care"  means  direct  or  consultative services
 provided by a psychologist licensed in the state in which  the  psychol-
 ogist practices.
   (viii)  "therapeutic  care"  means  services  provided  by licensed or
 certified [speech therapists, occupational therapists,  social  workers,
 or  physical  therapists] PROVIDERS IN THE FIELDS OF COUNSELING, OCCUPA-
 TIONAL THERAPY, PHYSICAL THERAPY, SOCIAL WORK, OR  SPEECH  AND  LANGUAGE
 PATHOLOGY.
   (ix) "treatment of autism spectrum disorder" shall include the follow-
 ing  care  and assistive communication devices prescribed or ordered for
 an individual diagnosed with autism  spectrum  disorder  by  a  licensed
 physician or a licensed psychologist:
   (1) behavioral health treatment;
   (2) psychiatric care;
   (3) psychological care;
   (4) medical care provided by a licensed health care provider;
   (5) therapeutic care, including therapeutic care which is deemed habi-
 litative or nonrestorative, in the event that the policy provides cover-
 age for therapeutic care; and
   (6)  pharmacy  care in the event that the policy provides coverage for
 prescription drugs.
   (X) "DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELATIONSHIP-BASED  TREAT-
 MENT" MEANS THE IMPLEMENTATION OF A FLOORTIME INTERVENTION THAT IS BASED
 ON  AN  ASSESSMENT  OF FUNCTIONAL-EMOTIONAL DEVELOPMENT AND THE PERSON'S
 INDIVIDUAL  PROFILE,  WHILE  UNDERSTANDING  THAT  HUMAN  DEVELOPMENT  IS
 A. 8548--A                          5
 
 FOSTERED  IN  THE CONTEXT OF RELATIONSHIPS WITH OTHERS. THE PRIMARY GOAL
 IS TO PROMOTE DEVELOPMENT AND ADDRESS DEVELOPMENTAL CHALLENGES AND DEFI-
 CITS THAT OFTEN ACCOMPANY AUTISM AND OTHER NEURODEVELOPMENTAL DISORDERS.
   §  3.  Paragraphs  2  and  3 of subsection (ee) of section 4303 of the
 insurance law, paragraph 2 as amended by section 31 of subpart A of part
 BB of chapter 57 of the laws of 2019, paragraph 3 as amended by  chapter
 596  of  the  laws  of 2011, subparagraphs (A) and (C) of paragraph 3 as
 amended by section 32 of subpart A of part BB of chapter 57 of the  laws
 of 2019, are amended to read as follows:
   (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 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 AND DEVELOP-
 MENTAL,  INDIVIDUAL-DIFFERENCES,  RELATIONSHIP-BASED  TREATMENT SHALL BE
 SUBJECT TO A MAXIMUM BENEFIT OF SIX HUNDRED EIGHTY  HOURS  OF  TREATMENT
 PER POLICY DURING A CALENDAR YEAR PER COVERED INDIVIDUAL. 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 sole-
 ly  applied  to  the  treatment  of  autism spectrum disorder, EXCEPT AS
 PROVIDED IN THIS SUBPARAGRAPH FOR COVERAGE FOR APPLIED BEHAVIOR ANALYSIS
 AND DEVELOPMENTAL, INDIVIDUAL DIFFERENCES, RELATIONSHIP-BASED TREATMENT.
 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) For purposes of this subsection:
   (A) "autism  spectrum  disorder"  means  any  pervasive  developmental
 disorder  as  defined  in  the most recent edition of the diagnostic and
 statistical manual of mental disorders, INCLUDING, BUT NOT  LIMITED  TO,
 AUTISTIC SPECTRUM DISORDER.
   (B)  "applied behavior analysis" means the design, implementation, and
 evaluation of environmental modifications, using behavioral stimuli  and
 consequences,  to  produce  socially  significant  improvement  in human
 behavior, including the use  of  direct  observation,  measurement,  and
 functional  analysis  of the relationship between environment and behav-
 ior.
   (C) "behavioral  health  treatment"  means  counseling  and  treatment
 programs,  INCLUDING  DEVELOPMENTAL,  INDIVIDUAL-DIFFERENCES,  RELATION-
 SHIP-BASED TREATMENT, when  provided  by  a  licensed  provider  WITH  A
 PROFESSIONAL CERTIFICATE IN DEVELOPMENTAL, INDIVIDUAL-DIFFERENCES, RELA-
 TIONSHIP-BASED  TREATMENT FROM THE INTERDISCIPLINARY COUNCIL ON DEVELOP-
 MENT AND LEARNING, and applied behavior analysis,  when  provided  by  a
 person  that  is  licensed, certified or otherwise authorized to provide
 applied behavior analysis, that are necessary to develop,  maintain,  or
 restore,  to the maximum extent practicable, the functioning of an indi-
 vidual.  INDIVIDUALS THAT PROVIDE BEHAVIORAL HEALTH TREATMENT UNDER  THE
 A. 8548--A                          6
 
 SUPERVISION  OF A LICENSED PROVIDER PURSUANT TO THIS SUBSECTION SHALL BE
 SUBJECT TO STANDARDS OF PROFESSIONALISM, SUPERVISION AND RELEVANT  EXPE-
 RIENCE  PURSUANT  TO  REGULATIONS  PROMULGATED  BY THE SUPERINTENDENT IN
 CONSULTATION WITH THE COMMISSIONERS OF HEALTH AND EDUCATION.
   (D)  "diagnosis of autism spectrum disorder" means assessments, evalu-
 ations, or tests to diagnose whether an individual has  autism  spectrum
 disorder.
   (E)  "pharmacy care" means medications prescribed by a licensed health
 care provider legally authorized to prescribe under title eight  of  the
 education law.
   (F)  "psychiatric care" means direct or consultative services provided
 by a psychiatrist licensed in the state in which the psychiatrist  prac-
 tices.
   (G)   "psychological  care"  means  direct  or  consultative  services
 provided by a psychologist licensed in the state in which  the  psychol-
 ogist practices.
   (H)  "therapeutic  care" means services provided by licensed or certi-
 fied [speech therapists, occupational  therapists,  social  workers,  or
 physical therapists] PROVIDERS IN THE FIELDS OF COUNSELING, OCCUPATIONAL
 THERAPY,   PHYSICAL   THERAPY,  SOCIAL  WORK,  OR  SPEECH  AND  LANGUAGE
 PATHOLOGY.
   (I) "treatment of autism spectrum disorder" shall include the  follow-
 ing  care  and assistive communication devices prescribed or ordered for
 an individual diagnosed with autism  spectrum  disorder  by  a  licensed
 physician or a licensed psychologist:
   (i) behavioral health treatment;
   (ii) psychiatric care;
   (iii) psychological care;
   (iv) medical care provided by a licensed health care provider;
   (v) therapeutic care, including therapeutic care which is deemed habi-
 litative or nonrestorative, in the event that the policy provides cover-
 age for therapeutic care; and
   (vi)  pharmacy  care  in the event that the contract provides coverage
 for prescription drugs.
   § 4. This act shall take effect on the ninetieth day  after  it  shall
 have become a law.

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Assembly Bill A8548A

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Sponsored By

ABINANTI

Archive: Last Bill Status - In Assembly Committee

Bill Amendments

co-Sponsors

Jo Anne Simon

2021-A8548 - Details

2021-A8548 - Summary

2021-A8548 - Bill Text download pdf

co-Sponsors

Jo Anne Simon

Josh Jensen

2021-A8548A (ACTIVE) - Details

2021-A8548A (ACTIVE) - Summary

2021-A8548A (ACTIVE) - Bill Text download pdf

Comments