BILL NUMBER: S1578

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to including
applied behavioral analysis for treatment of autism spectrum disorder
under standard coverage for Medicaid recipients

 
PURPOSE:

To amend the Social Services Law in relation to providing Medicaid bene-
ficiaries who have autism spectrum disorder access to applied behavior
analysis services, comparable to commercial insurance coverage.

 
SUMMARY OF PROVISIONS:

Section one of the bill amends subdivision 2 of section 365-a of the
social services law by adding a new paragraph (ff), which adds coverage
of applied behavior analysis for the treatment of autism spectrum disor-
der to the standard Medicaid benefits.
              

Section two of the bill establishes the effective date.

 
JUSTIFICATION:

Although applied behavior analysis (ABA) for the treatment of autism
spectrum disorder (ASD) was added-to New York commercial insurance
coverage requirements in 2011, it is still not a covered benefit for the
thousands of New Yorkers who rely on Medicaid for health insurance. This
means that children with treatable conditions are denied the vital care
they need to achieve significant improvements in behavior that can have
a great impact on both the children and their families. This bill would
correct that omission.

ABA is the design, implementation and evaluation of modifications to
produce socially significant improvements in human behavior. ABA inter-
ventions are supported by scientific evidence as medically necessary for
people with ASD, and are covered based on a written prescription from a
physician or psychologist who states that such services are medically
necessary to develop, maintain, or restore the functioning of an indi-
vidual with a diagnosis of ASD.

In May of 2018, the Centers for Disease Control and Prevention released
an update of autism's estimated prevalence amongst the nation's chil-
dren. One key finding stated that 1 in 59 children had a diagnosis of
autism spectrum disorder by the age of 8 in 2014, a 15% increase from
2012, when the number was 1 in 68.

Most states cover ABA in their Medicaid programs. New York, a leader in
so many ways have fallen behind. This bill would correct that injustice
and enable access to this lifesaving service.

 
LEGISLATIVE HISTORY:

2019-2020: S1890A/A2798A Gottfried

 
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become a law. Effective immediately, the addition, amendment,
and/or appeal of any rules and regulations necessary to implement the
provisions of this act on its effective date are authorized and directed
to be completed on or before such effective date.

                                
 
BILL NUMBER: S1578A

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the social services law, in relation to including
applied behavioral analysis under standard coverage for Medicaid recipi-
ents

 
PURPOSE OR GENERAL IDEA OF BILL:

To provide Medicaid beneficiaries access to applied behavior analysis
services, comparable to commercial insurance coverage.

 
SUMMARY OF PROVISIONS:

Section 1 adds paragraph (ff) to subdivision 2 of section 365-a of the
social services law, adding coverage of applied behavior analysis to the
standard Medicaid benefits.

Section 2 is the effective date. This act shall take effect on the one
              

hundred eightieth day after it shall have become a law. Effective imme-
diately, the commissioner of health shall make regulations and take
other actions reasonably necessary to implement this act on that date.

 
JUSTIFICATION:

Applied behavior analysis (ABA) was added to New York commercial insur-
ance coverage requirements in 2011, but it is still not included in the
Social Services Law for the Medicaid program. Although the Legislature
and Executive agreed to add the benefit administratively in 2019, this
language must be added to the statute in order to guarantee the thou-
sands of New Yorkers who would qualify for this service and rely on
Medicaid for health insurance the same access as those who have commer-
cial coverage.

ABA is the design, implementation and evaluation of modifications to
produce socially significant improvements in human behavior. ABA inter-
ventions are supported by scientific evidence as medically necessary for
people with autism spectrum disorder (ASD), and they are covered based
on a written prescription from a physician or psychologist who states
that those services are medically necessary to develop, maintain, or
restore the functioning of the individual.

As outlined in a July 7, 2014, Centers for Medicare and Medicaid (CMS)
bulletin, states are obligated under section 1905(a)(4)(B) of the Social
Security Act to provide Early and Periodic Screening, Diagnostic and
Treatment (EPSDT) benefits for children and must cover all medically
necessary services, including applied behavioral analysis, to correct or
ameliorate defects and physical and mental illnesses or conditions. This
bill will bring New York in line with the rest of the country and make
it clear that ABA services will be a covered benefit under the Medicaid
program when provided by persons licensed, certified, exempt, or other-
wise authorized under Article 167 of the Education Law, which is the
same language in the commercial insurance requirement and includes
certain unlicensed individuals participating in the delivery of ABA
services as part of a multidisciplinary team.


As the number of children who need ABA services rises, New York must
ensure that our most vulnerable have access to these lifesaving services
now and in the future.

 
PRIOR LEGISLATIVE HISTORY:

2017-2018: S8953 Hannon

2019-2020: S1821 Passed Senate 2019

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:;

TBD

 
EFFECTIVE DATE:
This act shall take effect on the one hundred eightieth day after it
shall have become a law. Effective immediately, the commissioner of
health shall make regulations and take other actions reasonably neces-
sary to implement this act on that date.