S T A T E O F N E W Y O R K
________________________________________________________________________
2898
2023-2024 Regular Sessions
I N A S S E M B L Y
February 1, 2023
___________
Introduced by M. of A. CARROLL -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to requiring certain
insurance policies to cover neuropsychological exams for dyslexia
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. This act shall be known and may be cited as the "dyslexia
diagnosis access act".
§ 2. Legislative findings and intent. The legislature hereby finds and
declares the following:
a. Dyslexia is a specific learning disability that is neurobiological
in origin. It is characterized by difficulties with accurate and/or
fluent word recognition and impaired spelling and decoding abilities.
These difficulties typically result from a deficit in the phonological
component of language within the brain that is often discordant with the
person's intelligence and other cognitive abilities. Secondary effects
of undetected and unaddressed dyslexia include anxiety, depression,
worsened health, decreased life expectancy, lower education rates,
lower employment and income rates, and increased poverty and incarcera-
tion rates.
b. Studies indicate that as many as one in five children may have
dyslexia or another phonemic awareness issue. However, lack of access to
appropriate screening and diagnostic testing poses a barrier to compre-
hensively tracking the incidence of dyslexia and students are unlikely
to receive the intervention required to overcome dyslexia without a
positive diagnosis. Comprehensive neuropsychological exams are recog-
nized as the most effective way to positively diagnose dyslexia. Such
exams are often administered over the course of two days and currently
may cost in excess of six thousand dollars but are typically not paid
for by health insurance, making them unaffordable to many families.
§ 3. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 39 to read as follows:
(39) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR PHYSICIAN SERVICES,
MEDICAL, MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01994-01-3
A. 2898 2
PROVIDE COVERAGE FOR TESTING FOR SUSPECTED DYSLEXIA 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.
(I) COVERAGE SHALL INCLUDE COMPREHENSIVE NEUROPSYCHOLOGICAL EXAMINA-
TIONS FOR THE PURPOSES OF DIAGNOSING DYSLEXIA, PURSUANT TO THIS PARA-
GRAPH.
(II) CLINICIANS' NEUROPSYCHOLOGICAL REPORTS SHALL INCLUDE COMPREHEN-
SIVE RECOMMENDATIONS REGARDLESS OF DIAGNOSIS, INCLUDING A PSYCHOLOGICAL,
EMOTIONAL, AND EDUCATIONAL WELLNESS PLAN FOR THE INDIVIDUAL EVALUATED.
(B) COVERAGE UNDER THIS PARAGRAPH IS ONLY REQUIRED IF ONE OR MORE OF
THE FOLLOWING CRITERIA ARE MET:
(I) THE INSURED IS AT AN INCREASED HEREDITARY RISK FOR DYSLEXIA OWING
TO A FAMILY HISTORY OF DYSLEXIA; OR
(II) THE INDIVIDUAL IS A STUDENT WHO HAS FAILED TWO (IF IN KINDERGAR-
TEN OR FIRST GRADE) OR ONE (IF IN SECOND GRADE OR ABOVE) READILY AVAIL-
ABLE LITERACY SCREENING BENCHMARK(S) OF PROVEN PSYCHOMETRIC VALUE; AND
IS DEEMED AT RISK ACCORDING TO THEIR INSTRUCTOR, SCHOOL, OR OTHER SUPER-
VISING EDUCATIONAL BODY; OR
(III) THE INDIVIDUAL'S PEDIATRICIAN IDENTIFIES THE INDIVIDUAL AS AT
RISK FOR DYSLEXIA AS INDICATED BY FINDINGS FROM A VALID AND RELIABLE
SCREENER AND RECOMMENDS A NEUROPSYCHOLOGICAL EXAMINATION; OR
(IV) THE INDIVIDUAL IS A STUDENT WITH A HISTORY OF RISK FACTOR(S)
KNOWN TO IMPACT LEARNING AND EDUCATIONAL OUTCOMES, INCLUDING BUT NOT
LIMITED TO: FETAL TOXIN EXPOSURE, PREMATURITY, AND HISTORY OF NEUROLOGI-
CAL DISORDER, SUCH AS EPILEPSY.
(C) COVERAGE REQUIRED BY THIS PARAGRAPH SHALL BE CAPPED AT SIX THOU-
SAND DOLLARS, INDEXED TO INFLATION TO BE ADJUSTED EVERY TWO YEARS
ACCORDING TO CONSUMER PRICE INDEX FOR ALL URBAN CONSUMERS FOR THE
NATION, AS PREPARED BY THE UNITED STATES DEPARTMENT OF LABOR, FOR THE
CALENDAR YEAR PRECEDING THE CALENDAR YEAR IN WHICH THE ADJUSTMENT TO THE
MAXIMUM BENEFIT AMOUNT IS PROMULGATED.
§ 4. Section 3221 of the insurance law is amended by adding a new
subsection (u) to read as follows:
(U) (1) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR PHYSICIAN
SERVICES, MEDICAL, MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE
SHALL PROVIDE COVERAGE FOR TESTING FOR SUSPECTED DYSLEXIA IN ACCORDANCE
WITH THIS SUBSECTION AND SHALL NOT EXCLUDE COVERAGE FOR THE SCREENING,
DIAGNOSIS OR TREATMENT OF MEDICAL CONDITIONS OTHERWISE COVERED BY THE
POLICY.
(B) COVERAGE SHALL INCLUDE COMPREHENSIVE NEUROPSYCHOLOGICAL EXAMINA-
TIONS FOR THE PURPOSES OF DIAGNOSING DYSLEXIA, PURSUANT TO THIS
SUBSECTION.
(C) CLINICIANS' NEUROPSYCHOLOGICAL REPORTS SHALL INCLUDE COMPREHENSIVE
RECOMMENDATIONS REGARDLESS OF DIAGNOSIS, INCLUDING A PSYCHOLOGICAL,
EMOTIONAL, AND EDUCATIONAL WELLNESS PLAN FOR THE INDIVIDUAL EVALUATED.
(2) COVERAGE UNDER THIS SUBSECTION IS ONLY REQUIRED IF ONE OR MORE OF
THE FOLLOWING CRITERIA ARE MET:
(A) THE INSURED IS AT AN INCREASED HEREDITARY RISK FOR DYSLEXIA OWING
TO A FAMILY HISTORY OF DYSLEXIA; OR
(B) THE INDIVIDUAL IS A STUDENT WHO HAS FAILED TWO (IF IN KINDERGARTEN
OR FIRST GRADE) OR ONE (IF IN SECOND GRADE OR ABOVE) READILY AVAILABLE
LITERACY SCREENING BENCHMARK(S) OF PROVEN PSYCHOMETRIC VALUE; AND IS
DEEMED AT RISK ACCORDING TO THEIR INSTRUCTOR, SCHOOL, OR OTHER SUPERVIS-
ING EDUCATIONAL BODY; OR
A. 2898 3
(C) THE INDIVIDUAL'S PEDIATRICIAN IDENTIFIES THE INDIVIDUAL AS AT RISK
FOR DYSLEXIA AS INDICATED BY FINDINGS FROM A VALID AND RELIABLE SCREENER
AND RECOMMENDS A NEUROPSYCHOLOGICAL EXAMINATION; OR
(D) THE INDIVIDUAL IS A STUDENT WITH A HISTORY OF RISK FACTOR(S) KNOWN
TO IMPACT LEARNING AND EDUCATIONAL OUTCOMES, INCLUDING BUT NOT LIMITED
TO: FETAL TOXIN EXPOSURE, PREMATURITY, AND HISTORY OF NEUROLOGICAL
DISORDER, SUCH AS EPILEPSY.
(3) COVERAGE REQUIRED BY THIS SUBSECTION SHALL BE CAPPED AT SIX THOU-
SAND DOLLARS, INDEXED TO INFLATION TO BE ADJUSTED EVERY TWO YEARS
ACCORDING TO CONSUMER PRICE INDEX FOR ALL URBAN CONSUMERS FOR THE
NATION, AS PREPARED BY THE UNITED STATES DEPARTMENT OF LABOR, FOR THE
CALENDAR YEAR PRECEDING THE CALENDAR YEAR IN WHICH THE ADJUSTMENT TO THE
MAXIMUM BENEFIT AMOUNT IS PROMULGATED.
§ 5. Section 4303 of the insurance law is amended by adding a new
subsection (uu) to read as follows:
(UU) (1) (A) EVERY POLICY THAT PROVIDES COVERAGE FOR PHYSICIAN
SERVICES, MEDICAL, MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE
SHALL PROVIDE COVERAGE FOR TESTING FOR SUSPECTED DYSLEXIA IN ACCORDANCE
WITH THIS SUBSECTION AND SHALL NOT EXCLUDE COVERAGE FOR THE SCREENING,
DIAGNOSIS OR TREATMENT OF MEDICAL CONDITIONS OTHERWISE COVERED BY THE
POLICY.
(B) COVERAGE SHALL INCLUDE COMPREHENSIVE NEUROPSYCHOLOGICAL EXAMINA-
TIONS FOR THE PURPOSES OF DIAGNOSING DYSLEXIA, PURSUANT TO THIS
SUBSECTION.
(C) CLINICIANS' NEUROPSYCHOLOGICAL REPORTS SHALL INCLUDE COMPREHENSIVE
RECOMMENDATIONS REGARDLESS OF DIAGNOSIS, INCLUDING A PSYCHOLOGICAL,
EMOTIONAL, AND EDUCATIONAL WELLNESS PLAN FOR THE INDIVIDUAL EVALUATED.
(2) COVERAGE UNDER THIS SUBSECTION IS ONLY REQUIRED IF ONE OR MORE OF
THE FOLLOWING CRITERIA ARE MET:
(A) THE INSURED IS AT AN INCREASED HEREDITARY RISK FOR DYSLEXIA OWING
TO A FAMILY HISTORY OF DYSLEXIA; OR
(B) THE INDIVIDUAL IS A STUDENT WHO HAS FAILED TWO (IF IN KINDERGARTEN
OR FIRST GRADE) OR ONE (IF IN SECOND GRADE OR ABOVE) READILY AVAILABLE
LITERACY SCREENING BENCHMARK(S) OF PROVEN PSYCHOMETRIC VALUE; AND IS
DEEMED AT RISK ACCORDING TO THEIR INSTRUCTOR, SCHOOL, OR OTHER SUPERVIS-
ING EDUCATIONAL BODY; OR
(C) THE INDIVIDUAL'S PEDIATRICIAN IDENTIFIES THE INDIVIDUAL AS AT RISK
FOR DYSLEXIA AS INDICATED BY FINDINGS FROM A VALID AND RELIABLE SCREENER
AND RECOMMENDS A NEUROPSYCHOLOGICAL EXAMINATION; OR
(D) THE INDIVIDUAL IS A STUDENT WITH A HISTORY OF RISK FACTOR(S) KNOWN
TO IMPACT LEARNING AND EDUCATIONAL OUTCOMES INCLUDING, BUT NOT LIMITED
TO: FETAL TOXIN EXPOSURE, PREMATURITY, AND HISTORY OF NEUROLOGICAL
DISORDER, SUCH AS EPILEPSY.
(3) COVERAGE REQUIRED BY THIS SUBSECTION SHALL BE CAPPED AT SIX THOU-
SAND DOLLARS, INDEXED TO INFLATION TO BE ADJUSTED EVERY TWO YEARS
ACCORDING TO CONSUMER PRICE INDEX FOR ALL URBAN CONSUMERS FOR THE
NATION, AS PREPARED BY THE UNITED STATES DEPARTMENT OF LABOR, FOR THE
CALENDAR YEAR PRECEDING THE CALENDAR YEAR IN WHICH THE ADJUSTMENT TO THE
MAXIMUM BENEFIT AMOUNT IS PROMULGATED.
§ 6. 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 and contracts issued, renewed, modified, altered, or amended on
or after such date. Effective immediately, the addition, amendment
and/or repeal of any rule or regulation necessary for the implementation
of this act on its effective date are authorized to be made and
completed on or before such date.