S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5481
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               March 6, 2023
                                ___________
 
 Introduced  by Sen. HOYLMAN-SIGAL -- 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  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
 S. 5481                             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
 S. 5481                             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.