Senate Gives Final Passage to Bill to Ensure Individuals WITH Autism Receive Insurance Coverage for Treatments and Therapies

Senator Dean Skelos today announced that the state Senate has given
final legislative passage to legislation to ensure individuals with
autism are able to receive insurance coverage for applied behavioral
analysis (ABA) therapy as intended under New York State’s autism insurance
reform law.

The legislation is in response to regulations implemented by the New
York State Department of Financial Services which have dramatically limited
the number of ABA practitioners where individuals with autism can receive
therapy which is covered by insurance.

“When we enacted the autism insurance reform law it was intended to
provide coverage for families who were spending thousands of dollars for
their loved ones to receive therapies and treatments for autism,” Senator
Skelos said. “However, many families did not get the coverage they needed
due to regulations that were contrary to the law’s intent.  This new
measure will ensure that people with autism get the coverage they were
promised, and that they need, just as the original law intended.”

     Under New York’s autism insurance reform law, insurance companies
must provide coverage for the screening, diagnosis, and treatment of autism
spectrum disorders, including applied behavioral analysis (ABA), one of the
most widely used autism therapies.  Additionally, insurance companies
cannot terminate coverage or refuse to renew, adjust, amend, issue, or
execute a policy solely because the individual has been diagnosed with or
received treatment for autism spectrum disorders.  The law was designed to
help families who were spending tens of thousands of dollars out of pocket
each year on treatments and therapies for their loved ones with autism that
many insurance companies refused to cover.

     The law directed the New York State Department of Financial Services
(DFS), in consultation with the Departments of Health and Education, to
promulgate rules and regulations as to what qualifications a provider must
have in order to qualify for coverage, but clearly specified that
certification by the national Behavior Analyst Certification Board would be
sufficient to receive coverage for ABA services.  Instead, DFS implemented
regulations requiring ABA practitioners to be licensed in order to qualify
for insurance reimbursement, even though no such license exists in New York
State.

     As a result, only behavior analysts who have another type of state
license, such as a physician or psychologist, and performs ABA therapy
within the normal scope of their duties can currently qualify for insurance
reimbursement.  This significantly limits the number of available providers
where families can go to receive insurance-covered ABA therapy and forces
many to still pay for this therapy out of pocket, contrary to the law’s
intent.

     The bill (S4862B) would establish a state license for behavior
analysts and allow those behavior analysts who are already certified by the
national Behavior Analyst Certification Board to immediately be licensed
upon their filing an application with the state and paying a licensing fee.
This would greatly expand the places where individuals with autism could
access the care they need and have it covered by insurance, as the law
intended.

     The bill will be sent to the Governor for his consideration.

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