Bill Text: NY A05365 | 2011-2012 | General Assembly | Introduced
Bill Title: Requires that individual accident and health insurance policies shall provide coverage for screening, diagnosis and treatment of autism spectrum disorder.
Spectrum: Moderate Partisan Bill (Democrat 24-6)
Status: (Introduced - Dead) 2012-01-04 - referred to insurance [A05365 Detail]
Download: New_York-2011-A05365-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 5365 2011-2012 Regular Sessions I N A S S E M B L Y February 16, 2011 ___________ Introduced by M. of A. MORELLE, SILVER, NOLAN, SCHROEDER, LAVINE, LUPAR- DO, GOTTFRIED, PERRY, HEVESI, CUSICK, J. RIVERA, SWEENEY, JAFFEE, ZEBROWSKI, GALEF, MAISEL, SPANO, ROSENTHAL, ARROYO, TITONE, WEPRIN -- Multi-Sponsored by -- M. of A. BARCLAY, CALHOUN, DESTITO, ENGLEBRIGHT, JORDAN, LIFTON, MILLMAN, RAIA, SCHIMEL, TOBACCO -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to coverage for the screening, diagnosis and treatment of autism spec- trum disorder THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Paragraph 25 of subsection (i) of section 3216 of the 2 insurance law, as added by chapter 557 of the laws of 2006, is amended 3 to read as follows: 4 (25) Every policy which provides coverage for hospital, surgical, or 5 medical care coverage shall [not exclude] PROVIDE coverage for THE 6 SCREENING, diagnosis and treatment of [medical conditions otherwise 7 covered by the policy solely because the treatment is provided to diag- 8 nose or treat] autism spectrum disorder IN ACCORDANCE WITH THIS PARA- 9 GRAPH AND SHALL NOT EXCLUDE COVERAGE FOR THE TREATMENT OF MEDICAL CONDI- 10 TIONS OTHERWISE COVERED BY THE POLICY BECAUSE THE INDIVIDUAL IS 11 DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER. SUCH COVERAGE MAY BE 12 SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE 13 DEEMED APPROPRIATE BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH 14 THOSE IMPOSED ON OTHER BENEFITS UNDER THE POLICY. THIS PARAGRAPH SHALL 15 NOT BE CONSTRUED AS LIMITING THE BENEFITS THAT ARE OTHERWISE AVAILABLE 16 TO AN INDIVIDUAL UNDER THE POLICY. COVERAGE MAY BE SUBJECT TO UTILIZA- 17 TION REVIEW OF HEALTH CARE SERVICES, INCLUDING THE REVIEW OF MEDICAL 18 NECESSITY, CASE MANAGEMENT, AND OTHER MANAGED CARE PROVISIONS. 19 (A) For purposes of this [section] PARAGRAPH, "autism spectrum disor- 20 der" means a GROUP OF neurobiological [condition that includes autism, EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05243-01-1 A. 5365 2 1 Asperger syndrome, Rett's syndrome, or pervasive developmental disorder] 2 CONDITIONS DEFINED IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL 3 DISORDERS IV REVISED, OR ITS SUCCESSOR, AS PERVASIVE DEVELOPMENTAL 4 DISORDERS. 5 (B) THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE SUPERINTEN- 6 DENT, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS- 7 SIONER OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL, 8 NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBPARA- 9 GRAPH, PROMULGATE AND THEREAFTER REGULARLY UPDATE, REGULATIONS WHICH 10 SHALL IDENTIFY TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE SHALL BE 11 REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM 12 DISORDER PURSUANT TO THIS PARAGRAPH. SUCH TREATMENT AND THERAPY OPTIONS 13 SHALL BE EVIDENCE-BASED, PEER-REVIEWED AND CLINICALLY PROVEN. COVERAGE 14 FOR BEHAVIORAL THERAPIES REQUIRED PURSUANT TO THIS SUBPARAGRAPH SHALL 15 NOT BE DENIED ON THE BASIS THAT SUCH THERAPIES ARE EDUCATIONAL OR HABI- 16 LITATIVE IN NATURE, UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE 17 COVERED PERSON PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTI- 18 CLE EIGHTY-NINE OF THE EDUCATION LAW. THE PROVISION OF SERVICES PURSU- 19 ANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND 20 FIVE HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED 21 EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE OF THE EDUCATION LAW OR AN 22 INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE OFFICE FOR 23 PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL NOT AFFECT COVERAGE UNDER 24 THE POLICY FOR SERVICES PROVIDED ON A SUPPLEMENTAL BASIS OUTSIDE OF AN 25 EDUCATIONAL SETTING IF SUCH SERVICES ARE DEEMED MEDICALLY NECESSARY. 26 (C) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI- 27 GATION TO PROVIDE SERVICES TO AN INDIVIDUAL UNDER AN INDIVIDUALIZED 28 FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE HUNDRED FORTY-FIVE 29 OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE 30 EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED SERVICE PLAN 31 PURSUANT TO REGULATIONS OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL 32 DISABILITIES. 33 (D) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI- 34 GATION TO PROVIDE COVERAGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE 35 BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES 36 PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS 37 ARTICLE OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE 38 OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES. 39 (E) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT A POLICY 40 FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING PROVIDERS WHO 41 SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUDING PROVIDER 42 CREDENTIALING. 43 S 2. Paragraph 17 of subsection (l) of section 3221 of the insurance 44 law, as added by chapter 557 of the laws of 2006, is amended to read as 45 follows: 46 (17) [A] EVERY group or blanket accident [or] AND health insurance 47 policy [or issuing a group or blanket policy for delivery in this state] 48 DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE which provides coverage 49 for hospital, surgical, or medical care coverage shall [not exclude] 50 PROVIDE coverage for THE SCREENING, diagnosis and treatment of [medical 51 conditions otherwise covered by the policy because the treatment is 52 provided to diagnose or treat] autism spectrum disorder IN ACCORDANCE 53 WITH THIS PARAGRAPH AND SHALL NOT EXCLUDE COVERAGE FOR THE TREATMENT OF 54 MEDICAL CONDITIONS OTHERWISE COVERED BY THE POLICY BECAUSE THE INDIVID- 55 UAL IS DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER. SUCH COVERAGE MAY BE 56 SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE A. 5365 3 1 DEEMED APPROPRIATE BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH 2 THOSE IMPOSED ON OTHER BENEFITS UNDER THE POLICY. THIS PARAGRAPH SHALL 3 NOT BE CONSTRUED AS LIMITING THE BENEFITS THAT ARE OTHERWISE AVAILABLE 4 TO AN INDIVIDUAL UNDER THE POLICY. COVERAGE MAY BE SUBJECT TO UTILIZA- 5 TION REVIEW OF HEALTH CARE SERVICES, INCLUDING THE REVIEW OF MEDICAL 6 NECESSITY, CASE MANAGEMENT, AND OTHER MANAGED CARE PROVISIONS. 7 (A) For purposes of this [section] PARAGRAPH, "autism spectrum disor- 8 der" means a GROUP OF neurobiological [condition that includes autism, 9 Asperger syndrome, Rett's syndrome, or pervasive developmental disorder] 10 CONDITIONS DEFINED IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL 11 DISORDERS IV REVISED, OR ITS SUCCESSOR, AS PERVASIVE DEVELOPMENTAL 12 DISORDERS. 13 (B) THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE SUPERINTEN- 14 DENT, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS- 15 SIONER OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL, 16 NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBPARA- 17 GRAPH, PROMULGATE AND THEREAFTER REGULARLY UPDATE, REGULATIONS WHICH 18 SHALL IDENTIFY TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE SHALL BE 19 REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM 20 DISORDER PURSUANT TO THIS PARAGRAPH. SUCH TREATMENT AND THERAPY OPTIONS 21 SHALL BE EVIDENCE-BASED, PEER-REVIEWED AND CLINICALLY PROVEN. COVERAGE 22 FOR BEHAVIORAL THERAPIES REQUIRED PURSUANT TO THIS SUBPARAGRAPH SHALL 23 NOT BE DENIED ON THE BASIS THAT SUCH THERAPIES ARE EDUCATIONAL OR HABI- 24 LITATIVE IN NATURE, UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE 25 COVERED PERSON PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTI- 26 CLE EIGHTY-NINE OF THE EDUCATION LAW. THE PROVISION OF SERVICES PURSU- 27 ANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND 28 FIVE HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED 29 EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE OF THE EDUCATION LAW OR AN 30 INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE OFFICE FOR 31 PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL NOT AFFECT COVERAGE UNDER 32 THE POLICY FOR SERVICES PROVIDED ON A SUPPLEMENTAL BASIS OUTSIDE OF AN 33 EDUCATIONAL SETTING IF SUCH SERVICES ARE DEEMED MEDICALLY NECESSARY. 34 (C) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI- 35 GATION TO PROVIDE SERVICES TO AN INDIVIDUAL UNDER AN INDIVIDUALIZED 36 FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE HUNDRED FORTY-FIVE 37 OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE 38 EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED SERVICE PLAN 39 PURSUANT TO REGULATIONS OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL 40 DISABILITIES. 41 (D) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI- 42 GATION TO PROVIDE COVERAGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE 43 BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES 44 PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS 45 ARTICLE OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE 46 OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES. 47 (E) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT A POLICY 48 FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING PROVIDERS WHO 49 SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUDING PROVIDER 50 CREDENTIALING. 51 S 3. Subsection (ee) of section 4303 of the insurance law, as added by 52 chapter 557 of the laws of 2006, is amended to read as follows: 53 (ee) A medical expense indemnity corporation, a hospital service 54 corporation or a health service corporation which provides coverage for 55 hospital, surgical, or medical care coverage shall [not exclude] PROVIDE 56 coverage for THE SCREENING, diagnosis and treatment of [medical condi- A. 5365 4 1 tions otherwise covered by the policy solely because the treatment is 2 provided to diagnose or treat] autism spectrum disorder IN ACCORDANCE 3 WITH THIS SUBSECTION AND SHALL NOT EXCLUDE COVERAGE FOR THE TREATMENT OF 4 MEDICAL CONDITIONS OTHERWISE COVERED BY THE POLICY BECAUSE THE INDIVID- 5 UAL IS DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER. SUCH COVERAGE MAY BE 6 SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE 7 DEEMED APPROPRIATE BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH 8 THOSE IMPOSED ON OTHER BENEFITS UNDER THE CONTRACT. THIS SUBSECTION 9 SHALL NOT BE CONSTRUED AS LIMITING THE BENEFITS THAT ARE OTHERWISE 10 AVAILABLE TO AN INDIVIDUAL UNDER THE CONTRACT. COVERAGE MAY BE SUBJECT 11 TO UTILIZATION REVIEW OF HEALTH CARE SERVICES, INCLUDING THE REVIEW OF 12 MEDICAL NECESSITY, CASE MANAGEMENT, AND OTHER MANAGED CARE PROVISIONS. 13 (1) For purposes of this [section] SUBSECTION, "autism spectrum disor- 14 der" means a GROUP OF neurobiological [condition that includes autism, 15 Asperger syndrome, Rett's syndrome, or pervasive developmental disorder] 16 CONDITIONS DEFINED IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL 17 DISORDERS IV REVISED, OR ITS SUCCESSOR, AS PERVASIVE DEVELOPMENTAL 18 DISORDERS. 19 (2) THE COMMISSIONER OF HEALTH, IN CONSULTATION WITH THE SUPERINTEN- 20 DENT, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS- 21 SIONER OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES SHALL, 22 NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBPARA- 23 GRAPH, PROMULGATE AND THEREAFTER REGULARLY UPDATE, REGULATIONS WHICH 24 SHALL IDENTIFY TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE SHALL BE 25 REQUIRED FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM 26 DISORDER PURSUANT TO THIS SUBSECTION. SUCH TREATMENT AND THERAPY OPTIONS 27 SHALL BE EVIDENCE-BASED, PEER-REVIEWED AND CLINICALLY PROVEN. COVERAGE 28 FOR BEHAVIORAL THERAPIES REQUIRED PURSUANT TO THIS PARAGRAPH SHALL NOT 29 BE DENIED ON THE BASIS THAT SUCH THERAPIES ARE EDUCATIONAL OR HABILITA- 30 TIVE IN NATURE, UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE COVERED 31 PERSON PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE EIGHT- 32 Y-NINE OF THE EDUCATION LAW. THE PROVISION OF SERVICES PURSUANT TO AN 33 INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE 34 HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION 35 PLAN UNDER ARTICLE EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED 36 SERVICE PLAN PURSUANT TO REGULATIONS OF THE OFFICE FOR PEOPLE WITH 37 DEVELOPMENTAL DISABILITIES SHALL NOT AFFECT COVERAGE UNDER THE CONTRACT 38 FOR SERVICES PROVIDED ON A SUPPLEMENTAL BASIS OUTSIDE OF AN EDUCATIONAL 39 SETTING IF SUCH SERVICES ARE DEEMED MEDICALLY NECESSARY. 40 (3) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO AFFECT ANY OBLI- 41 GATION TO PROVIDE SERVICES TO AN INDIVIDUAL UNDER AN INDIVIDUALIZED 42 FAMILY SERVICE PLAN UNDER SECTION TWO THOUSAND FIVE HUNDRED FORTY-FIVE 43 OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE 44 EIGHTY-NINE OF THE EDUCATION LAW OR AN INDIVIDUALIZED SERVICE PLAN 45 PURSUANT TO REGULATIONS OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL 46 DISABILITIES. 47 (4) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO AFFECT ANY OBLI- 48 GATION TO PROVIDE COVERAGE FOR OTHERWISE COVERED SERVICES SOLELY ON THE 49 BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES 50 PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS 51 CHAPTER OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE 52 OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES. 53 (5) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO PREVENT A 54 CONTRACT FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING 55 PROVIDERS WHO SHALL MEET CERTAIN REQUIREMENTS FOR PARTICIPATION, INCLUD- 56 ING PROVIDER CREDENTIALING. A. 5365 5 1 S 4. Section 2500-j of the public health law is amended by adding a 2 new subdivision 4 to read as follows: 3 4. THE COMMISSIONER, IN CONSULTATION WITH THE SUPERINTENDENT OF INSUR- 4 ANCE, THE COMMISSIONER OF THE OFFICE OF MENTAL HEALTH AND THE COMMIS- 5 SIONER OF THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, SHALL 6 PROMULGATE NO LATER THAN TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS 7 SUBDIVISION, AND REGULARLY UPDATE, REGULATIONS WHICH SHALL IDENTIFY 8 TREATMENT AND THERAPY OPTIONS FOR WHICH COVERAGE SHALL BE REQUIRED FOR 9 THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM DISORDER 10 PURSUANT TO SECTIONS THREE THOUSAND TWO HUNDRED SIXTEEN, THREE THOUSAND 11 TWO HUNDRED TWENTY-ONE AND FOUR THOUSAND THREE HUNDRED THREE OF THE 12 INSURANCE LAW. 13 S 5. Severability clause. If any clause, sentence, paragraph, subdivi- 14 sion, section or part of this act shall be adjudged by any court of 15 competent jurisdiction to be invalid, such judgment shall not affect, 16 impair, or invalidate the remainder thereof, but shall be confined in 17 its operation to the clause, sentence, paragraph, subdivision, section 18 or part thereof directly involved in the controversy in which such judg- 19 ment shall have been rendered. It is hereby declared to be the intent of 20 the legislature that this act would have been enacted even if such 21 invalid provisions had not been included herein. 22 S 6. This act shall take effect immediately, provided that sections 23 one, two and three of this act shall take effect upon the promulgation 24 of either emergency or permanent rules and regulations by the commis- 25 sioner of health outlining the treatment insurers are required to 26 provide to cover autism spectrum disorder as provided for in this act 27 and shall apply to all policies or contracts issued, renewed, modified, 28 altered or amended on and after such effective date; provided that the 29 commissioner of health shall notify the legislative bill drafting 30 commission upon the promulgation of such emergency or permanent rules 31 and regulations in order that the commission may maintain an accurate 32 and timely effective data base of the official text of the laws of the 33 state of New York in furtherance of effectuating the provisions of 34 section 44 of the legislative law and section 70-b of the public offi- 35 cers law.