Bill Text: NY A07913 | 2023-2024 | General Assembly | Introduced
Bill Title: Relates to coverage for applied behavior analysis and for developmental, individual-differences, relationship-based treatment of autism spectrum disorder.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Introduced) 2024-01-03 - referred to insurance [A07913 Detail]
Download: New_York-2023-A07913-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7913 2023-2024 Regular Sessions IN ASSEMBLY August 4, 2023 ___________ Introduced by M. of A. SIMON, JENSEN -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to coverage for the screening, diagnosis and treatment of autism spectrum disorder The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraphs (B) and (C) of paragraph 25 of subsection 2 (i) of section 3216 of the insurance law, subparagraph (B) as amended by 3 section 2 of subpart A of part BB of chapter 57 of the laws of 2019, 4 subparagraph (C) as amended by chapter 596 of the laws of 2011, items 5 (i) and (iii) of subparagraph (C) as amended by section 3 of subpart A 6 of part BB of chapter 57 of the laws of 2019, are amended to read as 7 follows: 8 (B) Every policy that provides physician services, medical, major 9 medical or similar comprehensive-type coverage shall provide coverage 10 for the screening, diagnosis and treatment of autism spectrum disorder 11 in accordance with this paragraph and shall not exclude coverage for the 12 screening, diagnosis or treatment of medical conditions otherwise 13 covered by the policy because the individual is diagnosed with autism 14 spectrum disorder. Such coverage may be subject to annual deductibles, 15 copayments and coinsurance as may be deemed appropriate by the super- 16 intendent and shall be consistent with those imposed on other benefits 17 under the policy. Coverage for applied behavior analysis and develop- 18 mental, individual-differences, relationship-based treatment shall be 19 subject to a maximum benefit of six hundred eighty hours of treatment 20 per policy during a calendar year per covered individual. This paragraph 21 shall not be construed as limiting the benefits that are otherwise 22 available to an individual under the policy, provided however that such 23 policy shall not contain any limitations on visits that are solely 24 applied to the treatment of autism spectrum disorder, except as provided 25 in this subparagraph for coverage for applied behavior analysis and EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD09798-01-3A. 7913 2 1 developmental, individual differences, relationship-based treatment. No 2 insurer shall terminate coverage or refuse to deliver, execute, issue, 3 amend, adjust, or renew coverage to an individual solely because the 4 individual is diagnosed with autism spectrum disorder or has received 5 treatment for autism spectrum disorder. Coverage shall be subject to 6 utilization review and external appeals of health care services pursuant 7 to article forty-nine of this chapter as well as case management and 8 other managed care provisions. 9 (C) For purposes of this paragraph: 10 (i) "autism spectrum disorder" means any pervasive developmental 11 disorder as defined in the most recent edition of the diagnostic and 12 statistical manual of mental disorders, including, but not limited to, 13 autistic spectrum disorder. 14 (ii) "applied behavior analysis" means the design, implementation, and 15 evaluation of environmental modifications, using behavioral stimuli and 16 consequences, to produce socially significant improvement in human 17 behavior, including the use of direct observation, measurement, and 18 functional analysis of the relationship between environment and behav- 19 ior. 20 (iii) "behavioral health treatment" means counseling and treatment 21 programs, including developmental, individual-differences and relation- 22 ship-based treatment, when provided by a licensed provider with a 23 professional certificate in developmental, individual-differences, rela- 24 tionship-based treatment from the interdisciplinary council on develop- 25 ment and learning, and applied behavior analysis, when provided by a 26 person licensed, certified or otherwise authorized to provide applied 27 behavior analysis, that are necessary to develop, maintain, or restore, 28 to the maximum extent practicable, the functioning of an individual. 29 Individuals that provide behavioral health treatment under the super- 30 vision of a licensed provider pursuant to this paragraph shall be 31 subject to standards of professionalism, supervision and relevant expe- 32 rience pursuant to regulations promulgated by the superintendent in 33 consultation with the commissioners of health and education. 34 (iv) "diagnosis of autism spectrum disorder" means assessments, evalu- 35 ations, or tests to diagnose whether an individual has autism spectrum 36 disorder. 37 (v) "pharmacy care" means medications prescribed by a licensed health 38 care provider legally authorized to prescribe under title eight of the 39 education law. 40 (vi) "psychiatric care" means direct or consultative services provided 41 by a psychiatrist licensed in the state in which the psychiatrist prac- 42 tices. 43 (vii) "psychological care" means direct or consultative services 44 provided by a psychologist licensed in the state in which the psychol- 45 ogist practices. 46 (viii) "therapeutic care" means services provided by licensed or 47 certified [speech therapists, occupational therapists, social workers,48or physical therapists] providers in the fields of counseling, occupa- 49 tional therapy, physical therapy, social work, or speech and language 50 pathology. 51 (ix) "treatment of autism spectrum disorder" shall include the follow- 52 ing care and assistive communication devices prescribed or ordered for 53 an individual diagnosed with autism spectrum disorder by a licensed 54 physician or a licensed psychologist: 55 (1) behavioral health treatment; 56 (2) psychiatric care;A. 7913 3 1 (3) psychological care; 2 (4) medical care provided by a licensed health care provider; 3 (5) therapeutic care, including therapeutic care which is deemed habi- 4 litative or nonrestorative, in the event that the policy provides cover- 5 age for therapeutic care; and 6 (6) pharmacy care in the event that the policy provides coverage for 7 prescription drugs. 8 (x) "developmental, individual-differences, relationship-based treat- 9 ment" means the implementation of a floortime intervention that is based 10 on an assessment of functional-emotional development and the person's 11 individual profile, while understanding that human development is 12 fostered in the context of relationships with others. The primary goal 13 is to promote development and address developmental challenges and defi- 14 cits that often accompany autism and other neurodevelopmental disorders. 15 § 2. Subparagraphs (B) and (C) of paragraph 17 of subsection (l) of 16 section 3221 of the insurance law, subparagraph (B) as amended by 17 section 19 of subpart A of part BB of chapter 57 of the laws of 2019, 18 subparagraph (C) as amended by chapter 596 of the laws of 2011, items 19 (i) and (iii) of subparagraph (C) as amended by section 20 of subpart A 20 of part BB of chapter 57 of the laws of 2019, are amended to read as 21 follows: 22 (B) Every group or blanket policy that provides physician services, 23 medical, major medical or similar comprehensive-type coverage shall 24 provide coverage for the screening, diagnosis and treatment of autism 25 spectrum disorder in accordance with this paragraph and shall not 26 exclude coverage for the screening, diagnosis or treatment of medical 27 conditions otherwise covered by the policy because the individual is 28 diagnosed with autism spectrum disorder. Such coverage may be subject to 29 annual deductibles, copayments and coinsurance as may be deemed appro- 30 priate by the superintendent and shall be consistent with those imposed 31 on other benefits under the group or blanket policy. Coverage for 32 applied behavior analysis and developmental, individual-differences, 33 relationship-based treatment shall be subject to a maximum benefit of 34 six hundred eighty hours of treatment per policy during a calendar year 35 per covered individual. This paragraph shall not be construed as limit- 36 ing the benefits that are otherwise available to an individual under the 37 group or blanket policy, provided however that such policy shall not 38 contain any limitations on visits that are solely applied to the treat- 39 ment of autism spectrum disorder, except as provided in this subpara- 40 graph for coverage for applied behavior analysis and developmental, 41 individual differences, relationship-based treatment. No insurer shall 42 terminate coverage or refuse to deliver, execute, issue, amend, adjust, 43 or renew coverage to an individual solely because the individual is 44 diagnosed with autism spectrum disorder or has received treatment for 45 autism spectrum disorder. Coverage shall be subject to utilization 46 review and external appeals of health care services pursuant to article 47 forty-nine of this chapter as well as case management and other managed 48 care provisions. 49 (C) For purposes of this paragraph: 50 (i) "autism spectrum disorder" means any pervasive developmental 51 disorder as defined in the most recent edition of the diagnostic and 52 statistical manual of mental disorders, including, but not limited to, 53 autistic spectrum disorder. 54 (ii) "applied behavior analysis" means the design, implementation, and 55 evaluation of environmental modifications, using behavioral stimuli and 56 consequences, to produce socially significant improvement in humanA. 7913 4 1 behavior, including the use of direct observation, measurement, and 2 functional analysis of the relationship between environment and behav- 3 ior. 4 (iii) "behavioral health treatment" means counseling and treatment 5 programs, including developmental, individual-differences, relation- 6 ship-based treatment, when provided by a licensed provider with a 7 professional certificate in developmental, individual-differences, rela- 8 tionship-based treatment from the interdisciplinary council on develop- 9 ment and learning, and applied behavior analysis, when provided by a 10 person licensed, certified or otherwise authorized to provide applied 11 behavior analysis, that are necessary to develop, maintain, or restore, 12 to the maximum extent practicable, the functioning of an individual. 13 Individuals that provide behavioral health treatment under the super- 14 vision of a licensed provider pursuant to this paragraph shall be 15 subject to standards of professionalism, supervision and relevant expe- 16 rience pursuant to regulations promulgated by the superintendent in 17 consultation with the commissioners of health and education. 18 (iv) "diagnosis of autism spectrum disorder" means assessments, evalu- 19 ations, or tests to diagnose whether an individual has autism spectrum 20 disorder. 21 (v) "pharmacy care" means medications prescribed by a licensed health 22 care provider legally authorized to prescribe under title eight of the 23 education law. 24 (vi) "psychiatric care" means direct or consultative services provided 25 by a psychiatrist licensed in the state in which the psychiatrist prac- 26 tices. 27 (vii) "psychological care" means direct or consultative services 28 provided by a psychologist licensed in the state in which the psychol- 29 ogist practices. 30 (viii) "therapeutic care" means services provided by licensed or 31 certified [speech therapists, occupational therapists, social workers,32or physical therapists] providers in the fields of counseling, occupa- 33 tional therapy, physical therapy, social work, or speech and language 34 pathology. 35 (ix) "treatment of autism spectrum disorder" shall include the follow- 36 ing care and assistive communication devices prescribed or ordered for 37 an individual diagnosed with autism spectrum disorder by a licensed 38 physician or a licensed psychologist: 39 (1) behavioral health treatment; 40 (2) psychiatric care; 41 (3) psychological care; 42 (4) medical care provided by a licensed health care provider; 43 (5) therapeutic care, including therapeutic care which is deemed habi- 44 litative or nonrestorative, in the event that the policy provides cover- 45 age for therapeutic care; and 46 (6) pharmacy care in the event that the policy provides coverage for 47 prescription drugs. 48 (x) "developmental, individual-differences, relationship-based treat- 49 ment" means the implementation of a floortime intervention that is based 50 on an assessment of functional-emotional development and the person's 51 individual profile, while understanding that human development is 52 fostered in the context of relationships with others. The primary goal 53 is to promote development and address developmental challenges and defi- 54 cits that often accompany autism and other neurodevelopmental disorders. 55 § 3. Paragraphs 2 and 3 of subsection (ee) of section 4303 of the 56 insurance law, paragraph 2 as amended by section 31 of subpart A of partA. 7913 5 1 BB of chapter 57 of the laws of 2019, paragraph 3 as amended by chapter 2 596 of the laws of 2011, subparagraphs (A) and (C) of paragraph 3 as 3 amended by section 32 of subpart A of part BB of chapter 57 of the laws 4 of 2019, are amended to read as follows: 5 (2) Every contract that provides physician services, medical, major 6 medical or similar comprehensive-type coverage shall provide coverage 7 for the screening, diagnosis and treatment of autism spectrum disorder 8 in accordance with this paragraph and shall not exclude coverage for the 9 screening, diagnosis or treatment of medical conditions otherwise 10 covered by the contract because the individual is diagnosed with autism 11 spectrum disorder. Such coverage may be subject to annual deductibles, 12 copayments and coinsurance as may be deemed appropriate by the super- 13 intendent and shall be consistent with those imposed on other benefits 14 under the contract. Coverage for applied behavior analysis and develop- 15 mental, individual-differences, relationship-based treatment shall be 16 subject to a maximum benefit of six hundred eighty hours of treatment 17 per policy during a calendar year per covered individual. This paragraph 18 shall not be construed as limiting the benefits that are otherwise 19 available to an individual under the contract, provided however that 20 such contract shall not contain any limitations on visits that are sole- 21 ly applied to the treatment of autism spectrum disorder, except as 22 provided in this subparagraph for coverage for applied behavior analysis 23 and developmental, individual differences, relationship-based treatment. 24 No insurer shall terminate coverage or refuse to deliver, execute, 25 issue, amend, adjust, or renew coverage to an individual solely because 26 the individual is diagnosed with autism spectrum disorder or has 27 received treatment for autism spectrum disorder. Coverage shall be 28 subject to utilization review and external appeals of health care 29 services pursuant to article forty-nine of this chapter as well as case 30 management and other managed care provisions. 31 (3) For purposes of this subsection: 32 (A) "autism spectrum disorder" means any pervasive developmental 33 disorder as defined in the most recent edition of the diagnostic and 34 statistical manual of mental disorders, including, but not limited to, 35 autistic spectrum disorder. 36 (B) "applied behavior analysis" means the design, implementation, and 37 evaluation of environmental modifications, using behavioral stimuli and 38 consequences, to produce socially significant improvement in human 39 behavior, including the use of direct observation, measurement, and 40 functional analysis of the relationship between environment and behav- 41 ior. 42 (C) "behavioral health treatment" means counseling and treatment 43 programs, including developmental, individual-differences, relation- 44 ship-based treatment, when provided by a licensed provider with a 45 professional certificate in developmental, individual-differences, rela- 46 tionship-based treatment from the interdisciplinary council on develop- 47 ment and learning, and applied behavior analysis, when provided by a 48 person that is licensed, certified or otherwise authorized to provide 49 applied behavior analysis, that are necessary to develop, maintain, or 50 restore, to the maximum extent practicable, the functioning of an indi- 51 vidual. Individuals that provide behavioral health treatment under the 52 supervision of a licensed provider pursuant to this subsection shall be 53 subject to standards of professionalism, supervision and relevant expe- 54 rience pursuant to regulations promulgated by the superintendent in 55 consultation with the commissioners of health and education.A. 7913 6 1 (D) "diagnosis of autism spectrum disorder" means assessments, evalu- 2 ations, or tests to diagnose whether an individual has autism spectrum 3 disorder. 4 (E) "pharmacy care" means medications prescribed by a licensed health 5 care provider legally authorized to prescribe under title eight of the 6 education law. 7 (F) "psychiatric care" means direct or consultative services provided 8 by a psychiatrist licensed in the state in which the psychiatrist prac- 9 tices. 10 (G) "psychological care" means direct or consultative services 11 provided by a psychologist licensed in the state in which the psychol- 12 ogist practices. 13 (H) "therapeutic care" means services provided by licensed or certi- 14 fied [speech therapists, occupational therapists, social workers, or15physical therapists] providers in the fields of counseling, occupational 16 therapy, physical therapy, social work, or speech and language 17 pathology. 18 (I) "treatment of autism spectrum disorder" shall include the follow- 19 ing care and assistive communication devices prescribed or ordered for 20 an individual diagnosed with autism spectrum disorder by a licensed 21 physician or a licensed psychologist: 22 (i) behavioral health treatment; 23 (ii) psychiatric care; 24 (iii) psychological care; 25 (iv) medical care provided by a licensed health care provider; 26 (v) therapeutic care, including therapeutic care which is deemed habi- 27 litative or nonrestorative, in the event that the policy provides cover- 28 age for therapeutic care; and 29 (vi) pharmacy care in the event that the contract provides coverage 30 for prescription drugs. 31 § 4. This act shall take effect on the ninetieth day after it shall 32 have become a law.
