Bill Text: NY S05762 | 2023-2024 | General Assembly | Introduced

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Bill Title: Requires health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder; establishes an advisory panel on health insurance coverage for autism spectrum disorder to annually compile a list of treatments and therapy options for which health insurers will be required to provide coverage; establishes a toll-free, 24 hour a day, autism and health insurance coverage hotline to receive and act upon complaints and questions from families with autistic children, relating to insurance coverage for autism spectrum disorder.

Spectrum: Partisan Bill (Democrat 5-0)

Status: (Introduced) 2024-01-03 - REFERRED TO INSURANCE [S05762 Detail]

Download: New_York-2023-S05762-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          5762

                               2023-2024 Regular Sessions

                    IN SENATE

                                     March 15, 2023
                                       ___________

        Introduced  by  Sens.  PARKER, ADDABBO, BAILEY, KENNEDY, PERSAUD -- 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 establishing an advi-
          sory panel on health insurance coverage for autism spectrum disorder

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section 1. The insurance law is amended by adding a new section 346 to
     2  read as follows:
     3    §  346. Coverage for autism spectrum disorder. (a) (1) There is hereby
     4  established within the department an advisory panel on health  insurance
     5  coverage  for  autism spectrum disorder. Such panel shall be composed of
     6  nine members who are experts in health care and  appointed  as  follows:
     7  seven members who are officers or employees of the department of health,
     8  office  of  mental  health  or  the office for people with developmental
     9  disabilities shall be appointed by the governor; and the temporary pres-
    10  ident of the senate and the speaker of the assembly shall each appoint a
    11  member who is a representative of an autism advocacy group. Each  member
    12  shall  serve a term of two years. The governor shall designate the chair
    13  of the panel from among his or her appointees. Vacancies in the  member-
    14  ship  of  the  panel shall be filled in the manner provided for original
    15  appointments.
    16    (2) The members of the panel shall receive no compensation  for  their
    17  services  but  shall  be  allowed  their  actual  and necessary expenses
    18  incurred in the performance of their duties pursuant to this subsection.
    19    (3) The advisory panel on health insurance coverage for  autism  spec-
    20  trum  disorder shall annually, on or before September first, compile and
    21  submit to the superintendent a list of successful treatment and  therapy
    22  options for autism spectrum disorder that will be required to be covered
    23  pursuant  to  paragraph  twenty-five  of subsection (i) of section three
    24  thousand two hundred sixteen, paragraph seventeen of subsection  (1)  of

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD06012-01-3
        S. 5762                             2

     1  section  three  thousand  two  hundred twenty-one and subsection (ee) of
     2  section four thousand three hundred three of this chapter.
     3    (4)  Within forty-five days of receipt of each list submitted pursuant
     4  to paragraph three of this subsection, the superintendent shall,  on  an
     5  emergency  basis, promulgate and implement rules and regulations requir-
     6  ing coverage for the treatment and therapy options included in each such
     7  list.
     8    (b) (1) Within one hundred  eighty  days  of  the  submission  of  the
     9  initial  list  to  the  superintendent  pursuant  to  paragraph three of
    10  subsection (a) of this section, the department shall establish and oper-
    11  ate an autism and health insurance coverage hotline. The  hotline  shall
    12  be a toll-free, twenty-four hour a day consumer call center for families
    13  with  autistic children who have complaints about or questions on insur-
    14  ers and coverage for autism spectrum disorder. All  complaints  received
    15  by  such  hotline  shall  be  documented and referred to the appropriate
    16  official in the department for corrective action.
    17    (2) The department may contract with a qualified not-for-profit corpo-
    18  ration for the provision and operation of the hotline required  by  this
    19  subsection. Any such contract shall only be awarded after the department
    20  has  conducted  a  request  for  proposals process. The department shall
    21  select a not-for-profit corporation which has the resources and  ability
    22  to  operate  a  statewide  hotline,  and  is staffed by employees and/or
    23  volunteers with strong experience in autism spectrum disorder.
    24    (3) If the department elects to  establish  and  operate  the  hotline
    25  using  its own personnel and resources, such hotline shall be staffed by
    26  officers and employees with strong experience in autism spectrum  disor-
    27  der.  Until  the  state  civil service commission shall have established
    28  civil service titles  and  competitive  examinations  for  positions  as
    29  employees  of the hotline, the superintendent is authorized and directed
    30  to appoint and employ such qualified officers and employees as shall  be
    31  necessary to operate the autism and health insurance coverage hotline.
    32    (4)  The  superintendent is authorized to promulgate and implement any
    33  rules and regulations necessary to carry  out  the  provisions  of  this
    34  subsection.
    35    §  2.  Subparagraphs  (A) and (B) of paragraph 25 of subsection (i) of
    36  section 3216 of the insurance law, subparagraph (A) as amended by  chap-
    37  ter  595 of the laws of 2011, and subparagraph (B) as amended by section
    38  2 of subpart A of part BB of chapter 57 of the laws of 2019, are amended
    39  to read as follows:
    40    (A) Every policy which provides  coverage  for  hospital  or  surgical
    41  coverage  shall  [not exclude] include full coverage for the prevention,
    42  early detection, screening, diagnosis and treatment of  [medical  condi-
    43  tions  otherwise  covered  by the policy solely because the treatment is
    44  provided to diagnose or treat] autism spectrum disorder.
    45    (B) Every policy that  provides  physician  services,  medical,  major
    46  medical or similar comprehensive-type coverage shall provide full cover-
    47  age for the screening, diagnosis and treatment of autism spectrum disor-
    48  der in accordance with this paragraph and shall not exclude coverage for
    49  the  prevention,  early  detection, screening, diagnosis or treatment of
    50  medical conditions otherwise covered by the policy because the  individ-
    51  ual  is  diagnosed  with  autism spectrum disorder. Such coverage may be
    52  subject to annual deductibles, copayments  and  coinsurance  as  may  be
    53  deemed  appropriate  by  the superintendent and shall be consistent with
    54  those imposed on other benefits under the policy. This  paragraph  shall
    55  not  be  construed as limiting the benefits that are otherwise available
    56  to an individual under the policy, provided  however  that  such  policy
        S. 5762                             3

     1  shall  not  contain any limitations on visits that are solely applied to
     2  the treatment of autism spectrum disorder. No  insurer  shall  terminate
     3  coverage  or  refuse to deliver, execute, issue, amend, adjust, or renew
     4  coverage  to  an  individual  solely because the individual is diagnosed
     5  with autism spectrum disorder or has received treatment for autism spec-
     6  trum disorder. Coverage shall  be  subject  to  utilization  review  and
     7  external  appeals of health care services pursuant to article forty-nine
     8  of this chapter as well  as  case  management  and  other  managed  care
     9  provisions.
    10    §  3.  Subparagraphs  (A) and (B) of paragraph 17 of subsection (l) of
    11  section 3221 of the insurance law, subparagraph (A) as amended by  chap-
    12  ter  595  of the laws of 2011, subparagraph (B) as amended by section 19
    13  of subpart A of part BB of chapter 57 of the laws of 2019,  are  amended
    14  to read as follows:
    15    (A) Every group or blanket accident and health insurance policy deliv-
    16  ered  or  issued  for delivery in this state which provides coverage for
    17  hospital or surgical care coverage  shall  [not  exclude]  include  full
    18  coverage  for  the prevention, early detection, screening, diagnosis and
    19  treatment of medical conditions otherwise covered by the policy  because
    20  the treatment is provided to diagnose or treat autism spectrum disorder.
    21    (B)  Every  group  or blanket policy that provides physician services,
    22  medical, major medical  or  similar  comprehensive-type  coverage  shall
    23  provide  full  coverage  for  the  screening, diagnosis and treatment of
    24  autism spectrum disorder in accordance with this paragraph and shall not
    25  exclude coverage for the prevention, early detection, screening, diagno-
    26  sis or treatment of medical conditions otherwise covered by  the  policy
    27  because  the individual is diagnosed with autism spectrum disorder. Such
    28  coverage may be subject to annual deductibles,  copayments  and  coinsu-
    29  rance  as  may  be deemed appropriate by the superintendent and shall be
    30  consistent with those imposed on other benefits under the group or blan-
    31  ket policy. This paragraph shall not be construed as limiting the  bene-
    32  fits  that  are  otherwise available to an individual under the group or
    33  blanket policy, provided however that such policy shall not contain  any
    34  limitations on visits that are solely applied to the treatment of autism
    35  spectrum  disorder.  No  insurer  shall  terminate coverage or refuse to
    36  deliver, execute, issue, amend, adjust, or renew coverage to an individ-
    37  ual solely because the individual  is  diagnosed  with  autism  spectrum
    38  disorder  or has received treatment for autism spectrum disorder. Cover-
    39  age shall be subject to  utilization  review  and  external  appeals  of
    40  health  care  services pursuant to article forty-nine of this chapter as
    41  well as case management and other managed care provisions.
    42    § 4. Paragraphs 1 and 2 of subsection (ee)  of  section  4303  of  the
    43  insurance law, paragraph 1 as amended by chapter 596 of the laws of 2011
    44  and  paragraph  2  as  amended  by section 31 of subpart A of part BB of
    45  chapter 57 of the laws of 2019, are amended to read as follows:
    46    (1) A medical expense indemnity corporation, a hospital service corpo-
    47  ration or a health  service  corporation  which  provides  coverage  for
    48  hospital  or  surgical  care  coverage  shall [not exclude] include full
    49  coverage for the prevention, early detection, screening,  diagnosis  and
    50  treatment of medical conditions otherwise covered by the contract solely
    51  because  the  treatment is provided to diagnose or treat autism spectrum
    52  disorder.
    53    (2) Every contract that provides physician  services,  medical,  major
    54  medical or similar comprehensive-type coverage shall provide full cover-
    55  age for the screening, diagnosis and treatment of autism spectrum disor-
    56  der in accordance with this paragraph and shall not exclude coverage for
        S. 5762                             4

     1  the  prevention,  early  detection, screening, diagnosis or treatment of
     2  medical conditions otherwise covered by the contract because  the  indi-
     3  vidual  is diagnosed with autism spectrum disorder. Such coverage may be
     4  subject  to  annual  deductibles,  copayments  and coinsurance as may be
     5  deemed appropriate by the superintendent and shall  be  consistent  with
     6  those imposed on other benefits under the contract. This paragraph shall
     7  not  be  construed as limiting the benefits that are otherwise available
     8  to an individual under the contract, provided however that such contract
     9  shall not contain any limitations on visits that are solely  applied  to
    10  the  treatment  of  autism spectrum disorder. No insurer shall terminate
    11  coverage or refuse to deliver, execute, issue, amend, adjust,  or  renew
    12  coverage  to  an  individual  solely because the individual is diagnosed
    13  with autism spectrum disorder or has received treatment for autism spec-
    14  trum disorder. Coverage shall  be  subject  to  utilization  review  and
    15  external  appeals of health care services pursuant to article forty-nine
    16  of this chapter as well  as  case  management  and  other  managed  care
    17  provisions.
    18    §  5.  This  act shall take effect on the thirtieth day after it shall
    19  have become a law.