A6305-2011 Actions

• Nov 1, 2011: signed chap.595
• Oct 31, 2011: delivered to governor
• Jun 17, 2011: RETURNED TO ASSEMBLY
• Jun 17, 2011: PASSED SENATE
• Jun 17, 2011: 3RD READING CAL.1338
• Jun 17, 2011: SUBSTITUTED FOR S4005A
• Jun 17, 2011: REFERRED TO RULES
• Jun 17, 2011: delivered to senate
• Jun 17, 2011: passed assembly
• Jun 15, 2011: ordered to third reading rules cal.302
• Jun 15, 2011: rules report cal.302
• Jun 15, 2011: reported
• Jun 15, 2011: reported referred to rules
• Jun 13, 2011: reported referred to ways and means
• Jun 8, 2011: print number 6305a
• Jun 8, 2011: amend (t) and recommit to insurance
• Mar 11, 2011: referred to insurance

A6305-2011 Votes

A6305-2011 Text

                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

      S. 4005                                                  A. 6305

                         2011-2012 Regular Sessions

                        SENATE - ASSEMBLY

                               March 11, 2011
                                 ___________

  IN  SENATE  --  Introduced by Sens. FUSCHILLO, McDONALD, BRESLIN, DUANE,
    ADAMS, ADDABBO, AVELLA, BALL, BONACIC, DeFRANCISCO, DILAN,  ESPAILLAT,
    FARLEY,   FLANAGAN,   GALLIVAN,   GOLDEN,  GRIFFO,  GRISANTI,  HANNON,
    HASSELL-THOMPSON, JOHNSON,  KLEIN,  KRUEGER,  KRUGER,  LANZA,  LARKIN,
    LAVALLE,  LIBOUS,  LITTLE,  MARCELLINO,  MARTINS, MAZIARZ, MONTGOMERY,
    NOZZOLIO, O'MARA, OPPENHEIMER, PARKER, PERKINS, RITCHIE, ROBACH, SAMP-
    SON, SKELOS, STAVISKY, STEWART-COUSINS, VALESKY, ZELDIN -- read  twice
    and ordered printed, and when printed to be committed to the Committee
    on Insurance

  IN ASSEMBLY -- Introduced by M. of A. MORELLE, SILVER, NOLAN, SCHROEDER,
    LAVINE, LUPARDO, GOTTFRIED, PERRY, HEVESI, CUSICK, J. RIVERA, SWEENEY,
    JAFFEE,  ZEBROWSKI,  GALEF,  MAISEL, SPANO, ROSENTHAL, ARROYO, TITONE,
    WEPRIN, ABINANTI -- 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,  in  relation  to  coverage  for  the
    screening, diagnosis and treatment of autism spectrum disorders

    THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
  BLY, DO ENACT AS FOLLOWS:


    Section 1.  Paragraph 25 of subsection (i)  of  section  3216  of  the
  insurance  law,  as added by chapter 557 of the laws of 2006, is amended
  to read as follows:

    (25) Every policy which provides coverage for hospital,  surgical,  or
  medical  care  coverage  shall  [not  exclude]  PROVIDE coverage for THE
  SCREENING, diagnosis and  treatment  of  [medical  conditions  otherwise
  covered  by the policy solely because the treatment is provided to diag-
  nose or treat] autism spectrum [disorder] DISORDERS 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
  BECAUSE THE INDIVIDUAL IS DIAGNOSED WITH AN  AUTISM  SPECTRUM  DISORDER.

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD08567-01-1

 S. 4005                             2                            A. 6305

  SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COIN-
  SURANCE  AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND SHALL BE
  CONSISTENT WITH THOSE IMPOSED ON OTHER BENEFITS UNDER THE  POLICY.  THIS
  PARAGRAPH  SHALL  NOT  BE  CONSTRUED  AS  LIMITING THE BENEFITS THAT ARE
  OTHERWISE AVAILABLE TO AN INDIVIDUAL UNDER THE POLICY. NO INSURER  SHALL
  TERMINATE  COVERAGE OR REFUSE TO DELIVER, EXECUTE, ISSUE, AMEND, ADJUST,
  OR RENEW COVERAGE TO AN INDIVIDUAL  SOLELY  BECAUSE  THE  INDIVIDUAL  IS
  DIAGNOSED  WITH  ONE  OF  THE  AUTISM SPECTRUM DISORDERS OR HAS RECEIVED
  TREATMENT FOR AUTISM SPECTRUM DISORDERS. COVERAGE SHALL  BE  SUBJECT  TO
  UTILIZATION REVIEW AND EXTERNAL APPEALS OF HEALTH CARE SERVICES PURSUANT
  TO  ARTICLE  FORTY-NINE OF THIS CHAPTER AS WELL AS, CASE MANAGEMENT, AND
  OTHER MANAGED CARE PROVISIONS.
    (A) For purposes of this [section,] PARAGRAPH:

    (I) "autism  spectrum  disorder"  means  a  GROUP  OF  neurobiological
  [condition  that includes autism, Asperger syndrome, Rett's syndrome, or
  pervasive developmental  disorder.]  CONDITIONS  THAT  INCLUDE  AUTISTIC
  DISORDER, ASPERGER'S DISORDER, RETT'S DISORDER, CHILDHOOD DISINTEGRATIVE
  DISORDER,  AND  PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED
  (PDD-NOS), AS DEFINED IN THE MOST RECENT EDITION OF THE  DIAGNOSTIC  AND
  STATISTICAL MANUAL OF MENTAL DISORDERS.
    (II) "APPLIED BEHAVIOR ANALYSIS" MEANS THE DESIGN, IMPLEMENTATION, AND
  EVALUATION  OF ENVIRONMENTAL MODIFICATIONS, USING BEHAVIORAL STIMULI AND
  CONSEQUENCES, TO  PRODUCE  SOCIALLY  SIGNIFICANT  IMPROVEMENT  IN  HUMAN
  BEHAVIOR,  INCLUDING  THE  USE  OF  DIRECT OBSERVATION, MEASUREMENT, AND
  FUNCTIONAL ANALYSIS OF THE RELATIONSHIP BETWEEN ENVIRONMENT  AND  BEHAV-
  IOR.
    (III)  "BEHAVIORAL  HEALTH  TREATMENT" MEANS PROFESSIONAL, COUNSELING,
  AND GUIDANCE SERVICES AND TREATMENT PROGRAMS, INCLUDING APPLIED BEHAVIOR
  ANALYSIS WHEN PROVIDED OR  SUPERVISED  BY  A  BOARD  CERTIFIED  BEHAVIOR
  ANALYST,  THAT  ARE  NECESSARY TO DEVELOP, MAINTAIN, AND RESTORE, TO THE
  MAXIMUM EXTENT PRACTICABLE, THE FUNCTIONING OF AN INDIVIDUAL.
    (IV) "DIAGNOSIS OF AUTISM SPECTRUM DISORDERS"  MEANS  THE  ASSESSMENT,
  EVALUATIONS,  OR  TESTS TO DIAGNOSE WHETHER AN INDIVIDUAL HAS ONE OF THE
  AUTISM SPECTRUM DISORDERS.
    (V) "PHARMACY CARE" MEANS MEDICATIONS PRESCRIBED BY A LICENSED  PHYSI-
  CIAN AND ANY HEALTH-RELATED SERVICES TO DETERMINE THE NEED OR EFFECTIVE-
  NESS OF THE MEDICATIONS.
    (VI) "PSYCHIATRIC CARE" MEANS DIRECT OR CONSULTATIVE SERVICES PROVIDED
  BY  A PSYCHIATRIST LICENSED IN THE STATE IN WHICH THE PSYCHIATRIST PRAC-
  TICES.
    (VII) "PSYCHOLOGICAL  CARE"  MEANS  DIRECT  OR  CONSULTATIVE  SERVICES
  PROVIDED  BY  A PSYCHOLOGIST LICENSED IN THE STATE IN WHICH THE PSYCHOL-
  OGIST PRACTICES.
    (VIII) "THERAPEUTIC CARE"  MEANS  SERVICES  PROVIDED  BY  LICENSED  OR
  CERTIFIED SPEECH THERAPISTS, OCCUPATIONAL THERAPISTS, SOCIAL WORKERS, OR
  PHYSICAL THERAPISTS.
    (IX)  "TREATMENT  FOR  AUTISM  SPECTRUM  DISORDERS"  WILL  INCLUDE THE
  FOLLOWING CARE AND RELATED EQUIPMENT PRESCRIBED OR ORDERED FOR AN  INDI-
  VIDUAL DIAGNOSED WITH ONE OF THE AUTISM SPECTRUM DISORDERS BY A LICENSED
  PHYSICIAN OR A LICENSED PSYCHOLOGIST:

    (1) BEHAVIORAL HEALTH TREATMENT;
    (2) PHARMACY CARE;
    (3) PSYCHIATRIC CARE;
    (4) PSYCHOLOGICAL CARE;
    (5) THERAPEUTIC CARE; AND
    (6) ANY OTHER MEDICAL CARE PROVIDED BY A LICENSED PHYSICIAN.

 S. 4005                             3                            A. 6305

    (B)  COVERAGE  UNDER  THIS  PARAGRAPH SHALL NOT BE DENIED ON THE BASIS
  THAT THE TREATMENT IS HABILITATIVE, NON-RESTORATIVE, OR  EDUCATIONAL  IN
  NATURE,  UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE COVERED PERSON
  PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER  ARTICLE  EIGHTY-NINE
  OF  THE EDUCATION LAW. THE PROVISION OF SERVICES PURSUANT TO AN INDIVID-
  UALIZED FAMILY SERVICE PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE
  OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
  EIGHTY-NINE OF THE EDUCATION LAW,  OR  AN  INDIVIDUALIZED  SERVICE  PLAN
  PURSUANT  TO  REGULATIONS  OF  THE OFFICE FOR PERSONS WITH DEVELOPMENTAL
  DISABILITIES SHALL NOT AFFECT COVERAGE UNDER  THE  POLICY  FOR  SERVICES
  PROVIDED  ON  A  SUPPLEMENTAL BASIS OUTSIDE OF AN EDUCATIONAL SETTING IF
  SUCH SERVICES  ARE  PRESCRIBED  BY  A  LICENSED  PHYSICIAN  OR  LICENSED
  PSYCHOLOGIST.
    (C)  NOTHING  IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI-
  GATION TO PROVIDE SERVICES TO  AN  INDIVIDUAL  UNDER  AN  INDIVIDUALIZED
  FAMILY  SERVICE PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF THE
  PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE EIGHT-
  Y-NINE OF THE EDUCATION LAW, OR AN INDIVIDUALIZED SERVICE PLAN  PURSUANT
  TO  REGULATIONS  OF  THE OFFICE FOR PERSONS WITH DEVELOPMENTAL DISABILI-
  TIES.
    (D) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT  ANY  OBLI-
  GATION  TO PROVIDE COVERAGE FOR OTHERWISE-COVERED SERVICES SOLELY ON THE
  BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION  PROGRAM  SERVICES
  PURSUANT  TO  SECTION  THREE  THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS
  ARTICLE OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE
  OFFICE FOR PERSONS WITH DEVELOPMENTAL DISABILITIES.
    (E) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT  A  POLICY
  FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING PROVIDERS WHO
  SHALL  MEET  CERTAIN  REQUIREMENTS FOR PARTICIPATION, INCLUDING PROVIDER
  CREDENTIALING.
    (F) COVERAGE UNDER THIS SECTION SHALL NOT BE SUBJECT TO ANY LIMITS  ON
  THE  NUMBER  OF  VISITS  AN  INDIVIDUAL MAY MAKE FOR TREATMENT OF AUTISM
  SPECTRUM DISORDER. EXCEPT FOR INPATIENT SERVICES, IF  AN  INDIVIDUAL  IS
  RECEIVING  TREATMENT FOR AUTISM SPECTRUM DISORDERS, AN INSURER WILL HAVE
  THE RIGHT TO REQUEST A REVIEW OF THAT TREATMENT NOT MORE THAN ONCE EVERY
  TWELVE MONTHS UNLESS THE INSURER AND THE INDIVIDUAL'S LICENSED PHYSICIAN
  OR LICENSED PSYCHOLOGIST AGREE, ON AN INDIVIDUALIZED BASIS, THAT A  MORE
  FREQUENT  REVIEW IS NECESSARY. THE COST OF OBTAINING ANY REVIEW SHALL BE
  BORNE BY THE INSURER.
    S 2. Paragraph 17 of subsection (l) of section 3221 of  the  insurance
  law,  as added by chapter 557 of the laws of 2006, is amended to read as
  follows:

    (17) [A] EVERY group or blanket accident  [or]  AND  health  insurance
  policy  [or  issuing  a group or blanket policy] DELIVERED OR ISSUED for
  delivery in this state which provides coverage for  hospital,  surgical,
  or  medical  care  coverage shall [not exclude] PROVIDE coverage for THE
  SCREENING, diagnosis and  treatment  of  [medical  conditions  otherwise
  covered  by  the policy because the treatment is provided to diagnose or
  treat] autism spectrum [disorder]  DISORDERS  IN  ACCORDANCE  WITH  THIS
  PARAGRAPH AND SHALL NOT EXCLUDE COVERAGE FOR THE SCREENING, DIAGNOSIS OR
  TREATMENT  OF MEDICAL CONDITIONS OTHERWISE COVERED BY THE POLICY BECAUSE
  THE INDIVIDUAL IS DIAGNOSED  WITH  AN  AUTISM  SPECTRUM  DISORDER.  SUCH
  COVERAGE  MAY  BE  SUBJECT TO ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSU-
  RANCE AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT  AND  SHALL  BE
  CONSISTENT  WITH  THOSE IMPOSED ON OTHER BENEFITS UNDER THE POLICY. THIS
  PARAGRAPH SHALL NOT BE CONSTRUED  AS  LIMITING  THE  BENEFITS  THAT  ARE

 S. 4005                             4                            A. 6305

  OTHERWISE  AVAILABLE TO AN INDIVIDUAL UNDER THE POLICY. NO INSURER SHALL
  TERMINATE COVERAGE OR REFUSE TO DELIVER, EXECUTE, ISSUE, AMEND,  ADJUST,
  OR  RENEW  COVERAGE  TO  AN  INDIVIDUAL SOLELY BECAUSE THE INDIVIDUAL IS
  DIAGNOSED  WITH  ONE  OF  THE  AUTISM SPECTRUM DISORDERS OR HAS RECEIVED
  TREATMENT FOR AUTISM SPECTRUM DISORDERS. COVERAGE SHALL  BE  SUBJECT  TO
  UTILIZATION REVIEW AND EXTERNAL APPEALS OF HEALTH CARE SERVICES PURSUANT
  TO  ARTICLE  FORTY-NINE  OF THIS CHAPTER AS WELL AS CASE MANAGEMENT, AND
  OTHER MANAGED CARE PROVISIONS.
    (A) [For] FOR purposes of this [section,] PARAGRAPH:

    (1) "autism  spectrum  disorder"  means  a  GROUP  OF  neurobiological
  [condition  that includes autism, Asperger syndrome, Rett's syndrome, or
  pervasive  developmental  disorder]  CONDITIONS  THAT  INCLUDE  AUTISTIC
  DISORDER, ASPERGER'S DISORDER, RETT'S DISORDER, CHILDHOOD DISINTEGRATIVE
  DISORDER,  AND  PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED
  (PDD-NOS), AS DEFINED IN THE MOST RECENT EDITION OF THE  DIAGNOSTIC  AND
  STATISTICAL MANUAL OF MENTAL DISORDERS.
    (2)  "APPLIED BEHAVIOR ANALYSIS" MEANS THE DESIGN, IMPLEMENTATION, AND
  EVALUATION OF ENVIRONMENTAL MODIFICATIONS, USING BEHAVIORAL STIMULI  AND
  CONSEQUENCES,  TO  PRODUCE  SOCIALLY  SIGNIFICANT  IMPROVEMENT  IN HUMAN
  BEHAVIOR, INCLUDING THE USE  OF  DIRECT  OBSERVATION,  MEASUREMENT,  AND
  FUNCTIONAL  ANALYSIS  OF THE RELATIONSHIP BETWEEN ENVIRONMENT AND BEHAV-
  IOR.
    (3) "BEHAVIORAL HEALTH TREATMENT" MEANS PROFESSIONAL, COUNSELING,  AND
  GUIDANCE  SERVICES  AND  TREATMENT  PROGRAMS, INCLUDING APPLIED BEHAVIOR
  ANALYSIS WHEN PROVIDED OR  SUPERVISED  BY  A  BOARD  CERTIFIED  BEHAVIOR
  ANALYST,  THAT  ARE  NECESSARY TO DEVELOP, MAINTAIN, AND RESTORE, TO THE
  MAXIMUM EXTENT PRACTICABLE, THE FUNCTIONING OF AN INDIVIDUAL.
    (4) "DIAGNOSIS OF AUTISM SPECTRUM  DISORDERS"  MEANS  THE  ASSESSMENT,
  EVALUATIONS,  OR  TESTS TO DIAGNOSE WHETHER AN INDIVIDUAL HAS ONE OF THE
  AUTISM SPECTRUM DISORDERS.
    (5) "PHARMACY CARE" MEANS MEDICATIONS PRESCRIBED BY A LICENSED  PHYSI-
  CIAN AND ANY HEALTH-RELATED SERVICES TO DETERMINE THE NEED OR EFFECTIVE-
  NESS OF THE MEDICATIONS.
    (6)  "PSYCHIATRIC CARE" MEANS DIRECT OR CONSULTATIVE SERVICES PROVIDED
  BY A PSYCHIATRIST LICENSED IN THE STATE IN WHICH THE PSYCHIATRIST  PRAC-
  TICES.
    (7)   "PSYCHOLOGICAL  CARE"  MEANS  DIRECT  OR  CONSULTATIVE  SERVICES
  PROVIDED BY A PSYCHOLOGIST LICENSED IN THE STATE IN WHICH  THE  PSYCHOL-
  OGIST PRACTICES.
    (8)  "THERAPEUTIC  CARE" MEANS SERVICES PROVIDED BY LICENSED OR CERTI-
  FIED SPEECH THERAPISTS, OCCUPATIONAL THERAPISTS, SOCIAL WORKERS OR PHYS-
  ICAL THERAPISTS.
    (9) "TREATMENT FOR AUTISM SPECTRUM DISORDERS" WILL INCLUDE THE FOLLOW-
  ING CARE AND RELATED EQUIPMENT PRESCRIBED OR ORDERED FOR  AN  INDIVIDUAL
  DIAGNOSED WITH ONE OF THE AUTISM SPECTRUM DISORDERS BY A LICENSED PHYSI-
  CIAN OR A LICENSED PSYCHOLOGIST:

    (I) BEHAVIORAL HEALTH TREATMENT;
    (II) PHARMACY CARE;
    (III) PSYCHIATRIC CARE;
    (IV) PSYCHOLOGICAL CARE;
    (V) THERAPEUTIC CARE; AND
    (VI) ANY OTHER MEDICAL CARE PROVIDED BY A LICENSED PHYSICIAN.
    (B)  COVERAGE  UNDER  THIS  PARAGRAPH SHALL NOT BE DENIED ON THE BASIS
  THAT THE TREATMENT IS HABILITATIVE, NON-RESTORATIVE, OR  EDUCATIONAL  IN
  NATURE,  UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE COVERED PERSON
  PURSUANT TO AN INDIVIDUALIZED EDUCATION PLAN UNDER  ARTICLE  EIGHTY-NINE

 S. 4005                             5                            A. 6305

  OF  THE EDUCATION LAW. THE PROVISION OF SERVICES PURSUANT TO AN INDIVID-
  UALIZED FAMILY SERVICE PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE
  OF THE PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE
  EIGHTY-NINE  OF  THE  EDUCATION  LAW,  OR AN INDIVIDUALIZED SERVICE PLAN
  PURSUANT TO REGULATIONS OF THE OFFICE  FOR  PERSONS  WITH  DEVELOPMENTAL
  DISABILITIES  SHALL  NOT  AFFECT  COVERAGE UNDER THE POLICY FOR SERVICES
  PROVIDED ON A SUPPLEMENTAL BASIS OUTSIDE OF AN  EDUCATIONAL  SETTING  IF
  SUCH  SERVICES  ARE  PRESCRIBED  BY  A  LICENSED  PHYSICIAN  OR LICENSED
  PSYCHOLOGIST.
    (C) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT  ANY  OBLI-
  GATION  TO  PROVIDE  SERVICES  TO  AN INDIVIDUAL UNDER AN INDIVIDUALIZED
  FAMILY SERVICE PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF  THE
  PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE EIGHT-
  Y-NINE  OF THE EDUCATION LAW, OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT
  TO REGULATIONS OF THE OFFICE FOR PERSONS  WITH  DEVELOPMENTAL  DISABILI-
  TIES.
    (D)  NOTHING  IN THIS PARAGRAPH SHALL BE CONSTRUED TO AFFECT ANY OBLI-
  GATION TO PROVIDE COVERAGE FOR OTHERWISE-COVERED SERVICES SOLELY ON  THE
  BASIS  THAT  THE SERVICES CONSTITUTE EARLY INTERVENTION PROGRAM SERVICES
  PURSUANT TO SECTION THREE THOUSAND TWO  HUNDRED  THIRTY-FIVE-A  OF  THIS
  ARTICLE OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE
  OFFICE FOR PERSONS WITH DEVELOPMENTAL DISABILITIES.
    (E)  NOTHING  IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT A POLICY
  FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING PROVIDERS WHO
  SHALL MEET CERTAIN REQUIREMENTS FOR  PARTICIPATION,  INCLUDING  PROVIDER
  CREDENTIALING.
    (F)  COVERAGE  UNDER THIS PARAGRAPH SHALL NOT BE SUBJECT TO ANY LIMITS
  ON THE NUMBER OF VISITS AN INDIVIDUAL MAY MAKE FOR TREATMENT  OF  AUTISM
  SPECTRUM  DISORDER.  EXCEPT  FOR INPATIENT SERVICES, IF AN INDIVIDUAL IS
  RECEIVING TREATMENT FOR AUTISM SPECTRUM DISORDERS, AN INSURER WILL  HAVE
  THE RIGHT TO REQUEST A REVIEW OF THAT TREATMENT NOT MORE THAN ONCE EVERY
  TWELVE MONTHS UNLESS THE INSURER AND THE INDIVIDUAL'S LICENSED PHYSICIAN
  OR  LICENSED PSYCHOLOGIST AGREE, ON AN INDIVIDUALIZED BASIS, THAT A MORE
  FREQUENT REVIEW IS NECESSARY. THE COST OF OBTAINING ANY REVIEW SHALL  BE
  BORNE BY THE INSURER.
    S 3. Subsection (ee) of section 4303 of the insurance law, as added by
  chapter 557 of the laws of 2006, is amended to read as follows:

    (ee)  A  medical  expense  indemnity  corporation,  a hospital service
  corporation or a health service corporation which provides coverage  for
  hospital, surgical, or medical care coverage shall [not exclude] PROVIDE
  coverage  for  THE SCREENING, diagnosis and treatment of [medical condi-
  tions otherwise covered by the policy solely because  the  treatment  is
  provided  to  diagnose or treat] autism spectrum [disorder] DISORDERS IN
  ACCORDANCE WITH THIS SUBSECTION AND SHALL NOT EXCLUDE COVERAGE  FOR  THE
  SCREENING,  DIAGNOSIS  OR  TREATMENT  OF  MEDICAL  CONDITIONS  OTHERWISE
  COVERED BY THE POLICY BECAUSE THE INDIVIDUAL IS DIAGNOSED WITH AN AUTISM
  SPECTRUM DISORDER. SUCH COVERAGE MAY BE SUBJECT TO  ANNUAL  DEDUCTIBLES,
  COPAYMENTS  AND  COINSURANCE  AS MAY BE DEEMED APPROPRIATE BY THE SUPER-
  INTENDENT AND SHALL BE CONSISTENT WITH THOSE IMPOSED ON  OTHER  BENEFITS
  UNDER  THE  CONTRACT. THIS SUBSECTION SHALL NOT BE CONSTRUED AS LIMITING
  THE BENEFITS THAT ARE OTHERWISE AVAILABLE TO  AN  INDIVIDUAL  UNDER  THE
  CONTRACT.  NO  INSURER  CAN  TERMINATE  COVERAGE  OR  REFUSE TO DELIVER,
  EXECUTE, ISSUE, AMEND, ADJUST, OR RENEW COVERAGE TO AN INDIVIDUAL SOLELY
  BECAUSE THE INDIVIDUAL IS DIAGNOSED WITH  ONE  OF  THE  AUTISM  SPECTRUM
  DISORDERS  OR  HAS  RECEIVED  TREATMENT  FOR  AUTISM SPECTRUM DISORDERS.
  COVERAGE SHALL BE SUBJECT TO UTILIZATION REVIEW AND EXTERNAL APPEALS  OF

 S. 4005                             6                            A. 6305

  HEALTH  CARE  SERVICES PURSUANT TO ARTICLE FORTY-NINE OF THIS CHAPTER AS
  WELL AS CASE MANAGEMENT, OR OTHER MANAGED CARE PROVISIONS.
    (A)(1)  For  purposes  of  this [section] SUBSECTION, "autism spectrum
  disorder" means a GROUP  OF  neurobiological  [condition  that  includes
  autism,  Asperger  syndrome, Rett's syndrome, or pervasive developmental
  disorder] CONDITIONS THAT INCLUDE AUTISTIC DISORDER,  ASPERGER'S  DISOR-
  DER,  RETT'S  DISORDER, CHILDHOOD DISINTEGRATIVE DISORDER, AND PERVASIVE
  DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED (PDD-NOS), AS DEFINED  IN
  THE  MOST  RECENT  EDITION  OF  THE DIAGNOSTIC AND STATISTICAL MANUAL OF
  MENTAL DISORDERS.
    (2) "APPLIED BEHAVIOR ANALYSIS" MEANS THE DESIGN, IMPLEMENTATION,  AND
  EVALUATION  OF ENVIRONMENTAL MODIFICATIONS, USING BEHAVIORAL STIMULI AND
  CONSEQUENCES, TO  PRODUCE  SOCIALLY  SIGNIFICANT  IMPROVEMENT  IN  HUMAN
  BEHAVIOR,  INCLUDING  THE  USE  OF  DIRECT OBSERVATION, MEASUREMENT, AND
  FUNCTIONAL ANALYSIS OF THE RELATIONSHIP BETWEEN ENVIRONMENT  AND  BEHAV-
  IOR.
    (3)  "BEHAVIORAL HEALTH TREATMENT" MEANS PROFESSIONAL, COUNSELING, AND
  GUIDANCE SERVICES AND TREATMENT  PROGRAMS,  INCLUDING  APPLIED  BEHAVIOR
  ANALYSIS  WHEN  PROVIDED  OR  SUPERVISED  BY  A BOARD CERTIFIED BEHAVIOR
  ANALYST, THAT ARE NECESSARY TO DEVELOP, MAINTAIN, AND  RESTORE,  TO  THE
  MAXIMUM EXTENT PRACTICABLE, THE FUNCTIONING OF AN INDIVIDUAL.
    (4)  "DIAGNOSIS  OF  AUTISM  SPECTRUM DISORDERS" MEANS THE ASSESSMENT,
  EVALUATIONS, OR TESTS TO DIAGNOSE WHETHER AN INDIVIDUAL HAS ONE  OF  THE
  AUTISM SPECTRUM DISORDERS.
    (5)  "PHARMACY CARE" MEANS MEDICATIONS PRESCRIBED BY A LICENSED PHYSI-
  CIAN AND ANY HEALTH-RELATED SERVICES TO DETERMINE THE NEED OR EFFECTIVE-
  NESS OF THE MEDICATIONS.
    (6) "PSYCHIATRIC CARE" MEANS DIRECT OR CONSULTATIVE SERVICES  PROVIDED
  BY  A PSYCHIATRIST LICENSED IN THE STATE IN WHICH THE PSYCHIATRIST PRAC-
  TICES.
    (7)  "PSYCHOLOGICAL  CARE"  MEANS  DIRECT  OR  CONSULTATIVE   SERVICES
  PROVIDED  BY  A PSYCHOLOGIST LICENSED IN THE STATE IN WHICH THE PSYCHOL-
  OGIST PRACTICES.
    (8) "THERAPEUTIC CARE" MEANS SERVICES PROVIDED BY LICENSED  OR  CERTI-
  FIED SPEECH THERAPISTS, OCCUPATIONAL THERAPISTS, SOCIAL WORKERS OR PHYS-
  ICAL THERAPISTS.
    (9) "TREATMENT FOR AUTISM SPECTRUM DISORDERS" WILL INCLUDE THE FOLLOW-
  ING  CARE  AND RELATED EQUIPMENT PRESCRIBED OR ORDERED FOR AN INDIVIDUAL
  DIAGNOSED WITH ONE OF THE AUTISM SPECTRUM DISORDERS BY A LICENSED PHYSI-
  CIAN OR A LICENSED PSYCHOLOGIST:

    (I) BEHAVIORAL HEALTH TREATMENT;
    (II) PHARMACY CARE;
    (III) PSYCHIATRIC CARE;
    (IV) PSYCHOLOGICAL CARE;
    (V) THERAPEUTIC CARE; AND
    (VI) ANY OTHER MEDICAL CARE PROVIDED BY A LICENSED PHYSICIAN.
    (B) COVERAGE UNDER THIS SUBSECTION SHALL NOT BE DENIED  ON  THE  BASIS
  THAT  THE  TREATMENT IS HABILITATIVE, NON-RESTORATIVE, OR EDUCATIONAL IN
  NATURE, UNLESS SUCH TREATMENTS ARE BEING PROVIDED TO THE COVERED  PERSON
  PURSUANT  TO  AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE EIGHTY-NINE
  OF THE EDUCATION LAW. THE PROVISION OF SERVICES PURSUANT TO AN  INDIVID-
  UALIZED FAMILY SERVICE PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE
  OF  THE  PUBLIC  HEALTH  LAW, AN INDIVIDUAL EDUCATION PLAN UNDER ARTICLE
  EIGHTY-NINE OF THE EDUCATION LAW,  OR  AN  INDIVIDUALIZED  SERVICE  PLAN
  PURSUANT  TO  REGULATIONS  OF  THE OFFICE FOR PERSONS WITH DEVELOPMENTAL
  DISABILITIES SHALL NOT AFFECT COVERAGE UNDER  THE  POLICY  FOR  SERVICES

 S. 4005                             7                            A. 6305

  PROVIDED  ON  A  SUPPLEMENTAL BASIS OUTSIDE OF AN EDUCATIONAL SETTING IF
  SUCH SERVICES  ARE  PRESCRIBED  BY  A  LICENSED  PHYSICIAN  OR  LICENSED
  PSYCHOLOGIST.
    (C)  NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO AFFECT ANY OBLI-
  GATION TO PROVIDE SERVICES TO  AN  INDIVIDUAL  UNDER  AN  INDIVIDUALIZED
  FAMILY  SERVICE PLAN UNDER SECTION TWENTY-FIVE HUNDRED FORTY-FIVE OF THE
  PUBLIC HEALTH LAW, AN INDIVIDUALIZED EDUCATION PLAN UNDER ARTICLE EIGHT-
  Y-NINE OF THE EDUCATION LAW, OR AN INDIVIDUALIZED SERVICE PLAN  PURSUANT
  TO  REGULATIONS  OF  THE OFFICE FOR PERSONS WITH DEVELOPMENTAL DISABILI-
  TIES.
    (D) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO AFFECT ANY  OBLI-
  GATION  TO PROVIDE COVERAGE FOR OTHERWISE-COVERED SERVICES SOLELY ON THE
  BASIS THAT THE SERVICES CONSTITUTE EARLY INTERVENTION  PROGRAM  SERVICES
  PURSUANT  TO  SECTION  THREE  THOUSAND TWO HUNDRED THIRTY-FIVE-A OF THIS
  CHAPTER OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE
  OFFICE FOR PERSONS WITH DEVELOPMENTAL DISABILITIES.
    (E) NOTHING IN THIS SUBSECTION SHALL BE CONSTRUED TO PREVENT A  POLICY
  FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPATING PROVIDERS WHO
  SHALL  MEET  CERTAIN  REQUIREMENTS FOR PARTICIPATION, INCLUDING PROVIDER
  CREDENTIALING.
    (F) COVERAGE UNDER THIS SUBSECTION SHALL NOT BE SUBJECT TO ANY  LIMITS
  ON  THE  NUMBER OF VISITS AN INDIVIDUAL MAY MAKE FOR TREATMENT OF AUTISM
  SPECTRUM DISORDER. EXCEPT FOR INPATIENT SERVICES, IF  AN  INDIVIDUAL  IS
  RECEIVING  TREATMENT FOR AUTISM SPECTRUM DISORDERS, AN INSURER WILL HAVE
  THE RIGHT TO REQUEST A REVIEW OF THAT TREATMENT NOT MORE THAN ONCE EVERY
  TWELVE MONTHS UNLESS THE INSURER AND INDIVIDUAL'S LICENSED PHYSICIAN  OR
  LICENSED  PSYCHOLOGIST  AGREE,  ON  AN INDIVIDUALIZED BASIS, THAT A MORE
  FREQUENT REVIEW IS NECESSARY. THE COST OF OBTAINING ANY REVIEW SHALL  BE
  BORNE BY THE INSURER.
    S 4. Severability clause. If any clause, sentence, paragraph, subdivi-
  sion,  section  or  part  of  this act shall be adjudged by any court of
  competent jurisdiction to be invalid, such judgement shall  not  affect,
  impair,  or  invalidate  the remainder thereof, but shall be confined in
  its operation to the clause, sentence, paragraph,  subdivision,  section
  or part thereof directly involved in the controversy in which such judg-
  ment  shall have rendered. It is hereby declared to be the intent of the
  legislature that this act would have been enacted even if  such  invalid
  provisions had not been included herein.
    S  5. 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.