A6305A-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

A6305A-2011 Votes

A6305A-2011 Text

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

      S. 4005--A                                            A. 6305--A

                         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, KENNEDY,  KLEIN,  KRUEGER,  KRUGER,  LANZA,
    LARKIN,  LAVALLE,  LIBOUS, LITTLE, MARCELLINO, MARTINS, MAZIARZ, MONT-
    GOMERY,  NOZZOLIO,  O'MARA,  OPPENHEIMER,  PARKER,  PERALTA,  PERKINS,
    RITCHIE,   RIVERA,   ROBACH,   SAMPSON,   SAVINO,   SKELOS,  STAVISKY,
    STEWART-COUSINS, VALESKY, ZELDIN -- read twice  and  ordered  printed,
    and  when  printed  to  be  committed to the Committee on Insurance --
    reported favorably from said committee and committed to the  Committee
    on Finance -- committee discharged, bill amended, ordered reprinted as
    amended and recommitted to said committee

  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,  P. RIVERA,  BENEDETTO,  PEOPLES-STOKES,   PRETLOW,
    WRIGHT,  MOYA,  LINARES, McENENY, COLTON, ROBERTS, GUNTHER, BRAUNSTEIN
    -- Multi-Sponsored by -- M. of A.  BARCLAY,  CALHOUN,  DUPREY,  ENGLE-
    BRIGHT,  JORDAN, LIFTON, McDONOUGH, McKEVITT, MENG, MILLMAN, MOLINARO,
    MONTESANO, PAULIN, RAIA, SALADINO, SAYWARD, SCHIMEL, TEDISCO, TOBACCO,
    WEINSTEIN -- read once and referred to the Committee on  Insurance  --
    committee  discharged,  bill amended, ordered reprinted as amended and
    recommitted to said committee

  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:


    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:


   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD08567-03-1

 S. 4005--A                          2                         A. 6305--A

    (25) (A) Every policy  which  provides  coverage  for  hospital[,]  OR
  surgical[,  or  medical  care]  coverage  shall not exclude coverage for
  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. [For purposes of this section,
  "autism  spectrum  disorder"  means  a  neurobiological  condition  that
  includes autism, Asperger syndrome, Rett's syndrome, or pervasive devel-
  opmental disorder.]
    (B)  EVERY  POLICY  WHICH  PROVIDES PHYSICIAN SERVICES, MEDICAL, MAJOR
  MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE  SHALL  PROVIDE  COVERAGE
  FOR  THE  SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM DISORDER
  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 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 POLICY. THIS PARAGRAPH SHALL NOT BE CONSTRUED AS LIMITING THE
  BENEFITS THAT ARE OTHERWISE AVAILABLE TO AN INDIVIDUAL UNDER THE POLICY,
  PROVIDED HOWEVER THAT SUCH POLICY SHALL NOT CONTAIN ANY  LIMITATIONS  ON
  VISITS  THAT  ARE  SOLELY  APPLIED  TO  THE TREATMENT OF AUTISM SPECTRUM
  DISORDER. 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 AUTISM SPECTRUM DISORDER OR HAS
  RECEIVED  TREATMENT  FOR  AUTISM  SPECTRUM  DISORDER.  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.
    (C) FOR PURPOSES OF THIS PARAGRAPH:

    (I)  "AUTISM  SPECTRUM  DISORDER"  MEANS  ANY  PERVASIVE DEVELOPMENTAL
  DISORDER AS DEFINED IN THE MOST RECENT EDITION  OF  THE  DIAGNOSTIC  AND
  STATISTICAL  MANUAL  OF  MENTAL  DISORDERS, INCLUDING AUTISTIC DISORDER,
  ASPERGER'S DISORDER, RETT'S DISORDER, CHILDHOOD DISINTEGRATIVE DISORDER,
  OR PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED (PDD-NOS).
    (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  COUNSELING  AND  TREATMENT
  PROGRAMS,  WHEN  PROVIDED  BY  A LICENSED PROVIDER, AND APPLIED BEHAVIOR
  ANALYSIS, WHEN PROVIDED OR SUPERVISED BY A  BEHAVIOR  ANALYST  CERTIFIED
  PURSUANT TO THE BEHAVIOR ANALYST CERTIFICATION BOARD, THAT ARE NECESSARY
  TO DEVELOP, MAINTAIN, OR RESTORE, TO THE MAXIMUM EXTENT PRACTICABLE, THE
  FUNCTIONING OF AN INDIVIDUAL. INDIVIDUALS THAT PROVIDE BEHAVIORAL HEALTH
  TREATMENT UNDER THE SUPERVISION OF A CERTIFIED BEHAVIOR ANALYST PURSUANT
  TO  THIS  PARAGRAPH SHALL BE SUBJECT TO STANDARDS OF PROFESSIONALISM AND
  RELEVANT EXPERIENCE PURSUANT TO REGULATIONS PROMULGATED  BY  THE  SUPER-
  INTENDENT IN CONSULTATION WITH THE COMMISSIONER OF HEALTH.
    (IV) "DIAGNOSIS OF AUTISM SPECTRUM DISORDER" MEANS ASSESSMENTS, EVALU-
  ATIONS,  OR  TESTS TO DIAGNOSE WHETHER AN INDIVIDUAL HAS AUTISM SPECTRUM
  DISORDER.
    (V) "PHARMACY CARE" MEANS MEDICATIONS PRESCRIBED BY A LICENSED  HEALTH
  CARE  PROVIDER  LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE
  EDUCATION LAW.

 S. 4005--A                          3                         A. 6305--A

    (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 OF AUTISM SPECTRUM DISORDER" SHALL INCLUDE THE FOLLOW-
  ING CARE AND RELATED EQUIPMENT PRESCRIBED OR ORDERED FOR  AN  INDIVIDUAL
  DIAGNOSED  WITH  AUTISM  SPECTRUM  DISORDER BY A LICENSED PHYSICIAN OR A
  LICENSED PSYCHOLOGIST:

    (1) BEHAVIORAL HEALTH TREATMENT;
    (2) PSYCHIATRIC CARE;
    (3) PSYCHOLOGICAL CARE;
    (4) MEDICAL CARE PROVIDED BY A LICENSED HEALTH CARE PROVIDER;
    (5) THERAPEUTIC CARE, INCLUDING THERAPEUTIC CARE WHICH IS DEEMED HABI-
  LITATIVE OR NONRESTORATIVE, IN THE EVENT THAT THE POLICY PROVIDES COVER-
  AGE FOR THERAPEUTIC CARE; AND
    (6) PHARMACY CARE IN THE EVENT THAT THE POLICY PROVIDES  COVERAGE  FOR
  PRESCRIPTION DRUGS.
    (D)  COVERAGE  MAY BE DENIED ON THE BASIS THAT SUCH TREATMENT IS 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 INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION
  TWENTY-FIVE HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN  INDIVIDUAL-
  IZED  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 PHYSI-
  CIAN OR LICENSED PSYCHOLOGIST.
    (E) 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.
    (F)  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.
    (G)  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.
    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] (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[,] OR surgi-

 S. 4005--A                          4                         A. 6305--A

  cal[, or medical] care coverage shall not exclude coverage  for  SCREEN-
  ING,  diagnosis and treatment of medical conditions otherwise covered by
  the policy because the treatment is provided to diagnose or treat autism
  spectrum  disorder.  [For  purposes  of  this  section, "autism spectrum
  disorder" means a neurobiological condition that includes autism, Asper-
  ger syndrome, Rett's syndrome, or pervasive developmental disorder.]
    (B) EVERY GROUP OR BLANKET POLICY WHICH PROVIDES  PHYSICIAN  SERVICES,
  MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPE COVERAGE SHALL
  PROVIDE COVERAGE FOR THE SCREENING, DIAGNOSIS AND  TREATMENT  OF  AUTISM
  SPECTRUM  DISORDER  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 AUTISM SPECTRUM DISORDER. SUCH COVERAGE MAY BE SUBJECT TO
  ANNUAL DEDUCTIBLES, COPAYMENTS AND COINSURANCE AS MAY BE  DEEMED  APPRO-
  PRIATE  BY THE SUPERINTENDENT AND SHALL BE CONSISTENT WITH THOSE IMPOSED
  ON OTHER BENEFITS UNDER THE GROUP  OR  BLANKET  POLICY.  THIS  PARAGRAPH
  SHALL  NOT  BE  CONSTRUED  AS  LIMITING  THE BENEFITS THAT ARE OTHERWISE
  AVAILABLE TO AN INDIVIDUAL UNDER THE GROUP OR BLANKET  POLICY,  PROVIDED
  HOWEVER  THAT  SUCH  POLICY  SHALL NOT CONTAIN ANY LIMITATIONS ON VISITS
  THAT ARE SOLELY APPLIED TO THE TREATMENT OF AUTISM SPECTRUM DISORDER. 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 AUTISM SPECTRUM DISORDER  OR  HAS  RECEIVED
  TREATMENT  FOR  AUTISM  SPECTRUM  DISORDER. 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.
    (C) FOR PURPOSES OF THIS PARAGRAPH:

    (I)  "AUTISM  SPECTRUM  DISORDER"  MEANS  ANY  PERVASIVE DEVELOPMENTAL
  DISORDER AS DEFINED IN THE MOST RECENT EDITION  OF  THE  DIAGNOSTIC  AND
  STATISTICAL  MANUAL  OF  MENTAL  DISORDERS, INCLUDING AUTISTIC DISORDER,
  ASPERGER'S DISORDER, RETT'S DISORDER, CHILDHOOD DISINTEGRATIVE DISORDER,
  OR PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED (PDD-NOS).
    (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  COUNSELING  AND  TREATMENT
  PROGRAMS,  WHEN  PROVIDED  BY  A LICENSED PROVIDER, AND APPLIED BEHAVIOR
  ANALYSIS, WHEN PROVIDED OR SUPERVISED BY A  BEHAVIOR  ANALYST  CERTIFIED
  PURSUANT TO THE BEHAVIOR ANALYST CERTIFICATION BOARD, THAT ARE NECESSARY
  TO DEVELOP, MAINTAIN, OR RESTORE, TO THE MAXIMUM EXTENT PRACTICABLE, THE
  FUNCTIONING OF AN INDIVIDUAL. INDIVIDUALS THAT PROVIDE BEHAVIORAL HEALTH
  TREATMENT UNDER THE SUPERVISION OF A CERTIFIED BEHAVIOR ANALYST PURSUANT
  TO  THIS  PARAGRAPH SHALL BE SUBJECT TO STANDARDS OF PROFESSIONALISM AND
  RELEVANT EXPERIENCE PURSUANT TO REGULATIONS PROMULGATED  BY  THE  SUPER-
  INTENDENT IN CONSULTATION WITH THE COMMISSIONER OF HEALTH.
    (IV) "DIAGNOSIS OF AUTISM SPECTRUM DISORDER" MEANS ASSESSMENTS, EVALU-
  ATIONS,  OR  TESTS TO DIAGNOSE WHETHER AN INDIVIDUAL HAS AUTISM SPECTRUM
  DISORDER.
    (V) "PHARMACY CARE" MEANS MEDICATIONS PRESCRIBED BY A LICENSED  HEALTH
  CARE  PROVIDER  LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE
  EDUCATION LAW.

 S. 4005--A                          5                         A. 6305--A

    (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 OF AUTISM SPECTRUM DISORDER" SHALL INCLUDE THE FOLLOW-
  ING CARE AND RELATED EQUIPMENT PRESCRIBED OR ORDERED FOR  AN  INDIVIDUAL
  DIAGNOSED  WITH  AUTISM  SPECTRUM  DISORDER BY A LICENSED PHYSICIAN OR A
  LICENSED PSYCHOLOGIST:

    (1) BEHAVIORAL HEALTH TREATMENT;
    (2) PSYCHIATRIC CARE;
    (3) PSYCHOLOGICAL CARE;
    (4) MEDICAL CARE PROVIDED BY A LICENSED HEALTH CARE PROVIDER;
    (5) THERAPEUTIC CARE, INCLUDING THERAPEUTIC CARE WHICH IS DEEMED HABI-
  LITATIVE OR NONRESTORATIVE, IN THE EVENT THAT THE POLICY PROVIDES COVER-
  AGE FOR THERAPEUTIC CARE; AND
    (6) PHARMACY CARE IN THE EVENT THAT THE POLICY PROVIDES  COVERAGE  FOR
  PRESCRIPTION DRUGS.
    (D)  COVERAGE  MAY BE DENIED ON THE BASIS THAT SUCH TREATMENT IS 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 INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION
  TWENTY-FIVE HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN  INDIVIDUAL-
  IZED  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 PHYSI-
  CIAN OR LICENSED PSYCHOLOGIST.
    (E) 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.
    (F)  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.
    (G) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT A GROUP OR
  BLANKET  POLICY FROM PROVIDING SERVICES THROUGH A NETWORK OF PARTICIPAT-
  ING PROVIDERS WHO SHALL MEET  CERTAIN  REQUIREMENTS  FOR  PARTICIPATION,
  INCLUDING PROVIDER CREDENTIALING.
    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)  (1)  A medical expense indemnity corporation, a hospital service
  corporation or a health service corporation which provides coverage  for
  hospital[,]  OR  surgical[,  or medical] care coverage shall not exclude
  coverage for SCREENING, diagnosis and treatment  of  medical  conditions

 S. 4005--A                          6                         A. 6305--A

  otherwise covered by the policy solely because the treatment is provided
  to  diagnose  or  treat  autism spectrum disorder. [For purposes of this
  section, "autism spectrum disorder" means  a  neurobiological  condition
  that  includes  autism, Asperger syndrome, Rett's syndrome, or pervasive
  developmental disorder.]
    (2) EVERY POLICY WHICH PROVIDES  PHYSICIAN  SERVICES,  MEDICAL,  MAJOR
  MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPE COVERAGE SHALL PROVIDE COVERAGE
  FOR THE SCREENING, DIAGNOSIS AND TREATMENT OF AUTISM  SPECTRUM  DISORDER
  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 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 POLICY. THIS PARAGRAPH SHALL NOT BE CONSTRUED AS LIMITING THE
  BENEFITS THAT ARE OTHERWISE AVAILABLE TO AN INDIVIDUAL UNDER THE POLICY,
  PROVIDED HOWEVER THAT SUCH POLICY SHALL NOT CONTAIN ANY  LIMITATIONS  ON
  VISITS  THAT  ARE  SOLELY  APPLIED  TO  THE TREATMENT OF AUTISM SPECTRUM
  DISORDER. 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 AUTISM SPECTRUM DISORDER OR HAS
  RECEIVED  TREATMENT  FOR  AUTISM  SPECTRUM  DISORDER.  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.
    (3) FOR PURPOSES OF THIS SUBSECTION:

    (A)  "AUTISM  SPECTRUM  DISORDER"  MEANS  ANY  PERVASIVE DEVELOPMENTAL
  DISORDER AS DEFINED IN THE MOST RECENT EDITION  OF  THE  DIAGNOSTIC  AND
  STATISTICAL  MANUAL  OF  MENTAL  DISORDERS, INCLUDING AUTISTIC DISORDER,
  ASPERGER'S DISORDER, RETT'S DISORDER, CHILDHOOD DISINTEGRATIVE DISORDER,
  OR PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED (PDD-NOS).
    (B) "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.
    (C)  "BEHAVIORAL  HEALTH  TREATMENT"  MEANS  COUNSELING  AND TREATMENT
  PROGRAMS, WHEN PROVIDED BY A LICENSED  PROVIDER,  AND  APPLIED  BEHAVIOR
  ANALYSIS,  WHEN  PROVIDED  OR SUPERVISED BY A BEHAVIOR ANALYST CERTIFIED
  PURSUANT TO THE BEHAVIOR ANALYST CERTIFICATION BOARD, THAT ARE NECESSARY
  TO DEVELOP, MAINTAIN, OR RESTORE, TO THE MAXIMUM EXTENT PRACTICABLE, THE
  FUNCTIONING OF AN INDIVIDUAL. INDIVIDUALS THAT PROVIDE BEHAVIORAL HEALTH
  TREATMENT UNDER THE SUPERVISION OF A CERTIFIED BEHAVIOR ANALYST PURSUANT
  TO THIS SUBSECTION SHALL BE SUBJECT TO STANDARDS OF PROFESSIONALISM  AND
  RELEVANT  EXPERIENCE  PURSUANT  TO REGULATIONS PROMULGATED BY THE SUPER-
  INTENDENT IN CONSULTATION WITH THE COMMISSIONER OF HEALTH.
    (D) "DIAGNOSIS OF AUTISM SPECTRUM DISORDER" MEANS ASSESSMENTS,  EVALU-
  ATIONS,  OR  TESTS TO DIAGNOSE WHETHER AN INDIVIDUAL HAS AUTISM SPECTRUM
  DISORDER.
    (E) "PHARMACY CARE" MEANS MEDICATIONS PRESCRIBED BY A LICENSED  HEALTH
  CARE  PROVIDER  LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE
  EDUCATION LAW.
    (F) "PSYCHIATRIC CARE" MEANS DIRECT OR CONSULTATIVE SERVICES  PROVIDED
  BY  A PSYCHIATRIST LICENSED IN THE STATE IN WHICH THE PSYCHIATRIST PRAC-
  TICES.

 S. 4005--A                          7                         A. 6305--A

    (G)  "PSYCHOLOGICAL  CARE"  MEANS  DIRECT  OR  CONSULTATIVE   SERVICES
  PROVIDED  BY  A PSYCHOLOGIST LICENSED IN THE STATE IN WHICH THE PSYCHOL-
  OGIST PRACTICES.
    (H)  "THERAPEUTIC  CARE" MEANS SERVICES PROVIDED BY LICENSED OR CERTI-
  FIED SPEECH THERAPISTS,  OCCUPATIONAL  THERAPISTS,  SOCIAL  WORKERS,  OR
  PHYSICAL THERAPISTS.
    (I)  "TREATMENT OF AUTISM SPECTRUM DISORDER" SHALL INCLUDE THE FOLLOW-
  ING CARE AND RELATED EQUIPMENT PRESCRIBED OR ORDERED FOR  AN  INDIVIDUAL
  DIAGNOSED  WITH  AUTISM  SPECTRUM  DISORDER BY A LICENSED PHYSICIAN OR A
  LICENSED PSYCHOLOGIST:

    (I) BEHAVIORAL HEALTH TREATMENT;
    (II) PSYCHIATRIC CARE;
    (III) PSYCHOLOGICAL CARE;
    (IV) MEDICAL CARE PROVIDED BY A LICENSED HEALTH CARE PROVIDER;
    (V) THERAPEUTIC CARE, INCLUDING THERAPEUTIC CARE WHICH IS DEEMED HABI-
  LITATIVE OR NONRESTORATIVE, IN THE EVENT THAT THE POLICY PROVIDES COVER-
  AGE FOR THERAPEUTIC CARE; AND
    (VI) PHARMACY CARE IN THE EVENT THAT THE POLICY PROVIDES COVERAGE  FOR
  PRESCRIPTION DRUGS.
    (4)  COVERAGE  MAY BE DENIED ON THE BASIS THAT SUCH TREATMENT IS 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 INDIVIDUALIZED FAMILY SERVICE PLAN UNDER SECTION
  TWENTY-FIVE HUNDRED FORTY-FIVE OF THE PUBLIC HEALTH LAW, AN  INDIVIDUAL-
  IZED  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 PHYSI-
  CIAN OR LICENSED PSYCHOLOGIST.
    (5) 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.
    (6)  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
  ARTICLE OR AN INDIVIDUALIZED SERVICE PLAN PURSUANT TO REGULATIONS OF THE
  OFFICE FOR PERSONS WITH DEVELOPMENTAL DISABILITIES.
    (7)  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.
    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. 4005--A                          8                         A. 6305--A

    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.