S4005A-2011 Actions

• Jun 17, 2011: SUBSTITUTED BY A6305A
• Jun 16, 2011: ORDERED TO THIRD READING CAL.1338
• Jun 13, 2011: REPORTED AND COMMITTED TO RULES
• Jun 8, 2011: PRINT NUMBER 4005A
• Jun 8, 2011: AMEND (T) AND RECOMMIT TO FINANCE
• Apr 11, 2011: REPORTED AND COMMITTED TO FINANCE
• Mar 11, 2011: REFERRED TO INSURANCE

S4005A-2011 Meetings

S4005A-2011 Calendars

S4005A-2011 Votes

S4005A-2011 Memo

BILL NUMBER:S4005A

TITLE OF BILL:
An act
to amend the insurance law, in relation to coverage for the
screening, diagnosis and
treatment of autism spectrum disorder

PURPOSE:
To expand health insurance coverage for the screening,
diagnosis and treatment of autism spectrum disorders.

SUMMARY OF PROVISIONS:
Amends sections 3216, 3221 and 4303 of the
Insurance Law to provide coverage for the screening, diagnosis and
treatment of autism spectrum disorders.

Provides that coverage may be subject to annual deductibles,
copayments and coinsurance consistent with those imposed on other
benefits under the contract.

Provides that the legislation shall not be construed as limiting the
benefits that are available to an individual under a health insurance
policy.

Provides that coverage may be subject to utilization and external
review of health care services, including case management and other
managed care provisions.

Defines "autism spectrum disorder" as Pervasive Developmental
Disorders including Autistic Disorder, Asperger's Disorder, Rett's
Disorder, Childhood Disintegrative Disorder, and pervasive
Developmental Disorder Not otherwise specified, as defined in the
most recent edition of the Diagnostic and statistical Manual of
Mental Disorders.

Defines "diagnosis of autism spectrum disorders", "behavioral health
treatment", "applied behavioral analysis", "treatment of autism
spectrum disorder", "pharmacy care", "psychiatric care",
"psychological care" and "therapeutic care".

Provides that licensed physician or psychologist are authorized to
prescribe care for the following: behavioral health treatment;
pharmacy care; psychiatric care; psychological care; therapeutic care
and other medical care prescribed by a licensed health care provider.

Provides that the provision of services pursuant to an individualized
family service plan, an individualized education program or an
individualized service plan 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 psychologist.

Provides that this legislation will not affect any obligation to
provide services to an individual under an individualized family


service plan or individualized education program or an individualized
service plan.

Provides that nothing in the legislation shall be construed to prevent
a contract from providing services through a network of participating
providers who shall meet certain requirements for participation,
including provider credentialing.

JUSTIFICATION:
Autism is a complex neurobiological disorder that
severely affects the way autistic individuals relate to others
socially and their ability to communicate and learn. Today the
Centers for Disease Control (CDC) estimate that the number of
children with autism is 1 in 110 nationwide, making it more common
than pediatric cancer, diabetes, and AIDS combined. It occurs in all
racial, ethnic, and social groups and is four times more likely to
strike boys than girls.

Existing state law requires that insurance coverage for autism "not
exclude" the diagnosis and treatment of autism spectrum disorder.
Current law does not provide sufficient clarity or an affirmative
obligation of health insurance to cover costs relating to autism
treatments. Moreover, parents are often faced with significant gaps
in treatments which may be needed over and above those provided
pursuant to an individualized family, education or service plan.
These families often pay as much as they can out-of-pocket for
services that can cost upwards of $50,000 per year. In the process,
many risk their homes and the education's of their unaffected
children essentially mortgaging their futures. This legislation would
expedite diagnosis and treatment by providing insurance parity for
autism sufferers by requiring equitable coverage of the disorder by
insurance companies.

If enacted, New York would join with 23 other states in requiring
coverage for conditions relating to autism spectrum disorder.

LEGISLATIVE HISTORY:

FISCAL IMPLICATIONS:
Treatment of autism spectrum disorders will
result in better long-term health outcomes for those afflicted with
this condition and should therefore lessen costs which are borne by
taxpayers. There will be some minor cost to the State for coverage
for it's own employees and their families. Actuarial cost estimates
provided by independent actuaries retained by a leading national
autism advocacy organization, Autism Speaks, determined that expected
impact upon insurance costs were approximately one-half of one
percent after full implementation of coverage over a number of years.
Cost implications for other 23 states which have enacted such
legislation have been very modest.

EFFECTIVE DATE:
This act shall take effect January 1 after enactment
and shall apply to insurance policies issued or renewed after that
date.

S4005A-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.

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