On November 1, 2011 Governor Andrew M. Cuomo signed into law a bill, sponsored by Senator Fuschillo and Assemblyman Morelle, that will require health insurance companies in New York to provide coverage for the diagnosis and treatment of autism spectrum disorders (ASD), though coverage may be subject to deductibles or co-pays just like other covered benefits.
Treatment of autism spectrum disorder under the new law will include the following care, as long as it has been prescribed by a licensed physician or licensed psychologist:
- Behavioral health treatments (including applied behavioral analysis)
- Psychiatric care
- Psychological care
- Medical care provided by a licensed health care provider
- Therapeutic care
- Pharmacy care (if included in the policy)
While health insurers currently cannot exclude diagnosis or treatment of autism disorder, the new law will require insurance companies to provide coverage of specified autism therapies, including “applied behavioral analysis” for both children and adults. These treatments and therapies will be covered by individual market and group health insurance, subject to applicable coinsurance and other coverage terms just like other benefits. Coverage for applied behavioral analysis, however, may be limited to $45,000 per year, per individual.
The law takes effect on November 1, 2012 and applies to health insurance plans issued or renewed after that date. Self-funded plans, such as large employer health benefit plans not purchased from a health insurance carrier, are not required to include this coverage.