New York S 5107: Relates to coverage for the screening, diagnosis and treatment of autism spectrum disorder

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S05107 Summary:

BILL NOS05107 

&nbsp

SAME ASSAME AS A03896

&nbsp

SPONSORHARCKHAM

&nbsp

COSPNSRADDABBO, CLEARE, HELMING, LIU, RHOADS, SALAZAR, WALCZYK

&nbsp

MLTSPNSR

&nbsp

Amd §§3216, 3221 & 4303, Ins L

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Relates to coverage for applied behavior analysis and for developmental, individual-differences, relationship-based treatment of autism spectrum disorder.

Go to top S05107 Actions:

BILL NOS05107 

&nbsp

02/19/2025REFERRED TO INSURANCE

01/07/2026REFERRED TO INSURANCE

Go to topS05107 Committee&nbspVotes:

Go to topS05107 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topS05107 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 5107

 2025-2026 Regular Sessions

 IN SENATE

 February 19, 2025
 ___________

 Introduced by Sens. HARCKHAM, ADDABBO, CLEARE, LIU, RHOADS, WALCZYK --
 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 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:

 1 Section 1. Subparagraphs (B) and (C) of paragraph 25 of subsection
 2 (i) of section 3216 of the insurance law, subparagraph (B) as amended by
 3 section 2 of subpart A of part BB of chapter 57 of the laws of 2019,
 4 subparagraph (C) as amended by chapter 596 of the laws of 2011, items
 5 (i) and (iii) of subparagraph (C) as amended by section 3 of subpart A
 6 of part BB of chapter 57 of the laws of 2019, are amended to read as
 7 follows:
 8 (B) Every policy that provides physician services, medical, major
 9 medical or similar comprehensive-type coverage shall provide coverage
 10 for the screening, diagnosis and treatment of autism spectrum disorder
 11 in accordance with this paragraph and shall not exclude coverage for the
 12 screening, diagnosis or treatment of medical conditions otherwise
 13 covered by the policy because the individual is diagnosed with autism
 14 spectrum disorder. Such coverage may be subject to annual deductibles,
 15 copayments and coinsurance as may be deemed appropriate by the super-
 16 intendent and shall be consistent with those imposed on other benefits
 17 under the policy. Coverage for applied behavior analysis and develop-
 18 mental, individual-differences, relationship-based treatment shall be
 19 subject to a maximum benefit of six hundred eighty hours of treatment
 20 per policy during a calendar year per covered individual. This paragraph
 21 shall not be construed as limiting the benefits that are otherwise
 22 available to an individual under the policy, provided however that such
 23 policy shall not contain any limitations on visits that are solely
 24 applied to the treatment of autism spectrum disorder, except as provided

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD06457-01-5

 S. 5107 2

 1 in this subparagraph for coverage for applied behavior analysis and
 2 developmental, individual differences, relationship-based treatment. No
 3 insurer shall terminate coverage or refuse to deliver, execute, issue,
 4 amend, adjust, or renew coverage to an individual solely because the
 5 individual is diagnosed with autism spectrum disorder or has received
 6 treatment for autism spectrum disorder. Coverage shall be subject to
 7 utilization review and external appeals of health care services pursuant
 8 to article forty-nine of this chapter as well as case management and
 9 other managed care provisions.
 10 (C) For purposes of this paragraph:
 11 (i) "autism spectrum disorder" means any pervasive developmental
 12 disorder as defined in the most recent edition of the diagnostic and
 13 statistical manual of mental disorders, including, but not limited to,
 14 autistic spectrum disorder.
 15 (ii) "applied behavior analysis" means the design, implementation, and
 16 evaluation of environmental modifications, using behavioral stimuli and
 17 consequences, to produce socially significant improvement in human
 18 behavior, including the use of direct observation, measurement, and
 19 functional analysis of the relationship between environment