New York A 3896: Relates to coverage for the screening, diagnosis and treatment of autism spectrum disorder

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A03896 Summary:

BILL NOA03896 

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SAME ASSAME AS S05107

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SPONSORSimon

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COSPNSRJensen, Eachus, Hevesi, Santabarbara, Seawright, Lunsford, Cruz, Yeger, Gallagher, Wieder, Berger,
 Eichenstein, Cook, Gandolfo, Jacobson, Clark, Barrett, Reyes, Bendett, McMahon, Colton, Carroll R

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MLTSPNSR

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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 A03896 Actions:

BILL NOA03896 

&nbsp

01/30/2025referred to insurance

01/07/2026referred to insurance

Go to topA03896 Committee&nbspVotes:

Go to topA03896 Floor&nbspVotes:

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

Go to topA03896 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 3896

 2025-2026 Regular Sessions

 IN ASSEMBLY

 January 30, 2025
 ___________

 Introduced by M. of A. SIMON, JENSEN, EACHUS -- 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 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
 25 in this subparagraph for coverage for applied behavior analysis and

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

 A. 3896 2

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