New York

New York Autism News:

Autism Speaks Joins New York Autism Community In Calling For An End To Autism Insurance Discrimination In The Empire State

Special Joint Senate Committee Hearing Explores Legislation Requiring Insurers to Cover Autism Diagnosis and Treatment 

NEW YORK, N.Y. (October 23, 2009) – Autism Speaks, the nation’s largest autism science and advocacy organization, today joined members of the New York autism community in calling on the state legislature to pass autism insurance reform legislation during the current legislative session. 

Fifteen states, including neighboring New Jersey and Connecticut, have already enacted legislation ending private insurers’ discrimination against children with autism.  New York is one of thirty-five states that do not require private insurance companies to cover even essential autism treatments and services. In those states, insurers often explicitly exclude coverage of these therapies from policies, which places a significant financial burden on families seeking to provide their children with necessary services. 

Testifying before a special joint hearing of three state senate committees, Autism Speaks Senior Policy Advisor and Counsel Lorri Unumb -- the mother of an eight year-old son with autism – told the senators that in the absence of insurance coverage, families often pay as much as they can out-of-pocket for essential, medically-necessary services that can cost upwards of $50,000 per year. In the process, many risk their homes and the educations of their unaffected children – essentially mortgaging their entire futures. 

“We know that behavioral therapies work, and yet we have kids who can’t get the treatment they need and deserve because their parents aren’t wealthy,” said Unumb. “It’s not only sad, it’s unfair, given that these families are paying insurance premiums every month to ensure that their children’s health needs are covered.”... Read more

Pictured above: Lorri Unumb, Autism Speaks Senior Policy Advisor & Counsel, testifies before the Special Committee.

Featured New York Headlines:

Alaska Governor Sarah Palin Attends 2009 Autism Speaks Walk Now for Autism in Westchester (June 7, 2009)

Autism Speaks Endorses New York Autism Insurance Reform Bills (March 4, 2009)

New York State Commission on Property Tax Relief Report to Governor Recommends Severe Cuts to Special Education (December 11, 2008)

Summary of Autism Insurance Reform Bills in New York:

Senate Bill 2366 - Sponsored by State Senator Charles J. Fuschillo, Jr. (8th Senate District)

Assembly Bill 6001 - Sponsored by State Assemblyman Harvey Weisenberg (20th Assembly District)

• Requires private health insurance companies to provide coverage for the diagnosis and treatment of autism spectrum disorder
  
  
• This bill will not affect a child's IFSP or IEP
  
  
• Coverage will be provided to individuals under the age of 21
  
  
• Coverage under this bill is subject to an inflation adjusted maximum benefit of $36,000 annually
  
  
• Coverage of treatments will be provided when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary
  
  
• The bill defines "medically necessary" as "health care services that a physician, exercising prudents clinical judgement, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms that are:
  • in accordance with generally accepted standards of medical practice;
  • clinically appropriate, in terms of type, frequency, exent, site, and duration, and considered effective for the patient's illness, injury, or disease; and
  • not primarily for the convenience of the patient, physician, or other health care provider and not more costly than an alternative services of sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease."
    
    
• The bill includes coverage of the following treatments: Habilitative or rehabilitative care, Pharmacy care, Psychiatric care, Psychological care, Therapeutic care, Applied Behavior Analysis (ABA), and any care for individuals with ASD that is determined by the state health department, based upon its review of best practices or evidence-based research, to be medically necessary
  
  
• The bill defines "evidence-based research" as "research that applies rigorous, systematic, and objective procedures to obtain valid knowledge relevant to ASDs
  
  
• The bill applies only to fully-funded health plans governed by the state