New Law Requires Coverage of Autism Disorder by Health Insurance Providers
Governor Andrew Cuomo has signed a law that will require health insurance providers to offer coverage for the diagnosis and treatment of autism spectrum disorder.
The legislation will help families afford the expensive health care costs related to treating loved ones with autistic disorders.
Under the new law, health insurance companies will be required to provide coverage for treatment of autism spectrum disorders, though coverage may be subject to deductibles, co-pays, and coinsurance consistent with those imposed on other benefits.
"This bill will help thousands of families across New York who struggle to obtain proper care for loved ones affected by autism spectrum disorder," Governor Cuomo said.
"When it comes to autism, early diagnosis and treatment is essential, and it is inexcusable that financial constraints would stand in the way of a brighter future for those affected by this disorder. This bill opens the door to families seeking earlier treatment and better results. I thank Senator Fuschillo and Assemblyman Morelle for sponsoring this much-needed legislation."
Previously, state law only required that insurance coverage not exclude the diagnosis and treatment of autism disorder. While some health insurers provide limited coverage for ASD treatment, such as vitamins or occupational therapy, most do not offer coverage for treatments that are deemed not medically necessary.
Families had little choice but to pay out-of-pocket for the necessary treatment, with costs sometimes more than $50,000 per year. Many families cannot afford to pay for treatment without a severe economic hardship and may have to forgo effective early treatment of ASD for their children.
With today's signing, New York is the twenty-ninth state to require health insurance coverage for conditions relating to autism spectrum disorder. As with other states, this legislation caps the cost of services per year.
The law takes effect one year after its enactment on November 1, 2012 and applies to insurance policies issued or renewed after that date.
Autism spectrum disorders are a group of complex, pervasive developmental brain conditions that are often characterized by difficulties in social interaction, impairments in communication, and repetitive patterns of behavior.
ASDs occur in approximately one in every 110 children in all racial, ethnic and social groups, and studies suggest that it is four times more likely to occur in boys than girls. Early detection of ASDs, when followed by the right interventions, can lead to better outcomes in functioning.
In New York, approximately 30,000 individuals under the age of 19 have been identified with an ASD.
New York State offers a number of services and supports to individuals with ASD and other developmental disabilities, including the Department of Health's Early Intervention Program, preschool special education services and special education services for school children under the auspices of the State Education Department, and an "Autism Platform," provided by the Office for People with Developmental Disabilities that offers certain services and support for individuals with ASD, most of which are Medicaid-funded and provided in conjunction with an individualized service plan.
The following statements were provided regarding the landmark legislation.
"Thousands of families throughout the state are facing critical choices between providing quality care for children and adults with autism or jeopardizing their finances. This bill will give them access to the tools that have been proven to make a difference in the life of an individual with autism. I thank Senator Fuschillo and Senator McDonald for their leadership, and commend the Governor for partnering with us to get this done." - Senate Majority Leader Dean G. Skelos
"A government that steps up to ensure a brighter future for vulnerable children and adults – especially in difficult times such as these – is a government with its priorities in order. I thank the Governor for standing up for those afflicted with Autism Spectrum Disorders and for their families who are striving to give them the best care possible; and to my colleague, Assemblyman Joe Morelle, for his leadership and his tireless efforts to help make today possible." - Assembly Speaker Sheldon Silver
"Today is a great day for individuals with autism. For years, families have fought for access to treatment coverage for their loved ones. This new law will afford individuals with autism the opportunity to receive treatments and therapies they need without being forced to spend tens of thousands of dollars out of pocket every year. I thank Governor Cuomo for signing this law which will dramatically improve the lives of every New York family affected by autism." - Senator Charles J. Fuschillo, Jr.
"Autism is quickly erupting into epidemic levels with diagnosis rates climbing at an astonishing level, this is a mental health issue that is going to get much worse before it gets better and this legislation helps real people and their families. I want to thank Governor Cuomo for his leadership and support of this bill, along with my colleagues in the Senate and Assembly who sponsored this legislation." - Senator Roy J. McDonald
"With Governor Cuomo's signature today, families will no longer have to decide between affording health care for one child or college education for another. New York has proven with this law that we remain a state that looks out for everyone, especially those who face hardship through no fault of their own. I thank the Governor for his leadership and attention to this issue, and I commend my colleagues in the legislature for passing this important bill." - Assemblyman Joseph Morelle
"Early detection of autism spectrum disorders, when followed by the right treatment programs, has been shown to lead to better functioning in patients, and will provide a more stable future for children and their families. I thank and commend Governor Cuomo and our Legislature for working together to enact legislation that will help families all across New York meet the challenges of autism spectrum disorders." - Dr. Nirav Shah, Commissioner of the Department of Health
"I cannot stress enough the importance of early diagnosis and treatment of autism spectrum disorders (ASDs). However, many families have had to forgo early intervention due to economic hardship. With the signing of this bill, caregivers can continue to advocate and support their child who has been diagnosed with autism, and not have to worry about the financial stress related to needed services. Today, the families of the 24,000 New York State citizens diagnosed with an ASD, whom OPWDD serves, join me in applauding Governor Cuomo and his decision to sign this vital bill." - Courtney Burke, Commissioner of the Office for People with Developmental Disabilities
"The struggle with autism is hard enough for families. Those families shouldn't be forced to choose between a mountain of medical bills or delaying care for their children. And early and accurate diagnosis is vital for long-term, effective treatment. There are some things that are simply the right things to do. This new law is one of them. The Governor and the Legislature have taken a tremendous burden off the backs of thousands of New York parents with children suffering from autism spectrum disorder." - John B. King, Jr., State Education Commissioner
"Autism Speaks thanks Governor Cuomo for his wisdom and courage in standing by our families who struggle with autism. We commend the Governor's willingness to work with us and our champions, Assemblyman Joe Morelle and Senator Chuck Fuschillo, to craft one of the most powerful autism insurance reform bills in the nation. Today New York becomes the 29th state to enact reform, joining the growing majority of states that put families first." - Bob Wright, Co-founder of Autism Speaks
"Some New York families, already hit hard by the recession, are paying tens of thousands of dollars out-of-pocket each year to provide their children with the therapies they need and deserve. This critical legislation will not only right this wrong, but also save the taxpayers of this state an estimated $13 million in special education, Medicaid and social service costs in the next six years. This is a good day for all New Yorkers." - Mark Roithmayr, President of Autism Speaks
"On behalf of the physician members of the Medical Society of the State of New York, the signing of this bill is a momentous event. The measure will expand health insurance coverage for the screening, diagnosis and treatment of autism spectrum disorders. Patients 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. We commend Governor Cuomo, Senator Fuschillo and Assemblyman Morelle for their foresight in championing this legislation which will expedite diagnosis and treatment by providing insurance parity for autism sufferers and result in better long-term health outcomes." - Paul A. Hamlin, MD, President, Medical Society of the State of New York said,
"Today's signing lifts a great financial burden on families in New York who have to care for individuals with autism. By requiring health insurance companies to provide coverage for the diagnosis and treatment of autism, families can now more easily detect autism in individuals and begin needed treatment as soon as possible. I commend Governor Cuomo and Sponsors Senator Fuschillo and Assemblyman Morelle for their work in passing this legislation." - Patricia Schissel, LMSW, Executive Director of Asperger Syndrome and High Functioning Autism Association (AHA)
"Having a child diagnosed with autism can create enormous financial difficulties for families already struggling with the impacts of our current economy and compounds the emotional/social challenges of caring for a chronically ill child. Without the kind of health care coverage this legislation requires, these families are often left with no choice to but forgo treatments. As a result of this draconian choice, their children are left even further behind their peers and absorb more services going forward. By requiring health insurance companies to pay for the diagnosis and treatment of autism and autism spectrum disorders, Governor Cuomo is ensuring that the tens of thousands of affected children in New York are given access to proper care and a better chance to grow and develop to their full potential. The more than five thousand pediatricians across New York sincerely I thank Assemblyman Morelle and Senator Fuschillo and their many colleagues for getting this law passed in the legislature. And we thank Governor Cuomo for signing it." - Elie Ward, Director of Policy & Advocacy, American Academy of Pediatrics, District II, NYS
"For so long, families who are raising children with autism have been weighed down by backbreaking out-of-pocket costs for autism disorder treatments. And for those families who cannot afford treatment, their children are left with even more of a disadvantage academically and socially. Requiring health insurance providers to cover these costs will change the lives of these families, and I thank Governor Cuomo for signing this into law." - Anita Altman, Deputy Managing Director for UJA-Federation of New York
"My family and I were so relieved when this bill finally passed in the legislature and could not be more excited that the Governor is signing it today. I would like to thank Senator Fuschillo, Assemblyman Morelle and all the advocates who worked on this piece of legislation. This law will acknowledge that autism is a medical condition and not just a psychiatric condition. I have seen first-hand how effective treatment can be. My children have grown leaps and bounds through both medical treatment and intensive educational support. It is important that all the individuals and families affected by autism be able to afford the care they so desperately need. We cannot pinch pennies over something as significant as improving long-term quality of life. This new law should smooth the road for those families whose loved-ones are affected by autism." - Katie Weisman, Secretary of the Autism Action Network
"In today's economy, having a child diagnosed with autism can be an enormous financial difficulty on already strained family budgets. Governor Cuomo is ensuring that proper medical and behavioral care will be reimbursed for the 1 in every 110 children and youth in New York with autism by requiring health insurance companies to pay for the diagnosis and treatment of this neurodevelopmental disorder. I would like to personally thank Assemblyman Morelle and Senator Fuschillo for getting this law passed in the legislature." - Susan Hyman, MD, Associate Professor of Pediatrics and Division Chief of Neurodevelopmental and Behavioral Pediatrics at Golisano Children's Hospital, University of Rochester Medical Center
"Autism spectrum disorders have profound effects on the lives of thousands of New Yorkers, their friends and their family members. Today, Governor Cuomo's show of support for those impacted by ASDs proves the state government is on their side. I thank the Governor for signing this bill into law and working to minimize the challenges that result from ASDs by requiring health insurance providers to cover its treatment and diagnosis." - Stephen Sulkes, MD, Professor of Pediatrics at Golisano Children's Hospital and Director of the Strong Center for Developmental Disabilities, said,
"I congratulate New York on becoming the latest state to pass the Autism Bill requiring health insurance companies to provide coverage for treating people with Autism Spectrum Disorders. This Bill demonstrates an understanding of the importance of comprehensive and early care and treatment for our children. As a parent of a young man with ASD and the co-chair of the Timothy's Law Campaign, I know firsthand the challenges that families have faced in the past. I thank Governor Cuomo, Senator Fuschillo and Assemblyman Morelle for their progressive leadership and commitment to our children and families." - Paige Pierce, Executive Director of Families Together in New York State and President of the Board of the Autism Society of the Greater Capital Region
"Governor Cuomo has made the improvement of healthcare and its financial impact on New York and its constituents a priority since taking office. Today's signing is another example of his commitment to progressive health care for families with special needs. This new law is great news for our children and families who have had to make enormous sacrifices to afford the high costs of ASD treatments, and I commend the Governor, Senator Fuschillo and Assemblyman Morelle for their hard work." - Jan Campito, Vice President of the Autism Society of the Greater Capital Region
"This bill signing is a monumental achievement for the tens of thousands of New Yorkers directly affected by autism, and their families. Governor Cuomo, together with Senator Fuschillo and Assemblyman Morelle and the entire State Legislature, has ensured that heath care providers will fulfill their obligations and no longer demand that families suffer the burden of these expensive treatments and care. This bill is a positive step forward, but, much work remains to be done in addressing the overall hurdles to insurance coverage for families. The autism epidemic will continue to be a high priority in the State Legislature." - Michael Smith, Chairman of the Foundation for Autism Information and Research, Inc.
"In today's economy, having a child diagnosed with autism can be an enormous financial difficulty on already strained family budgets. And if these families are left with no choice to but forgo treatments, their children are left even further behind their peers. By requiring health insurance companies to pay for the diagnosis and treatment of the disorder, Governor Cuomo is ensuring that the tens of thousands of affected children in New York are given proper care. I thank Assemblyman Morelle and Senator Fuschillo for getting this law passed in the Legislature." - Sarah Milko, President of Upstate New York Families for Effective Autism Treatment
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