June 17, 2011

Assembly Expands Health Insurance Coverage for Autism Spectrum Disorders

Assembly Speaker Sheldon Silver and Insurance Committee Chair Joseph D. Morelle today announced the passage of groundbreaking legislation (A.6305a) to specifically require HMOs and individual and group health insurers to require screening, diagnosis and treatment of autism spectrum disorders (ASD).

State law requires that insurance coverage for ASD "not exclude" diagnosis and treatment, however there is a lack of clarity in the existing statute to ensure that health insurance policies cover these costs.

"It is unconscionable to force families to pay huge out-of-pocket costs for this common, chronic condition," said Silver (D-Manhattan). "Some studies have indicated that the annual cost of treatment can be as high as $50,000 a year. Current law is written so that ASD coverage is 'not excluded' in health insurance policies, but we needed to make clarifications and in order to ensure that families are able to get the best options available to treat this serious developmental disorder."

"Reliable health insurance coverage for autistic children is long overdue. Parents and youngsters have suffered with uncertainty for too long," said Morelle (D-Irondequoit). "No longer will parents have to guess what medical treatments their insurance carrier will or will not cover. This bill would give families peace of mind, allowing them to confidently seek the medical care their autistic child needs."

The measure would require insurance coverage to mirror the cost sharing of other benefits under the policy, including annual deductibles, co-payments and coinsurance. Additionally, the bill would:

The estimated number of children with ASD has steadily increased since the condition was first identified in 1943. According to a recent study by the Centers for Disease Control, an estimated 1 out of 110 children are diagnosed with ASD.

Children with ASD demonstrate deficits in social interaction and verbal and non-verbal communication, and engage in repetitive behaviors or interests. Each of these symptoms varies from mild to severe. Although opinions vary on the best treatment for children with ASD, most professionals agree that early treatment is necessary and effective.