Anderson Center offers presentation on New York State Autism Legislation


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Anderson Center for Autism, in our ongoing effort to educate and inform, will provide presentations for advocacy groups, and other interested stakeholders and organizations on the impact that this new New York State law will have on services for individuals with Autism Spectrum Disorders.

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Anderson Center offers presentation on New York State Autism Legislation

  1. 1. What is the New York State Autism Insurance Law? On November 1, 2011, New York State Governor A ndrew C uomo signed a law requiring healthinsurance providers to offer coverage for the diagnosis and treatment of autism spectrum disorders (A SD). 1
  2. 2. BACKGROUND• New York is the 29th state to require autism insurance coverage.• The law takes effect on November 1, 2012.• The law applies to health insurance policies and contracts issued, renewed and modified on or after this date. Source: www.autism 2
  3. 3. WHAT ARE THE FACTS?175,000 individuals are estimated to have A SD in NYS 30,000 children (under 19) 145,000 adults (older than 21) Source: 3
  4. 4. WHAT IS NOT COVERED?• Services provided to individuals eligible for Office for People With Developmental Disabilities services through an Individual Service Provider (ISP)• Department of Health early intervention program through an Individual F? Service Provider (IFSP)• Preschool and school age special education programs under the New York State Department of E ducation through an Individualized E ducation Plan (IE P) 4
  5. 5. WHAT IS COVERED?• Requires health providers to offer medically necessary coverage for the screening, diagnosis, and treatment of A SD including:  Behavioral Health Treatment (A pplied Behavior A nalysis)  Pharmacy C are (if the policy covers other prescription drugs)  Psychiatric C are  Psychological C are  Related Services• Provides coverage for up to $45,000 per year for A BA provided or supervised by a Board C ertified Behavioral A nalyst (BC BA ) 5
  6. 6. WHAT ARE THE FACTS?• The law ensures there are no age caps or visit caps that apply solely to A SD.• The law allows deductibles, co-pays, co- insurance, care management, utilization review, and external appeals.• The law ensures that services must be prescribed by a physician or psychologist. 6
  7. 7. WHAT ARE THE FACTS? • The law prohibits an insurance company from terminating coverage solely because the individual has been diagnosed with or has received treatment for A SD. • The law applies ONL Y to state-regulated insurance plans. 7
  8. 8. WHAT IS THE ECONOMIC IMPACT?• Autism Speaks estimates that this law would save NYS 13 million dollars after six years through cost savings in:  E arly Intervention  Special E ducation C osts  OPWDD Services• E stimates indicate the increase in insurance premiums will be 1% to 3 % per year. Sources: 8
  9. 9. WHAT’S NEXT?• The governor has turned over the legislation to the New York Insurance Superintendent with the assistance of other state agencies to develop the rules and regulations by which this law will be implemented.• The outcome of this process shall reveal the true impact of this legislation. 9
  10. 10. THANK YOU FOR COMING!We invite you to stay informed by visiting our website at www.A ndersonC enterforA