Autism insurance PowerPoint Presentation

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Learn the basics about autism insurance legislation in New York State.

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Autism insurance PowerPoint Presentation

  1. 1. What is the New York State Autism Insurance Law? On November 1, 2011, New York State Governor Andrew Cuomo signed a law requiring health insurance providers to offer coverage for the diagnosis and treatment of autism spectrum disorders (ASD). 1
  2. 2. BACKGROUND 2013 STATE AUTISM INSURANCE REFORM INITIATIVE MAP KEY: Green = Enacted law Red = States with endorsed bill Yellow = States working on bill in 2013 Blue = States not currently pursuing legislation Source: www.autismspeaks.org 2
  3. 3. BACKGROUND • New York is the 29th state to require autism insurance coverage. • The law took 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.autismvotes.org 3
  4. 4. State STATE-BASED AUTISM INSURANCE REFORM Indiana South Carolina Texas Arizona Louisiana Florida Pennsylvania Illinois New Mexico Montana Nevada Colorado Connecticut Year Enacted 2001 2007 2007 2008 2008 2008 2008 2008 2009 2009 2009 2009 2009 Wisconsin New Jersey 2009 2009 State Population 6,483,802 4,625,364 25,145,561 6,392,017 4,533,372 18,801,310 12,702,379 12,830,632 2,059,179 989,415 2,700,551 5,029,196 3,574,097 Annual Dollar Cap None $50K None $50K: 0-8, $25K: 9-16 $36K ($144K lifetime) $36K ($200K lifetime) $36K $36K $36K ($200K lifetime) $50K: 0-8, $20K: 9-18 $36K $34K: 0-8, $12K: 9-19 $50K: 0-8, $35K: 9-12, $25K: 13-14 5,686,986 $50K for 4 yrs, $25K after 8,791,894 $36K Source: www.autismspeaks.org Age Cap None 16 <10 16/17 <17 <18 <21 <21 19/22 18 18/22 <20 <15 State E’ees Yes Yes No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Small Group? Yes No No No No No No Yes Yes Yes Yes Yes Yes None 21 Yes Yes Yes Yes 4
  5. 5. State STATE-BASED AUTISM INSURANCE REFORM New York Year Enacted 2010 2010 2010 2010 2010 2010 2010 2010 2011 2011 2011 2011 2011 California 2011 Maine Kentucky Kansas Iowa Vermont Missouri New Hampshire Massachusetts Arkansas West Virginia Virginia Rhode Island State Population 1,328,361 4,339,367 2,853,118 3,046,355 625,741 5,988,927 1,316,470 6,547,629 2,915,918 1,852,994 8,001,024 1,052,567 19,378,102 Annual Dollar Cap $36K $50K:0-7, $1K/mo:7-21 $36K:0-7, $27K:8-19 $36K None $40K $36K:0-12, $72K:13-21 None $50K $30K for 3yrs; $24K up to 18 $35K $32K $45K 37,253,956 None Age Cap <6 1-21 <19 <21 1 ½-6 19 21 None <18 3-18 2-6 15 None State Small E’ees Group? Yes Yes Yes Yes Yes only No Yes only No Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No Yes No Yes Yes None No No Since original publication of this data, five additional states including the District of Columbia (DC) have enacted similar legislation bringing the total to 34 states plus the DC . Source: www.autismspeaks.org 5
  6. 6. WHAT ARE THE FACTS? 60,000 individuals are estimated to have ASD in NYS 30,000 children (under 19) Source: www.dfs.ny.gov www.governor.ny.gov 6
  7. 7. WHAT IS NOT COVERED? • Services provided to individuals eligible for Office of Persons With Developmental Disabilities (OPWDD) services through an Individualized Service Plan (ISP). • Department of Health early intervention program through an Individual Family Service Plan (IFSP). • Preschool and school age special education programs under the NYS Department of Education through an Individualized Education Program (IEP). 7
  8. 8. WHAT IS COVERED? • Requires health providers to offer medically necessary coverage for the screening, diagnosis, and treatment of ASD including:  Behavior Health Treatment including Applied Behavior Analysis(ABA)  Pharmacy Care (if the policy covers other prescription drugs)  Psychiatric Care  Psychological Care  Related Services  Assistive Communication Devices • Provides coverage for up to $45,000 per year for ABA provided or supervised by a Board Certified Behavior Analyst (BCBA). 8
  9. 9. WHAT ARE THE FACTS? • There are no age caps or visit caps that apply solely to ASD. • Allows deductibles, co-pays, co-insurance, care management, utilization review, and external appeals. • Services must be prescribed by a physician or psychologist. 9
  10. 10. 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 ASD. • The law applies ONLY to state-regulated insurance plans. 10
  11. 11. NY CONSUMER PROTECTIONS THROUGH DEPARTMENT OF FINANCIAL SERVICES http://www.dfs.ny.gov/insurance/extapp/extappqa.htm • External appeals for medical necessity, experimental/investigational, clinical trial, rare disease treatment or certain out-of-network denials. • Department of Financial Services Consumer Assistance Unit is available to investigate any complaint you may have against your health plan. You can submit your complaint to the Department of Financial Services Consumer Assistance Unit using the Online Consumer Complaint Form. For more information on how to file a consumer complaint please call 1-800-342-3736 11
  12. 12. THANK YOU FOR COMING! We invite you to stay informed by visiting our website at www.AndersonCares.org 12

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