Tuesday, January 26, 2010

LEG. NEWS: New York - A full roster of autism insurance coverage legislation

The New York State Assembly has a VERY full roster of legislation proposing coverages for, and related to, autism diagnosis and treatment. This is in addition to the previously reported on NY S.3676 for establishing qualification standards for autism service providers for those 21 years or younger, including state recognition of the BACB Certifications and conditions of reimbursement and other clauses.

The insurance bills are (reported in approximate numerical order),


S 385 and A 2759
"Requires health insurers to provide full coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder, establishes an advisory panel on health insurance coverage for autism spectrum disorder to annually compile a list of treatments and therapy options for which health insurers will be required to provide coverage, establishes a toll-free, 24 hour a day, autism and health insurance coverage hotline."
S 385 and A 2759 do not specify or define applied behavior analysis nor providers nor competencies. Creates an advisory panel to determine on an annual basis a list of "successful treatment and therapy options" that will be required to be covered under the conditions of the bill.
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Although it is stated that there is no "same as" bill, this is very similar, if not identical to,
Applied behavior analysis is not defined in S.1175 or A 3332, but is categorized explicitly under "therapeutic care, including behavioral, speech, occupational and physical therapies that provide treatment in the following areas..4. Applied behavior analysis, intervention and modification,..."

Provider or competencies of provider of applied behavior analysis unspecified, although there is reference to "a provider of treatment for autism spectrum disorders".
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"Relates to autism spectrum disorders in individuals twenty-one years or less; directs the department of health to promulgate rules and regulations establishing standards for qualified autism services providers and upon such promulgation, payment for treatment of autism spectrum disorders covered shall only be made available to autism services providers who meet such standards; further directs the department of health shall further establish standards to be utilized by managed care plans for the credentialing of autism service providers and authorizes that the department of insurance may require that a managed care plan grant credentials to any autism service provider whom the department determines meets or exceeds the department's credentialing standards."
S 2366-A and A6001-A define Applied behavior analysis, and coverage is specified under "habilitative or rehabilitative care". Provider of applied behavior analysis services not specified nor the competencies of the Behavior Analyst Certification Board (BACB). An "Autism Services Provider" is identified as "any person, entity, or group that provides treatment of autism spectrum disorders". These bills have been endorsed by Autism Speaks.
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Applied behavior analysis is not defined in S. 6123 or A. 6888-B; it is included under "therapeutic care" as "applied behavior analysis, intervention and modification". Providers of behavior analytic intervention not defined, nor are the competencies of the BACB specified. There is reference to a "provider of treatment" and a mechanism for a coverage provider to refer to a specialist or nonparticipating provider with appropriate training and experience.

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For more information:
Autism Votes - New York
Currently specific to S2366 and A6001/Endorsed by Autism Speaks

New York State Assembly

Related: ABAI chapters in/that serve New York
New York State Association for Behavior Analysis (NYSABA)

Past related blog post:
Monday, January 25, 2010
Practitioner Issues in Behavior Analysis SIG blog
LEG. NEWS: New York S. 3676 Defines the practice of behavior analysis and recognizes the Behavior Analysis Certification Board competencies

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Practitioner Issues in Behavior Analysis SIG
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Views and news expressed in this blog or by the PIBA SIG are those of the SIG or individual SIG member authors and do not represent official policy of ABA International or other official body. For official policy of the Association of Behavior Analysis International, the reader is directed to their website, 

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