New York lawmakers have approved legislation to require health insurance companies to provide coverage for screening, diagnosis and lifetime treatment of autism spectrum disorders.
The bill passed in the Senate last week and in the Assembly on Monday night.
Citing a federal Centers for Disease Control estimate that one out of 110 children is diagnosed with the disorder, sponsors say the measure could increase overall health insurance premiums by as much as 2 percent in New York. The state would join 20 others that already require coverage.
Affected children struggle with social interaction and communication, ranging from mild to severe symptoms.
Sen. Roy McDonald, a Saratoga Republican, said he has two grandchildren with autism. "My guys don't talk, and it's a very serious thing," he said.
Under the bill, which still needs Gov. David Paterson's signature, state health officials will identify minimum coverage options for clinically proven treatment and therapy. Paterson will review it, spokesman Morgan Hook said Tuesday.
"The new law will prevent denial of coverage on the basis that treatments are educational rather than medical in their necessity, the most common grounds for refusal," said Assemblyman Joseph Morelle, a Rochester Democrat and bill sponsor. "To that end, it allows families to appeal denials to an independent review panel if an initial grievance to the insurer is unsuccessful."
Therapies covered by the new scope of insurance must be clinically proven and peer reviewed, Morelle said. Some parents had urged coverage of experimental treatments as well.
The Health Plan Association, which represents insurers, generally opposes mandates because they increase the cost of health care, spokeswoman Leslie Moran said.
"This bill is particularly troubling because it is so far-reaching," she said Tuesday. "There is no age limit on coverage. There's no annual or lifetime cap on the amount that would have to be paid for services."
Moran said many of the services are currently available in more appropriate settings like schools, and insurers don't believe they should pay for services such as teaching daily living and academic skills. They also think the 2 percent estimate is low -- New Yorkers already pay almost $28 billion in annual health care premiums, and that would mean at least another half-billion dollars.
Judith Ursitti, the regional director for Autism Speaks whose son Jack was diagnosed in 2005, said her family's out-of-pocket costs have ranged from about $60,000 a year initially to about $25,000 to $30,000 now that he is in school and almost 7 years old. "It's rare that parents are able to access coverage for children or adults," she said.
Jack, who was diagnosed at the severe end of the spectrum, is speaking after many thousands of dollars and years of therapy, Ursitti said. She and other advocates stressed the importance of early diagnosis and said it should happen between 18 and 24 months, though only about half of insurers reimburse for a simple screening test.