BILL NUMBER: S5107
SPONSOR: HARCKHAM
 
TITLE OF BILL:
An act to amend the insurance law, in relation to coverage for the
screening, diagnosis and treatment of autism spectrum disorder
 
PURPOSE:
To expand insurance coverage for the screening, diagnosis and treatment
of autism spectrum disorder to include DIR-Floortime, an evidence-based
developmental and relationship-based treatment.
 
SUMMARY OF PROVISIONS:
Section 1 of the bill amends insurance law section 3216 subparagraphs
(B) and (C) of paragraph 25 of subsection (i), as amended, and items (i)
and (iii) of subparagraph (C) as amended, to include insurance coverage
for applied behavior analysis and developmental, individual-differences,
relationship-based treatment to a maximum benefit of six hundred eighty
hours of treatment per policy during a calendar year per individual.
This section also amends the definitions of "autism spectrum disorder"
to include autistic spectrum disorder; and "behavioral health treatment"
to include developmental, individual-differences, relationship-based
treatment and applied behavioral analysis; and adds the definition for
"developmental, individual-differences, relationship-based treatment".
Section 2 amends insurance law section 3221 subparagraphs (B) and (c) of
paragraph 17 of subsection (1), and items (i) and (iii) of subparagraph
(C) as amended, to include insurance coverage for applied behavior anal-
ysis and developmental, individual-differences, relationship-based
treatment to a maximum benefit of six hundred eighty hours of treatment
per policy during a calendar year per individual. This section also
amends the definitions of "autism spectrum disorder," "behavioral health
treatment" and "therapeutic care" and adds the definition for "develop-
mental, individual-differences, relationship-based treatment" as set
forth in Section 1.
Section 3 amends insurance law section 4303 subsection(ee) paragraphs
(2) and (3) and paragraph (3) subparagraphs (A) and (C) as amended, to
include insurance coverage for applied behavior analysis and develop-
mental, individual-differences, relationship-based treatment to a maxi-
mum benefit of six hundred eighty hours of treatment per policy during a
calendar year per individual. This section also amends the definitions
of "autism spectrum disorder." "behavioral health treatment" and "thera-
peutic care", and adds the definition for "developmental, individual
differences, relationship-based treatment" as set forth in Sections 1
and 2.
Section 4 states the effective date.
 
JUSTIFICATION:
Autism is the fastest growing disorder affecting American children.
Research demonstrates that early diagnosis and treatment of autism spec-
trum disorder is essential and should be provided as soon as possible
without interruption. Delay or interruption of treatment may cause irre-
versible effects.
Developmental, individual-differences, relationship-based treatment
also, referred to as DIR Floortime treatment (DIR), is a more recent
therapeutic evidence-based developmental and relationship-based treat-
ment. Research on the brain shows that interventions must go beyond just
the behaviors we observe. DIR is rooted in the science of human develop-
ment and is a model to build healthy foundations for social, emotional
and intellectual capacities rather than focusing exclusively on skills
and isolated behaviors. Floortime and related DIR based approaches are
listed on evidence-based treatment reviews. Most recently, in January
2019, a systematic review of developmental social pragmatic approaches
including DIRFloortime was published that supported the efficacy of
developmental social pragmatic approaches for children with autism
(Binns, A & Cardy, J.O.(2019) Developmental social pragmatic inter-
ventions for preschoolers with autism spectrum disorder: A systematic
review. Autism and Developmental Language Impairments, 4(1): 1-18. SAGE
journals). This legislation will help to ensure that the most current
evidence-based treatment is covered by insurance and that children diag-
nosed with autism spectrum disorder are provided the treatment they need
to reach their potential.
 
PRIOR LEGISLATIVE HISTORY:
2023-2024: S5393/A7913 - Died in Insurance
2021-2022: S7673A/A8548A - Died in Insurance
 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
To be determined. The treatment of autism spectrum disorders will result
in better long-term health outcomes for individuals and should therefore
lessen costs.
 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become law.