Gov. Andrew Cuomo Signs Law Requiring Insurance Providers to Offer Coverage for Autism

Gov. Andrew Cuomo signs law requiring insurance providers to offer coverage for autism

Andrew Cuomo

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Syracuse, NY — Gov. Andrew M. Cuomo today signed a law that will require health insurance providers to offer coverage for the diagnosis and treatment of autism spectrum disorder.

Under the new law, health insurance companies will be required to provide coverage for treatment of autism spectrum disorders, though coverage may be subject to deductibles, co-pays, and coinsurance consistent with those imposed on other benefits.

Supporters say that will include routine toddler screenings, behavioral health treatments,
speech therapy, occupational therapy and physical therapy.

“This bill will help thousands of families across New York who struggle to obtain proper care for loved ones affected by autism spectrum disorder,” Cuomo said. “When it comes to autism, early diagnosis and treatment is essential, and it is inexcusable that financial constraints would stand in the way of a brighter future for those affected by this disorder.”

Previously, state law only required that insurance coverage not exclude the diagnosis and treatment of autism disorder. While some health insurers provide limited coverage for ASD treatment, such as vitamins or occupational therapy, most do not offer coverage for treatments that are deemed not medically necessary.

Families had little choice but to pay out-of-pocket for the necessary treatment, with costs sometimes more than $50,000 per year.

Cuomo says the new law has a coverage cap per person of about $45,000 per year.

New York is the 29th state to require health insurance coverage for conditions relating to autism spectrum disorder. As with other states, this legislation caps the cost of services per year. The law takes effect one year after its enactment on Nov. 1, 2012 and applies to insurance policies issued or renewed after that date.

Autism spectrum disorders are a group of complex, pervasive developmental brain conditions that are often characterized by difficulties in social interaction, impairments in communication, and repetitive patterns of behavior. ASDs occur in approximately one in every 110 children in all racial, ethnic and social groups, and studies suggest that it is four times more likely to occur in boys than girls.

In New York, approximately 30,000 individuals under the age of 19 have been identified with an ASD.


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