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New State Law Expands Autism Coverage rss

Posted on: November 3rd, 2011

With strong community support, including from UJA-Federation of New York, New York Governor Andrew Cuomo signed legislation on November 1st that will require health insurance providers to offer coverage for the diagnosis and treatment of autism spectrum disorders.

Previously, state law only required that insurance coverage not exclude the diagnosis and treatment of autism disorder, Cuomo said. While the governor said some health insurers have provided 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. Many families cannot afford to pay for treatment without a severe economic hardship and may have to forgo effective early treatment of ASD for their children, Cuomo said.

Anita Altman, deputy managing director for agency and external relations at UJA-Federation of New York said, “For so long, families who are raising children with autism have been weighed down by backbreaking out-of-pocket costs for autism disorder treatments. And for those families who cannot afford treatment, their children are left with even more of a disadvantage academically and socially. Requiring health insurance providers to cover these costs will change the lives of these families, and we thank the New York State Legislature for passage of this bill and to Governor Cuomo for signing it into law.” UJA-Federation was involved in distributing information about the legislation and helping to build a coalition to advocate on its behalf.

With the signing, New York became the twenty-ninth state to require health insurance coverage for conditions relating to autism spectrum disorder, Cuomo said. The law takes effect one year after its enactment on November 1, 2012 and applies to insurance policies issued or renewed after that date. 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.

Autism spectrum disorders are a group of complex developmental brain conditions often characterized by difficulties in social interaction, impairments in communication, and repetitive patterns of behavior. The governor’s office said autism spectrum disorders 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. Early detection, when followed by the right interventions, can lead to better outcomes in functioning, Cuomo’s office said, and in New York, approximately 30,000 individuals under the age of 19 have been identified with an autism spectrum disorder.