October 9, 2012  

Autism Mandate Required in New York State


New York health insurers are required to cover services for “the screening, diagnosis and treatment” of autism spectrum disorder (ASD) when prescribed by a licensed doctor or psychologist. The law takes effect with the first health plan renewal on or after November 1, 2012.

How Does This Affect You As An Employer?

This law requires policies and contracts that provide physician services, medical, major medical or similar comprehensive-type coverage to provide coverage for the screening, diagnosis and treatment of ASD.

The law prohibits any limitations on visits that are solely applied to the treatment of ASD. Treatment of ASD is defined to include behavioral health treatments, psychiatric care, psychological care, medical care, therapeutic care and specified pharmacy care.

These provisions specify that coverage for applied behavior analysis is subject to a maximum benefit of $45,000 per year. Additionally, prior authorization, utilization review, case management and other managed care provisions may apply.

The new autism mandate does not apply to self-funded plans.

What should I do next?
If you are an employer with a fully insured group health plan, consult with your Corporate Synergies Group Account Management team to review your upcoming renewal to ensure that the plan is now covering the required covered services. 

If you have any additional questions regarding the information within this eCommunication, please call Corporate Synergies at 1.866.CSG.1719 or CLICK HERE to contact us today.

Corporate Synergies is pleased to provide regular updates on issues affecting group benefits insurance. As an insurance broker and consultant, Corporate Synergies is proactive in monitoring federal and state legislative and regulatory activity to ensure that you stay informed. Our customers call us their "Dedicated Advocates." We work on your behalf.

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NOTE: This communication is in no way intended to substitute for legal advice. Please contact your attorney for advice about employment law issues.
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