S.4005-A (Fuschillo) / A.6305-A (Morelle)


Director of Government Afairs
518.465.7511 x207


S.4005-A (Fuschillo) / A.6305-A (Morelle)


Autism Spectrum Disorder Insurance Coverage Mandate



The Business Council of New York State opposes this bill, as it imposes an open-ended insurance coverage mandate on health insurance plans in New York State, with no relation to ensuring coverage is provided to the extent that such services are medically necessary within the covered benefits for other diseases and conditions under that health plan. The bill provides no requirement that treatments be evidence based, peer reviewed and clinically proven; it increases costs on taxpayers who fund the employer share for public employee health benefits; and will increase costs for individuals and employers in NYS.

The amendments to the original bill make some marginal improvements in attempting to quantify care. The amendments, however, are but modest improvements that do little to address the underlying flaws in the bill. The amended bill still does not adequately address coordination issues (both payment for, and services to individuals) between school systems and health care services mandated under this bill.  Significantly, the legislation contains no age parameters, and under current New York State law, this broadly written autism coverage would cover individuals under their parents’ plan up to age 29.

The increased number of individuals diagnosed with ASD warrants a public policy discussion on how best to meet the medical and educational needs of these individuals. Other states have taken a more careful approach on balancing the medical, educational and social development of those with ASD in their coverage mandates including consideration for age limitations on certain behavioral therapies, maximum yearly benefits, and, at least one state provides for an optional rider.

Insurance mandates drive up costs for all employer-sponsored plans, and those in the small group, community-rated market are hit the hardest.  This bill will drive costs up even further while providing none of the reasonable limitations found in other states with autism coverage mandates.  Additionally, taxpayers will shoulder an increased burden to absorb the increases associated with the “employer” share of public employee health benefit plans at all levels of government – pegged in Governor Paterson’s 2010 veto at a $70 million pricetag. Finally, this bill ignores the pending implementation of aspects of federal health care reform which require state-imposed insurance mandates, in excess of those required in the federal essential benefits menu, to be paid for by state revenues – not premium dollars.  Now is clearly not the time for the state to show a lack of fiscal discipline and impose costly coverage mandates for which they have identified no revenue source to pay.  

For these reasons, The Business Council opposes this bill.