Anderson Center for Autism, in our ongoing effort to educate and inform, will provide presentations for advocacy groups, and other interested stakeholders and organizations on the impact that this new New York State law will have on services for individuals with Autism Spectrum Disorders.

1. What is the
New York State Autism
Insurance Law?
On November 1, 2011, New York State
Governor A ndrew C uomo signed a law requiring health
insurance providers to offer coverage for the diagnosis and
treatment of autism spectrum disorders (A SD). 1

2. BACKGROUND
• New York is the 29th state to require autism
insurance coverage.
• The law takes effect on November 1, 2012.
• The law applies to health insurance policies and
contracts issued, renewed and modified on or
after this date.
Source: www.autism votes.org
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3. WHAT ARE THE FACTS?
175,000 individuals are estimated to
have A SD in NYS
30,000 children (under 19)
145,000 adults (older than 21)
Source: www.governor.ny.gov
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4. WHAT IS NOT COVERED?
• Services provided to individuals eligible for Office
for People With Developmental Disabilities services
through an Individual Service Provider (ISP)
• Department of Health early intervention program
through an Individual F? Service Provider (IFSP)
• Preschool and school age special education
programs under the New York State Department of
E ducation through an Individualized E ducation
Plan (IE P)
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5. WHAT IS COVERED?
• Requires health providers to offer medically necessary
coverage for the screening, diagnosis, and treatment of
A SD including:
 Behavioral Health Treatment (A pplied Behavior A nalysis)
 Pharmacy C are (if the policy covers other prescription drugs)
 Psychiatric C are
 Psychological C are
 Related Services
• Provides coverage for up to $45,000 per year for A BA
provided or supervised by a Board C ertified
Behavioral A nalyst (BC BA )
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6. WHAT ARE THE FACTS?
• The law ensures there are no age caps or visit
caps that apply solely to A SD.
• The law allows deductibles, co-pays, co-
insurance, care management, utilization
review, and external appeals.
• The law ensures that services must be
prescribed by a physician or psychologist.
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7. WHAT ARE THE FACTS?
• The law prohibits an insurance company
from terminating coverage solely because
the individual has been diagnosed with or
has received treatment for A SD.
• The law applies ONL Y to state-regulated
insurance plans.
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8. WHAT IS THE
ECONOMIC IMPACT?
• Autism Speaks estimates that this law would
save NYS 13 million dollars after six years
through cost savings in:
 E arly Intervention
 Special E ducation C osts
 OPWDD Services
• E stimates indicate the increase in insurance
premiums will be 1% to 3 % per year.
Sources: www.autismspeaks.org
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9. WHAT’S NEXT?
• The governor has turned over the legislation
to the New York Insurance Superintendent
with the assistance of other state agencies to
develop the rules and regulations by which
this law will be implemented.
• The outcome of this process shall reveal the
true impact of this legislation.
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10. THANK YOU FOR COMING!
We invite you to stay informed by visiting
our website at
www.A ndersonC enterforA utism.org