Former Gov. David Paterson vetoed legislation last year that would have required health-care coverage for medically necessary autism treatment, saying it could cost the state and municipalities $70 million a year.
Now, a similar bill for screening, diagnosis and evidence-based treatment awaits action by Gov. Andrew Cuomo after passage by the Legislature.
This version includes a $45,000-per-year cap on applied behavior analysis, a treatment that reinforces and rewards useful behaviors and reduces those that could interfere with learning, according to Autism Speaks. That group and other advocates said the bill would increase premiums by less than 1 percent.
Assemblyman Joseph Morelle, D-Irondequoit, Monroe County, said the Senate and Assembly adopted a chapter amendment for the bill after reaching a compromise agreement with the Cuomo administration. They added the cap, which would be adjusted for inflation, and a start date of one year from when it is signed, rather than Jan. 1, 2012.
"We worked very hard over the last several months to come up with a bill that was balanced and provided much-needed relief to families who are dealing with the autism spectrum disorder," said Morelle, the Assembly bill sponsor.
Cuomo spokesman Josh Vlasto said the administration had productive conversations with the bill sponsors and appreciates their cooperation. The bill has not been sent to the governor's office yet, and Vlasto declined to comment further....
"It really is a reasonable compromise for the families of New York who have loved ones with autism," said Judith Ursitti, director of state government affairs for Autism Speaks.
A hike of half of 1 percent would increase insurance premiums by less than $2 per month, she said, adding that last year's bill was vetoed based on incorrect fiscal information.
The actuarial firm Oliver Wyman estimated that private health-insurance premiums would go up between 0.27 percent and 0.63 percent after six years, Autism Speaks said.
Insurance companies might cover screening and diagnosis and a limited amount of speech therapy and occupational therapy, but they don't cover applied behavior analysis, a core therapy, Ursitti said. They may deny treatment and say it is the school system's responsibility, she said, but some kids need intervention beyond what the educational system can provide.
The legislation would not cover experimental treatments for autism, which has no known cause.
A study commissioned by Autism Speaks said the legislation would save the state $13 million over six years because private insurers would pay for services currently covered through Medicaid under New York's Early Intervention Program.
Autism groups disagreed on the legislation in 2010, but they found common ground this year and most supported the modified bill, Ursitti said.
The New York Health Plan Association, whose members represent nearly seven million New Yorkers, opposes the legislation because it would increase the cost of insurance, impose a new mandate and require coverage of some services that "really fall under the educational umbrella," said Leslie Moran, senior vice president.