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Bill would expand coverage for autism treatments

ALBANY - A widely backed bill seeks to expand autism treatments paid for by health insurers and extend coverage throughout a patient's life.

The measure, supported by 47 of 62 state senators and Assembly Speaker Sheldon Silver, would close gaps in coverage that have resulted in hardship for patients and their families.

The legislation generally mandates that insurers pay for screening, diagnosis and treatment of autism spectrum disorder, a neurobiological condition affecting communication skills. The causes are in dispute and there is no cure.

One in 110 children nationwide is afflicted, according to the Centers for Disease Control and Prevention. On Long Island, that amounts to about 5,000 children.

"There should be an insurance requirement. . . . Parents are remortgaging homes to pay for the health care and pharmaceutical needs of their child," Assemb. Harvey Weisenberg (D-Long Beach) said Tuesday.

Sen. Charles Fuschillo (R-Merrick) estimated autism therapy can run from $20,000 to $50,000 annually. The bill only covers treatments that are medically necessary and clinically proven. "This will put an end to parents being forced to choose between going broke or getting treatment," he said.

However, autism advocates are divided over the legislation sponsored by Sen. Neil Breslin (D-Albany) and Assemb. Joseph Morelle (D-Rochester).

Autism Speaks, an advocacy group, backs the bill, saying it ends insurance discrimination. Similar laws exist in 15 states.

But other groups, including the Autism Society of America and Autism Action Network, argue insurers will avoid paying for care. They endorse a rival measure - with fewer legislative sponsors - that specifies which treatments would be covered.

America's Health Insurance Plans, a trade group representing companies that insure more than 200 million people, opposes the Breslin-Morelle bill. Spokeswoman Susan Pisano said additional coverage requirements would drive up premiums.

"Employers are saying to us they cannot afford to pay more for health care services," she said.

The Association of Counties also opposes the bill, saying it includes a loophole where insurers wouldn't have to cover treatments provided by schools, local governments and the state. Under current law, counties provide early intervention programs for kids through age 3 with autism, Down syndrome and other conditions.

Last year, health insurers paid only a fraction of claims submitted by counties. "This bill makes it worse, ensuring that taxpayers will pay for all the medical costs of children with autism from here forward," said Stephen Acquario, director of the counties' association.

The impact on Nassau and Suffolk was uncertain Tuesday.

Asked about the criticism, Breslin said he was "open" to addressing the counties' concerns. However, he said, it was a mistake to require specific treatments because so little is known about autism.

Action on the bill could come within the next month.

Michael Giangregorio, the father of an autistic boy in Merrick, said, "we cannot wait another moment for an end to autism insurance discrimination."


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