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New law expands autism insurance coverage

Gov. Andrew M. Cuomo (Sept. 27, 2011)

Gov. Andrew M. Cuomo (Sept. 27, 2011) Photo Credit: AP

Insurance companies will be required to provide more comprehensive coverage for New Yorkers with autism under a law signed Tuesday by Gov. Andrew M. Cuomo.

Currently, insurers have to cover the diagnosis of autism spectrum disorder and some treatment, but can limit treatment to what they deem medically necessary. Those limitations have meant that families have paid tens of thousands of dollars out of pocket for more comprehensive treatments for children or other family members, advocates say.

"The children will get the help, the families will get the support and with the balance we put in the bill it won't be a burden that the insurance companies can't carry," Cuomo said at a news conference in Albany. "You're talking about 30,000 children in this state who need help and who need it desperately."

Former Gov. David A. Paterson vetoed a similar bill last year because of its costs. The difference this time around, Cuomo said, is that the bill caps insurers' annual payout at $45,000. The cap, which will be adjusted for inflation, was added as an amendment to the bill, which will take effect in one year.

"The cost is minimal, but the need is great to families throughout New York State," said Sen. Charles Fuschillo, (R-Merrick), who sponsored the bill in the State Senate.

The New York Health Plan Association, which represents 25 managed care health plans, said the new mandated coverage will increase insurance costs for everyone.

"This measure will mean an increase of hundreds of dollars to the average family premium and tens of thousands to the costs employers pay for coverage for their employees," HPA president Paul Macielak said in a statement. "For some New York families and employers, it could be the added costs that finally price them out of coverage all together."

But Bob Wright, co-founder of Autism Speaks, an organization that advocates and raises funds for autism research, said a study the group conducted showed that the bill would result in savings for the state.

"There will be a savings of over $13 million over the next six years by the state as a result of enacting this bill, savings in social services, savings in Medicaid and other savings," said Wright, a former chairman and chief executive of NBC.

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