New York Regulation Makes Autism Coverage Difficult

Welcome to New YorkInsurance companies in New York are required to cover the costs of applied behavior analysis. This went into effect in 2011. Now, a new state regulation has popped up that would greatly reduce the number of providers for ABA therapy that the insurance companies would cover. This will make it harder for families to afford the therapy that their children require.

In 2011, Governor Andrew Cuomo signed a law that required health insurance companies to cover the cost of autism services. The insurers had to pay up to $45,000 a year for therapy and treatment, including applied behavior analysis (ABA).

Previous to this law, insurers in New York were not covering the cost of autism therapy. ABA therapy is an extended form of treatment. It breaks down complex skills into smaller steps in order for children who have autism to improve their skills. ABA can help a child who has autism to improve his or her social skills, and can also help with skills related to eating, feeding, toileting, sleeping, and more.

Before the law was passed, parents were stuck in the position of coming up with the entire cost of autism therapy out of pocket. Those that couldn’t afford it would be unable to get their child what he or she needed. The law requiring insurers to cover autism treatment was intended to alleviate this problem.

Unfortunately, a new state law would undermine the intent of the law that requires insurance companies to cover autism treatment. The new regulation is, at this moment, temporary. It could become permanent next week.

The 2011 law states that autism therapy must be provided by, or supervised by, a certified behavior analyst. New York has about 750 board certified behavior analysts. The new regulation adds the word “license” into the 2011 law. The result of that addition would cut the pool of eligible supervisors down to 43. According to the New York State Education Department, there are about 23,000 children who are between the ages of 4 and 21 who have been identified with autism.

Judith Ursitti is the Director of State Government Affairs for Autism Speaks. She feels that it is possible that the addition of the word “license” was due to lobbying pressure from the insurance industry. She said:

The reason I say that is because we’ve passed autism insurance laws in other states, and once we pass the law and begin working on implementation, this particular roadblock seems to be popping up. We’ve had similar situations in Rhode Island and Virginia where we have worked through the process and resolved it.

Image by Bobby Hidy on Flickr