“Under this bill taxpayers will pay for medical services provided by counties and school districts which insurance companies are now required to reimburse,” said Tom Abinanti, Majority Leader of the Westchester County Legislature, and parent of a child diagnosed with autism.
The New York Assembly passed a bill yesterday that would radically change autism health insurance coverage for the worse. The Senate approved the measure last week.
If Governor David Paterson signs the bill, treatment for autism will have to meet an unprecedented new standard that is much higher than used for treatments of any other disorder under New York law, or the law of any other state or the federal government. Autism treatments will have to be "evidenced-based, clinically proven and peer reviewed." Treatments for all other disorders under New York law only need to meet the commonly used standard of “medically necessary.” “Chemotherapy for certain conditions often does not meet these criteria, especially “clinically proven,” but individuals are not denied coverage of chemotherapy.” said Dr. Mary Schuetz, a Board Certified Developmental Pediatrician from East Aurora. “Even the use of antibiotics, which is much more of a common occurrence, rarely follows these requirements.”
It is also expected that this standard will be used to deny coverage of occupational therapy, speech therapy, physical therapy and other commonly used interventions. The sponsors of the bill had circulated earlier in the session a 2007 article published by the American Academy of Pediatrics that they claimed that would serve as “guidelines” for approved treatments. The article said that occupational therapy and speech do not meet their criteria for efficacy, speech is uncertain and physical therapy was omitted entirely. 
“By imposing a higher standard for autism, the bill would limit coverage and create bureaucratic hurdles to obtaining medically necessary care,” said Michael Smith, a Clifton Park resident, and Northeast Director of the Foundation for Autism Information and Research. “The civil rights of tens of thousands of New York children with autism will be violated.”
The chairs of the insurance committees, Senator Neil Breslin (D-Delmar) and Assemblymember Joseph Morelle introduced the bill. “It’s a great bill for insurance companies, it’s a great bill for Senator Breslin and Assemblymember Morelle, it’s a great bill for everyone but the taxpayers, and people with autism!” said Christine Hoff, a parent of a child with autism from Buffalo.
The proposed law does not identify any treatments that insurers must cover, but instead would require four state agencies to jointly define covered treatments, a bureaucratic hurdle required for no other disorder under New York Law. “Can you imagine four state agencies agreeing on anything?” said John Gilmore, executive director of the Garden City-based Autism Action Network. “And this shuts out everyone but the agencies in making these decisions.”
And the bill will end up costing the taxpayer. “Under this bill taxpayers will pay for medical services provided by counties and school districts which insurance companies are now required to reimburse,” said Tom Abinanti, Majority Leader of the Westchester County Legislature, and parent of a child diagnosed with autism.
The bill also partially repeals a law passed in 2006 that prohibits the widespread practice of insurers denying coverage for healthcare not related to autism to people who have an autism diagnosis. "This is a step backwards, not a step forward, in insurance coverage for Autism,” said Kathy Eiss, president of the Western New York Chapter of the Autism Society of America.”
Opponents of the Autism Speaks bill who had been advocating for an alternate bill, which has been stuck in the insurance committees, are weighing options on how to proceed.