STATE OF NEW YORK ________________________________________________________________________ 9073 IN ASSEMBLY February 6, 2024 ___________ Introduced by M. of A. SOLAGES -- read once and referred to the Commit- tee on Health AN ACT to amend the social services law, in relation to studying the adequacy of applied behavioral analysis provider networks The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph (jj) of subdivision 2 of section 365-a of the 2 social services law, as added by chapter 733 of the laws of 2022, is 3 amended to read as follows: 4 [(jj)] (nn) applied behavior analysis, under article one hundred 5 sixty-seven of the education law, provided by a person licensed, certi- 6 fied, or otherwise authorized to provide applied behavior analysis under 7 that article. By December first of each year, the commissioner of health 8 shall make publicly available on the department of health's website a 9 report concerning access to applied behavior analysis for enrolled chil- 10 dren diagnosed with autism spectrum disorder meeting the following 11 requirements: 12 (i) the data in the report shall be organized by current procedural 13 terminology (CPT) code; 14 (ii) the report shall include the following information from the imme- 15 diately preceding fiscal year regarding the Medicaid program: 16 (A) the number of licensed behavior analysts and certified behavior 17 analyst assistants practicing in this state who are Medicaid providers; 18 (B) the number of Medicaid enrollees who are children with an autism 19 spectrum disorder diagnosis; 20 (C) the number of Medicaid enrollees who are children with an autism 21 spectrum disorder diagnosis who received applied behavior analysis; 22 (D) the number of licensed behavior analysts and certified behavior 23 analyst assistants with whom each Medicaid managed care plan in the 24 state has contracted, by county; 25 (E) the median number of days between diagnosis of a child with an 26 autism spectrum disorder and the time at which such child begins to 27 receive applied behavior analysis; EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD14099-01-4
A. 9073 2 1 (F) the number of Medicaid enrollees who are children with an autism 2 spectrum disorder diagnosis who did not receive applied behavior analy- 3 sis, despite it being recommended by the child's health care provider, 4 if ascertainable; 5 (G) the number of prior authorization requests for applied behavior 6 analysis that were denied and the number of appeals resulting from those 7 denials and partial denials; 8 (H) the median of recommended hours and the median of received hours 9 of applied behavior analysis for Medicaid enrollees who are children 10 with an autism spectrum disorder diagnosis who were approved for and 11 received applied behavior analysis but did not receive the number of 12 hours of treatment recommended by the child's health care provider, if 13 ascertainable; 14 (I) the median of recommended hours and the median of covered hours of 15 applied behavior analysis for Medicaid enrollees who are children with 16 an autism spectrum disorder diagnosis for whom the Medicaid program 17 covered fewer behavior analysis hours than were recommended by the 18 child's health care provider, if ascertainable; 19 (J) recommendations to improve the adequacy of the network of applied 20 behavior analysis providers who are Medicaid providers; and 21 (K) other recommendations to improve access to applied behavior analy- 22 sis; 23 (iii) the department shall make every effort to collect from applied 24 behavior analysis providers and enrollees any information necessary to 25 compile the report required by this section; and 26 (iv) the department shall develop education and outreach materials 27 that do both of the following: 28 (A) inform and educate parents and legal guardians of enrolled chil- 29 dren with an autism spectrum disorder diagnosis about relevant services 30 for which those children are eligible; and 31 (B) explain how to access those services. 32 § 2. This act shall take effect immediately.