Amd 3216, 3221 & 4303, Ins L; add 365-p, Soc Serv L
Requires health insurers to provide coverage for non-opioid treatments utilized for pain management including, but not limited to a drug or biological product that is indicated to produce analgesia without acting upon the body's opioid receptors that has demonstrated the ability to replace, reduce, or avoid opioid use or the quantity of opioids prescribed; or an implantable, reusable, or disposable medical device for the intended use of managing or treating pain that has demonstrated the ability to replace, reduce, or avoid opioid use or the quantity of opioids prescribed.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A4945
SPONSOR: Steck TITLE OF BILL:
An act to amend the insurance law and the social services law, in
relation to requiring health insurers to provide coverage for non-opioid
treatments utilized for pain management
PURPOSE:
Requires health insurers to provide coverage for non-opioid treatments
utilized for pain management.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1: Section 1. Subsection (i) of section 3216 of the insurance
law is amended by adding a new paragraph 36. Section 2: Subsection (1)
of section 3221 of the insurance law is amended by adding a new para-
graph. Section 3: Section 4303 of the insurance law is amended by adding
a new subsection (ss). Section 4: The social services law is amended by
adding a new section 365-o. Section 5: Identifies effective date.
JUSTIFICATION:
In the year ending March 30, the Centers for Disease Control and
Prevention reported 73,480 overdose deaths, the highest number ever
recorded. In addition, research published in the Journal of the American
Medical Association concluded that opioid-related hospitalizations cost
$2.2 billion a year. The CDC estimates the total economic burden of
prescription opioid misuse is $78.5 billion a year. Nationally, overdose
deaths were the highest in history with over 91,000 drug-involved over-
dose deaths and over 68,000 opioid-involved overdose deaths in 2020. New
York State is not an exception to this national trend, experiencing an
increase in overdose deaths involving any opioid increased by 44% from
2,939 in 2019 to 4,233 in 2020 at an average of nearly 12 resident
deaths every day during 2020. Research shows 80% of post-surgery
patients are prescribed opioids for pain, and 3 million of these
patients become persistent users. Opioid addiction is too often the
result when a patient is prescribed an opioid to relieve pain from an
injury or while recovering from surgery. However, there are non-opioid
alternatives available to relieve pain, either with medication or pain-
relieving devices. This bill would require every policy which provides
medical, major medical, or similar comprehensive type coverage shall
include coverage for non-opioid treatments utilized for pain management
LEGISLATIVE HISTORY:
New Bill
FISCAL IMPLICATIONS:
None
EFFECTIVE DATE:
This act shall take effect on the one hundred twentieth day after it
shall have become a law, and shall apply to all policies and contracts
issued, renewed, modified, altered or amended on or after such date
STATE OF NEW YORK
________________________________________________________________________
4945
2023-2024 Regular Sessions
IN ASSEMBLY
February 27, 2023
___________
Introduced by M. of A. STECK, K. BROWN -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law and the social services law, in
relation to requiring health insurers to provide coverage for non-o-
pioid treatments utilized for pain management
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 39 to read as follows:
3 (39) (A) Every policy which provides medical, major medical, or simi-
4 lar comprehensive type coverage shall include coverage for non-opioid
5 treatments utilized for pain management.
6 (B) As used in this paragraph "non-opioid treatments utilized for pain
7 management" shall include, but not be limited to:
8 (i) a drug or biological product that is indicated to produce analge-
9 sia without acting upon the body's opioid receptors that has demon-
10 strated the ability to replace, reduce, or avoid opioid use or the quan-
11 tity of opioids prescribed; or
12 (ii) an implantable, reusable, or disposable medical device for the
13 intended use of managing or treating pain that has demonstrated the
14 ability to replace, reduce, or avoid opioid use or the quantity of
15 opioids prescribed.
16 (C) Coverage provided under this paragraph may be subject to annual
17 deductibles and co-insurance as deemed appropriate by the superintendent
18 and that are consistent with those imposed on other benefits within a
19 given policy.
20 § 2. Subsection (l) of section 3221 of the insurance law is amended by
21 adding a new paragraph 22 to read as follows:
22 (22) (A) Every group or blanket policy which provides medical, major
23 medical, or similar comprehensive type coverage shall include coverage
24 for non-opioid treatments utilized for pain management.
25 (B) As used in this paragraph "non-opioid treatments utilized for pain
26 management" shall include, but not be limited to:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD09020-01-3
A. 4945 2
1 (i) a drug or biological product that is indicated to produce analge-
2 sia without acting upon the body's opioid receptors that has demon-
3 strated the ability to replace, reduce, or avoid opioid use or the quan-
4 tity of opioids prescribed; or
5 (ii) an implantable, reusable, or disposable medical device for the
6 intended use of managing or treating pain that has demonstrated the
7 ability to replace, reduce, or avoid opioid use or the quantity of
8 opioids prescribed.
9 (C) Coverage provided under this paragraph may be subject to annual
10 deductibles and co-insurance as deemed appropriate by the superintendent
11 and that are consistent with those imposed on other benefits within a
12 given policy.
13 § 3. Section 4303 of the insurance law is amended by adding a new
14 subsection (uu) to read as follows:
15 (uu) (1) Every contract issued by a medical expense indemnity corpo-
16 ration, hospital service corporation, or health service corporation
17 which provides medical, major medical, or similar comprehensive type
18 coverage shall include coverage for non-opioid treatments utilized for
19 pain management.
20 (2) As used in this subsection "non-opioid treatments utilized for
21 pain management" shall include, but not be limited to:
22 (A) a drug or biological product that is indicated to produce analge-
23 sia without acting upon the body's opioid receptors that has demon-
24 strated the ability to replace, reduce, or avoid opioid use or the quan-
25 tity of opioids prescribed; or
26 (B) an implantable, reusable, or disposable medical device for the
27 intended use of managing or treating pain that has demonstrated the
28 ability to replace, reduce, or avoid opioid use or the quantity of
29 opioids prescribed.
30 (3) Coverage provided under this subsection may be subject to annual
31 deductibles and co-insurance as deemed appropriate by the superintendent
32 and that are consistent with those imposed on other benefits within a
33 given policy.
34 § 4. The social services law is amended by adding a new section 365-p
35 to read as follows:
36 § 365-p. Provision of alternative treatment for pain management. 1.
37 The commissioner shall establish standards and guidelines for the
38 provision of non-opioid treatments utilized for pain management under
39 the medical assistance program. In establishing such standards and
40 guidelines, the commissioner shall consult with providers of non-opioid
41 treatments utilized for pain management and other interested parties.
42 2. For purposes of this title, "non-opioid treatments utilized for
43 pain management" shall include, but not be limited to:
44 (a) a drug or biological product that is indicated to produce analge-
45 sia without acting upon the body's opioid receptors that has demon-
46 strated the ability to replace, reduce, or avoid opioid use or the quan-
47 tity of opioids prescribed; or
48 (b) an implantable, reusable, or disposable medical device for the
49 intended use of managing or treating pain that has demonstrated the
50 ability to replace, reduce, or avoid opioid use or the quantity of
51 opioids prescribed.
52 § 5. This act shall take effect on the one hundred twentieth day after
53 it shall have become a law, and shall apply to all policies and
54 contracts issued, renewed, modified, altered or amended on or after such
55 date.
