Requires Medicaid to provide comprehensive coverage for the treatment of obesity including coverage for intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication.
STATE OF NEW YORK
________________________________________________________________________
2715
2025-2026 Regular Sessions
IN ASSEMBLY
January 22, 2025
___________
Introduced by M. of A. REYES -- read once and referred to the Committee
on Health
AN ACT to amend the social services law, in relation to expanding Medi-
caid coverage to include comprehensive coverage for the treatment of
obesity
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 2 of section 365-a of the social services law
2 is amended by adding a new paragraph (nn) to read as follows:
3 (nn) (i) comprehensive coverage for treatment of obesity, including
4 coverage for intensive behavioral therapy, bariatric surgery, and
5 FDA-approved anti-obesity medication, when such services are provided by
6 a health care practitioner licensed, certified, or authorized under
7 title eight of the education law, acting within such practitioner's
8 lawful scope of practice.
9 (ii) coverage criteria for FDA-approved anti-obesity medications
10 pursuant to subparagraph (i) of this paragraph shall not be more
11 restrictive than the FDA-approved indications for such treatments.
12 (iii) coverage provided pursuant to this paragraph shall be neither
13 different nor separate from coverage for any other illness, condition,
14 or disorder for purposes of determining deductibles, lifetime dollar
15 limits, copayment and coinsurance factors, and benefit year maximum for
16 deductibles and copayment and coinsurance factors.
17 (iv) nothing in this paragraph shall preclude the undertaking of
18 utilization management to determine the medical necessity for treatment
19 of obesity under this section, provided that all such appropriateness
20 and medical necessity determinations are made in the same manner as such
21 determinations are made for the treatment of any other illness, condi-
22 tion, or disorder covered by this section.
23 (v) the Medicaid program shall provide notice to its enrollees regard-
24 ing the coverage required by this section. The notice shall be in writ-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03144-01-5
A. 2715 2
1 ing and prominently positioned in any literature or correspondence sent
2 to enrollees and shall be transmitted to enrollees when annual informa-
3 tion is made available to enrollees, or in any other mailing to enrol-
4 lees, provided that such notice is provided to enrollees enrolled on the
5 effective date of this paragraph no later than one year after such
6 effective date.
7 (vi) for the purposes of this paragraph, the following terms shall
8 have the following meanings:
9 (1) "Comprehensive coverage for treatment of obesity" shall include
10 coverage for intensive behavioral therapy, bariatric surgery, and
11 FDA-approved anti-obesity medication.
12 (2) "FDA-approved anti-obesity medication" shall mean any medication
13 approved by the federal food and drug administration with an indication
14 for chronic weight management in patients with obesity.
15 § 2. This act shall take effect on the one hundred eightieth day after
16 it shall have become a law. Effective immediately, the addition, amend-
17 ment and/or repeal of any rule or regulation necessary for the implemen-
18 tation of this act on its effective date are authorized to be made and
19 completed on or before such effective date.
