A01921 Summary:
BILL NO | A01921A |
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SAME AS | No Same As |
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SPONSOR | Paulin |
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COSPNSR | Levenberg |
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MLTSPNSR | |
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Amd 3216, 3221 & 4303, Ins L | |
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Provides outpatient insurance coverage for non-opioid treatment of chronic pain including complementary and integrative treatments and non-opioid drugs. |
A01921 Actions:
BILL NO | A01921A | |||||||||||||||||||||||||||||||||||||||||||||||||
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01/14/2025 | referred to insurance | |||||||||||||||||||||||||||||||||||||||||||||||||
05/21/2025 | amend (t) and recommit to insurance | |||||||||||||||||||||||||||||||||||||||||||||||||
05/21/2025 | print number 1921a |
A01921 Memo:
Go to topNEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)   BILL NUMBER: A1921A SPONSOR: Paulin
  TITLE OF BILL: An act to amend the insurance law, in relation to providing insurance coverage for non-opioid treatment of chronic pain   SUMMARY OF PROVISIONS: OF BILL: Section 1 of the bill amends the Insurance Law, Section 3216 by insert- ing a new paragraph 39; Section 2 of the bill amends the Insurance Law, Section 3221 by inserting a new Paragraph 22; and Section 3 of the bill amends the Insurance Law, Section 4303 by insert- ing a new subsection (uu), such that respectively: a) every policy that provides medical, major medical, or similar comprehensive-type coverage for pain management services; b) every insurer issuing group or blanket policies in the State of New York for pain management services; and c) every contract issued by a hospital service corporation, health service corporation or medical expense indemnity corporation that includes pain management services shall provide coverage for non-opioid treatment of chronic pain, including complementary and integrative care. Treatment limitations and financial costs to patients may not be more stringent than contained in substantially all medical benefits and any opioid- based chronic pain treatment provided by the policy or contract. Section 4 provides the effective date.   JUSTIFICATION: This bill builds upon Section 3331 of the Public Health Law, Subdivision 9 ("Section 3331") which requires practitioners to consider, and discuss nonopioid treatments with patients affected by pain, and if appropriate, prescribe or provide a referral for such treatments prior to starting an opioid. Since Section 3331 lacks any payer requirements for coverage, most patients are unable to afford and therefore access many of the treat- ments recommend to their patients. The bill would require insurers to provide coverage for non-opioid treatments, including complementary and integrative treatments. Provision of adequate insurance coverage would encourage primary care practitioners, other medical practitioners and patients to seek out nonopioid treatments as a first line therapy, when appropriate.   LEGISLATIVE HISTORY: A.9716 of 2024, referred to insurance. Similar to S.9192 of 2024, referred to insurance.   FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: A substantial portion of pain management practice involves invasive treatments, such as surgery, and injections. Such treatments are expen- sive, ineffective for many patients and frequently result in adverse effects requiring additional medical attention. By contrast, the thera- pies that this bill promotes are much less expensive and rarely produce adverse effects. If this bill is enacted, it is expected that the out- of-pocket cost burden to the state and local governments for employee health insurance will be lower.   EFFECTIVE DATE: The January 1 following enactment and applying to all policies and contracts issued, renewed, modified, altered or amended on or after that date.
A01921 Text:
Go to top STATE OF NEW YORK ________________________________________________________________________ 1921--A 2025-2026 Regular Sessions IN ASSEMBLY January 14, 2025 ___________ Introduced by M. of A. PAULIN, LEVENBERG -- read once and referred to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to providing insurance coverage for non-opioid treatment of chronic pain 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 40 to read as follows: 3 (40) (A) Every policy that provides medical, major medical, or similar 4 comprehensive-type coverage that provides coverage for pain management 5 services shall provide outpatient coverage for non-opioid treatment of 6 chronic pain including complementary and integrative treatments and 7 non-opioid drugs approved by the United States Food and Drug Adminis- 8 tration (FDA) for the treatment of acute or chronic pain. Access to 9 non-opioid treatment shall be comparable to that of other covered 10 services. Coverage shall be comparable for services provided by licensed 11 professionals. 12 (B) Coverage under this subsection shall not apply financial require- 13 ments or treatment limitations to non-opioid treatment of chronic pain 14 that are more restrictive than either of the following: the predominant 15 financial requirements and treatment limitations applied to substantial- 16 ly all medical benefits covered by the contract; and the financial 17 requirements and treatment limitations applied to any opioid-based 18 treatment of chronic pain. Coverage under this paragraph shall not 19 disadvantage or discourage any non-opioid drug approved by the United 20 States Food and Drug Administration (FDA) for the treatment of chronic 21 or acute pain relative to any opioid drug for the treatment of chronic 22 or acute pain, where impermissible disadvantaging or discouragement 23 includes, without limitation: designating any such non-opioid drug as a 24 non-preferred drug if any opioid or narcotic drug is designated as a EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05350-02-5A. 1921--A 2 1 preferred drug; or establishing more restrictive or more extensive 2 utilization controls including, but not limited to, more restrictive or 3 more extensive financial requirements, prior authorization, or step 4 therapy requirements, for such non-opioid drug than the least restric- 5 tive or extensive utilization controls applicable to any such opioid or 6 narcotic drug. 7 (C) For the purposes of this paragraph the following terms shall have 8 the following meanings: 9 (i) "financial requirement" means deductible, co-payments, co-insu- 10 rance and out-of-pocket expenses; 11 (ii) "predominant" means that a financial requirement or treatment 12 limitation is the most common or frequent of such type of limit or 13 requirement; 14 (iii) "treatment limitation" means limits on the frequency of treat- 15 ment, number of visits, days of coverage, or other similar limits on the 16 scope or duration of treatment and includes non-quantitative treatment 17 limitations such as: medical management standards limiting or excluding 18 benefits based on medical necessity, or based on whether the treatment 19 is experimental or investigational; standards for provider admission to 20 participate in a network, including reimbursement rates; methods for 21 determining usual, customary and reasonable charges; exclusions based on 22 failure to complete a course of treatment; and restrictions based on 23 geographic location, facility type, provider specialty, and other crite- 24 ria that limit the scope or duration of benefits for services provided 25 under the contract; 26 (iv) "chronic pain" means pain that persists or recurs for more than 27 three months; and 28 (v) "acute pain" means pain whether resulting from disease, accidental 29 or intentional trauma, or other causes that is reasonably expected to 30 last only a short period of time. 31 § 2. Subsection (l) of section 3221 of the insurance law is amended by 32 adding a new paragraph 23 to read as follows: 33 (23) (A) Every insurer delivering a group or blanket policy or issuing 34 a group or blanket policy for delivery in this state that provides 35 coverage for pain management services shall provide outpatient coverage 36 for non-opioid treatment of chronic pain including complementary and 37 integrative treatments and non-opioid drugs approved by the United 38 States Food and Drug Administration (FDA) for the treatment of chronic 39 or acute pain. Access to non-opioid treatment and drugs for the treat- 40 ment of acute or chronic pain shall be comparable to that of other 41 covered services. Coverage shall be comparable for services provided by 42 licensed professionals. 43 (B) Coverage under this subsection shall not apply financial require- 44 ments or treatment limitations to non-opioid treatment of chronic pain 45 that are more restrictive than either of the following: the predominant 46 financial requirements and treatment limitations applied to substantial- 47 ly all medical benefits covered by the contract; and the financial 48 requirements and treatment limitations applied to any opioid-based 49 treatment of chronic pain. Coverage under this paragraph shall not 50 disadvantage or discourage any non-opioid drug approved by the United 51 States Food and Drug Administration (FDA) for the treatment of chronic 52 or acute pain relative to any opioid drug for the treatment of chronic 53 or acute pain, where impermissible disadvantaging or discouragement 54 includes, without limitation: designating any such non-opioid drug as a 55 non-preferred drug if any opioid or narcotic drug is designated as a 56 preferred drug; or establishing more restrictive or more extensiveA. 1921--A 3 1 utilization controls including, but not limited to, more restrictive or 2 more extensive financial requirements, prior authorization, or step 3 therapy requirements, for such non-opioid drug than the least restric- 4 tive or extensive utilization controls applicable to any such opioid or 5 narcotic drug. 6 (C) For the purposes of this paragraph the following terms shall have 7 the following meanings: 8 (i) "financial requirement" means deductible, co-payments, co-insu- 9 rance and out-of-pocket expenses; 10 (ii) "predominant" means that a financial requirement or treatment 11 limitation is the most common or frequent of such type of limit or 12 requirement; 13 (iii) "treatment limitation" means limits on the frequency of treat- 14 ment, number of visits, days of coverage, or other similar limits on the 15 scope or duration of treatment and includes non-quantitative treatment 16 limitations such as: medical management standards limiting or excluding 17 benefits based on medical necessity, or based on whether the treatment 18 is experimental or investigational; standards for provider admission to 19 participate in a network, including reimbursement rates; methods for 20 determining usual, customary and reasonable charges; exclusions based on 21 failure to complete a course of treatment; and restrictions based on 22 geographic location, facility type, provider specialty, and other crite- 23 ria that limit the scope or duration of benefits for services provided 24 under the contract; 25 (iv) "chronic pain" means pain that persists or recurs for more than 26 three months; and 27 (v) "acute pain" means pain whether resulting from disease, accidental 28 or intentional trauma, or other causes that is reasonably expected to 29 last only a short period of time. 30 § 3. Section 4303 of the insurance law is amended by adding a new 31 subsection (ww) to read as follows: 32 (ww) (1) Every contract issued by a hospital service corporation, 33 health service corporation or medical expense indemnity corporation that 34 includes coverage for pain management services shall provide outpatient 35 coverage for non-opioid treatment of chronic pain including complementa- 36 ry and integrative treatments, and non-opioid drugs approved by the 37 United States Food and Drug Administration (FDA) for the treatment of 38 acute or chronic pain. Access to non-opioid treatment shall be compara- 39 ble to that of other covered services. Coverage shall be comparable for 40 services provided by licensed professionals. 41 (2) Coverage under this subsection shall not apply financial require- 42 ments or treatment limitations to non-opioid treatment of chronic pain 43 that are more restrictive than either of the following: the predominant 44 financial requirements and treatment limitations applied to substantial- 45 ly all medical benefits covered by the contract; and the financial 46 requirements and treatment limitations applied to any opioid-based 47 treatment of chronic pain. Coverage under this subsection shall not 48 disadvantage or discourage any non-opioid drug approved by the United 49 States Food and Drug Administration (FDA) for the treatment of chronic 50 or acute pain relative to any opioid drug for the treatment of chronic 51 or acute pain, where impermissible disadvantaging or discouragement 52 includes, without limitation: designating any such non-opioid drug as a 53 non-preferred drug if any opioid or narcotic drug is designated as a 54 preferred drug; or establishing more restrictive or more extensive 55 utilization controls including, but not limited to, more restrictive or 56 more extensive financial requirements, prior authorization, or stepA. 1921--A 4 1 therapy requirements, for such non-opioid drug than the least restric- 2 tive or extensive utilization controls applicable to any such opioid or 3 narcotic drug. 4 (3) For the purposes of this subsection the following terms shall have 5 the following meanings: 6 (A) "financial requirement" means deductible, co-payments, co-insu- 7 rance and out-of-pocket expenses; 8 (B) "predominant" means that a financial requirement or treatment 9 limitation is the most common or frequent of such type of limit or 10 requirement; 11 (C) "treatment limitation" means limits on the frequency of treatment, 12 number of visits, days of coverage, or other similar limits on the scope 13 or duration of treatment and includes non-quantitative treatment limita- 14 tions such as: medical management standards limiting or excluding bene- 15 fits based on medical necessity, or based on whether the treatment is 16 experimental or investigational; standards for provider admission to 17 participate in a network, including reimbursement rates; methods for 18 determining usual, customary and reasonable charges; exclusions based on 19 failure to complete a course of treatment; and restrictions based on 20 geographic location, facility type, provider specialty, and other crite- 21 ria that limit the scope or duration of benefits for services provided 22 under the contract; 23 (D) "chronic pain" means pain that persists or recurs for more than 24 three months; and 25 (E) "acute pain" means pain whether resulting from disease, accidental 26 or intentional trauma, or other causes that is reasonably expected to 27 last only a short period of time. 28 § 4. This act shall take effect the first day of January next succeed- 29 ing the date on which it shall have become a law and shall apply to all 30 policies and contracts issued, renewed, modified, altered, or amended on 31 or after such date.