NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1921
SPONSOR: Paulin TITLE OF BILL:
An act to amend the insurance law, in relation to providing insurance
coverage for 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. Same as 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.
STATE OF NEW YORK
________________________________________________________________________
1921
2025-2026 Regular Sessions
IN ASSEMBLY
January 14, 2025
___________
Introduced by M. of A. PAULIN -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to providing insurance
coverage for 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. Access
7 to non-opioid treatment shall be comparable to that of other covered
8 services. Coverage shall be comparable for services provided by licensed
9 professionals.
10 (B) Coverage under this subsection shall not apply financial require-
11 ments or treatment limitations to non-opioid treatment of chronic pain
12 that are more restrictive than either of the following: the predominant
13 financial requirements and treatment limitations applied to substantial-
14 ly all medical benefits covered by the contract; and the financial
15 requirements and treatment limitations applied to any opioid-based
16 treatment of chronic pain.
17 (C) For the purposes of this paragraph the following terms shall have
18 the following meanings:
19 (i) "financial requirement" means deductible, co-payments, co-insu-
20 rance and out-of-pocket expenses;
21 (ii) "predominant" means that a financial requirement or treatment
22 limitation is the most common or frequent of such type of limit or
23 requirement;
24 (iii) "treatment limitation" means limits on the frequency of treat-
25 ment, number of visits, days of coverage, or other similar limits on the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05350-01-5
A. 1921 2
1 scope or duration of treatment and includes non-quantitative treatment
2 limitations such as: medical management standards limiting or excluding
3 benefits based on medical necessity, or based on whether the treatment
4 is experimental or investigational; standards for provider admission to
5 participate in a network, including reimbursement rates; methods for
6 determining usual, customary and reasonable charges; exclusions based on
7 failure to complete a course of treatment; and restrictions based on
8 geographic location, facility type, provider specialty, and other crite-
9 ria that limit the scope or duration of benefits for services provided
10 under the contract; and
11 (iv) "Chronic pain" means pain that persists or recurs for more than
12 three months.
13 § 2. Subsection (l) of section 3221 of the insurance law is amended by
14 adding a new paragraph 23 to read as follows:
15 (23) (A) Every insurer delivering a group or blanket policy or issuing
16 a group or blanket policy for delivery in this state that provides
17 coverage for pain management services shall provide outpatient coverage
18 for non-opioid treatment of chronic pain including complementary and
19 integrative treatments. Access to non-opioid treatment shall be compara-
20 ble to that of other covered services. Coverage shall be comparable for
21 services provided by licensed professionals.
22 (B) Coverage under this subsection shall not apply financial require-
23 ments or treatment limitations to non-opioid treatment of chronic pain
24 that are more restrictive than either of the following: the predominant
25 financial requirements and treatment limitations applied to substantial-
26 ly all medical benefits covered by the contract; and the financial
27 requirements and treatment limitations applied to any opioid-based
28 treatment of chronic pain.
29 (C) For the purposes of this paragraph the following terms shall have
30 the following meanings:
31 (i) "financial requirement" means deductible, co-payments, co-insu-
32 rance and out-of-pocket expenses;
33 (ii) "predominant" means that a financial requirement or treatment
34 limitation is the most common or frequent of such type of limit or
35 requirement;
36 (iii) "treatment limitation" means limits on the frequency of treat-
37 ment, number of visits, days of coverage, or other similar limits on the
38 scope or duration of treatment and includes non-quantitative treatment
39 limitations such as: medical management standards limiting or excluding
40 benefits based on medical necessity, or based on whether the treatment
41 is experimental or investigational; standards for provider admission to
42 participate in a network, including reimbursement rates; methods for
43 determining usual, customary and reasonable charges; exclusions based on
44 failure to complete a course of treatment; and restrictions based on
45 geographic location, facility type, provider specialty, and other crite-
46 ria that limit the scope or duration of benefits for services provided
47 under the contract; and
48 (iv) "chronic pain" means pain that persists or recurs for more than
49 three months.
50 § 3. Section 4303 of the insurance law is amended by adding a new
51 subsection (ww) to read as follows:
52 (ww) (1) Every contract issued by a hospital service corporation,
53 health service corporation or medical expense indemnity corporation that
54 includes coverage for pain management services shall provide outpatient
55 coverage for non-opioid treatment of chronic pain including complementa-
56 ry and integrative treatments. Access to non-opioid treatment shall be
A. 1921 3
1 comparable to that of other covered services. Coverage shall be compara-
2 ble for services provided by licensed professionals.
3 (2) Coverage under this subsection shall not apply financial require-
4 ments or treatment limitations to non-opioid treatment of chronic pain
5 that are more restrictive than either of the following: the predominant
6 financial requirements and treatment limitations applied to substantial-
7 ly all medical benefits covered by the contract; and the financial
8 requirements and treatment limitations applied to any opioid-based
9 treatment of chronic pain.
10 (3) For the purposes of this subsection the following terms shall have
11 the following meanings:
12 (A) "financial requirement" means deductible, co-payments, co-insu-
13 rance and out-of-pocket expenses;
14 (B) "predominant" means that a financial requirement or treatment
15 limitation is the most common or frequent of such type of limit or
16 requirement;
17 (C) "treatment limitation" means limits on the frequency of treatment,
18 number of visits, days of coverage, or other similar limits on the scope
19 or duration of treatment and includes non-quantitative treatment limita-
20 tions such as: medical management standards limiting or excluding bene-
21 fits based on medical necessity, or based on whether the treatment is
22 experimental or investigational; standards for provider admission to
23 participate in a network, including reimbursement rates; methods for
24 determining usual, customary and reasonable charges; exclusions based on
25 failure to complete a course of treatment; and restrictions based on
26 geographic location, facility type, provider specialty, and other crite-
27 ria that limit the scope or duration of benefits for services provided
28 under the contract; and
29 (D) "chronic pain" means pain that persists or recurs for more than
30 three months.
31 § 4. This act shall take effect the first day of January next succeed-
32 ing the date on which it shall have become a law and shall apply to all
33 policies and contracts issued, renewed, modified, altered, or amended on
34 or after such date.
