NEW 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.
