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A01921 Memo:

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.
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