S T A T E O F N E W Y O R K
________________________________________________________________________
4945
2023-2024 Regular Sessions
I N A S S E M B L Y
February 27, 2023
___________
Introduced by M. of A. STECK, K. BROWN -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law and the social services law, in
relation to requiring health insurers to provide coverage for non-o-
pioid treatments utilized for pain management
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (i) of section 3216 of the insurance law is
amended by adding a new paragraph 39 to read as follows:
(39) (A) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMI-
LAR COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE FOR NON-OPIOID
TREATMENTS UTILIZED FOR PAIN MANAGEMENT.
(B) AS USED IN THIS PARAGRAPH "NON-OPIOID TREATMENTS UTILIZED FOR PAIN
MANAGEMENT" SHALL INCLUDE, BUT NOT BE LIMITED TO:
(I) A DRUG OR BIOLOGICAL PRODUCT THAT IS INDICATED TO PRODUCE ANALGE-
SIA WITHOUT ACTING UPON THE BODY'S OPIOID RECEPTORS THAT HAS DEMON-
STRATED THE ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUAN-
TITY OF OPIOIDS PRESCRIBED; OR
(II) AN IMPLANTABLE, REUSABLE, OR DISPOSABLE MEDICAL DEVICE FOR THE
INTENDED USE OF MANAGING OR TREATING PAIN THAT HAS DEMONSTRATED THE
ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUANTITY OF
OPIOIDS PRESCRIBED.
(C) COVERAGE PROVIDED UNDER THIS PARAGRAPH MAY BE SUBJECT TO ANNUAL
DEDUCTIBLES AND CO-INSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT
AND THAT ARE CONSISTENT WITH THOSE IMPOSED ON OTHER BENEFITS WITHIN A
GIVEN POLICY.
§ 2. Subsection (l) of section 3221 of the insurance law is amended by
adding a new paragraph 22 to read as follows:
(22) (A) EVERY GROUP OR BLANKET POLICY WHICH PROVIDES MEDICAL, MAJOR
MEDICAL, OR SIMILAR COMPREHENSIVE TYPE COVERAGE SHALL INCLUDE COVERAGE
FOR NON-OPIOID TREATMENTS UTILIZED FOR PAIN MANAGEMENT.
(B) AS USED IN THIS PARAGRAPH "NON-OPIOID TREATMENTS UTILIZED FOR PAIN
MANAGEMENT" SHALL INCLUDE, BUT NOT BE LIMITED TO:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09020-01-3
A. 4945 2
(I) A DRUG OR BIOLOGICAL PRODUCT THAT IS INDICATED TO PRODUCE ANALGE-
SIA WITHOUT ACTING UPON THE BODY'S OPIOID RECEPTORS THAT HAS DEMON-
STRATED THE ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUAN-
TITY OF OPIOIDS PRESCRIBED; OR
(II) AN IMPLANTABLE, REUSABLE, OR DISPOSABLE MEDICAL DEVICE FOR THE
INTENDED USE OF MANAGING OR TREATING PAIN THAT HAS DEMONSTRATED THE
ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUANTITY OF
OPIOIDS PRESCRIBED.
(C) COVERAGE PROVIDED UNDER THIS PARAGRAPH MAY BE SUBJECT TO ANNUAL
DEDUCTIBLES AND CO-INSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT
AND THAT ARE CONSISTENT WITH THOSE IMPOSED ON OTHER BENEFITS WITHIN A
GIVEN POLICY.
§ 3. Section 4303 of the insurance law is amended by adding a new
subsection (uu) to read as follows:
(UU) (1) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPO-
RATION, HOSPITAL SERVICE CORPORATION, OR HEALTH SERVICE CORPORATION
WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPREHENSIVE TYPE
COVERAGE SHALL INCLUDE COVERAGE FOR NON-OPIOID TREATMENTS UTILIZED FOR
PAIN MANAGEMENT.
(2) AS USED IN THIS SUBSECTION "NON-OPIOID TREATMENTS UTILIZED FOR
PAIN MANAGEMENT" SHALL INCLUDE, BUT NOT BE LIMITED TO:
(A) A DRUG OR BIOLOGICAL PRODUCT THAT IS INDICATED TO PRODUCE ANALGE-
SIA WITHOUT ACTING UPON THE BODY'S OPIOID RECEPTORS THAT HAS DEMON-
STRATED THE ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUAN-
TITY OF OPIOIDS PRESCRIBED; OR
(B) AN IMPLANTABLE, REUSABLE, OR DISPOSABLE MEDICAL DEVICE FOR THE
INTENDED USE OF MANAGING OR TREATING PAIN THAT HAS DEMONSTRATED THE
ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUANTITY OF
OPIOIDS PRESCRIBED.
(3) COVERAGE PROVIDED UNDER THIS SUBSECTION MAY BE SUBJECT TO ANNUAL
DEDUCTIBLES AND CO-INSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT
AND THAT ARE CONSISTENT WITH THOSE IMPOSED ON OTHER BENEFITS WITHIN A
GIVEN POLICY.
§ 4. The social services law is amended by adding a new section 365-p
to read as follows:
§ 365-P. PROVISION OF ALTERNATIVE TREATMENT FOR PAIN MANAGEMENT. 1.
THE COMMISSIONER SHALL ESTABLISH STANDARDS AND GUIDELINES FOR THE
PROVISION OF NON-OPIOID TREATMENTS UTILIZED FOR PAIN MANAGEMENT UNDER
THE MEDICAL ASSISTANCE PROGRAM. IN ESTABLISHING SUCH STANDARDS AND
GUIDELINES, THE COMMISSIONER SHALL CONSULT WITH PROVIDERS OF NON-OPIOID
TREATMENTS UTILIZED FOR PAIN MANAGEMENT AND OTHER INTERESTED PARTIES.
2. FOR PURPOSES OF THIS TITLE, "NON-OPIOID TREATMENTS UTILIZED FOR
PAIN MANAGEMENT" SHALL INCLUDE, BUT NOT BE LIMITED TO:
(A) A DRUG OR BIOLOGICAL PRODUCT THAT IS INDICATED TO PRODUCE ANALGE-
SIA WITHOUT ACTING UPON THE BODY'S OPIOID RECEPTORS THAT HAS DEMON-
STRATED THE ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUAN-
TITY OF OPIOIDS PRESCRIBED; OR
(B) AN IMPLANTABLE, REUSABLE, OR DISPOSABLE MEDICAL DEVICE FOR THE
INTENDED USE OF MANAGING OR TREATING PAIN THAT HAS DEMONSTRATED THE
ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUANTITY OF
OPIOIDS PRESCRIBED.
§ 5. This act shall take effect on the one hundred twentieth day after
it shall have become a law, and shall apply to all policies and
contracts issued, renewed, modified, altered or amended on or after such
date.