S T A T E O F N E W Y O R K
________________________________________________________________________
9716
I N A S S E M B L Y
April 3, 2024
___________
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:
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 THAT PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE-TYPE COVERAGE THAT PROVIDES COVERAGE FOR PAIN MANAGEMENT
SERVICES SHALL PROVIDE OUTPATIENT COVERAGE FOR NON-OPIOID TREATMENT OF
CHRONIC PAIN INCLUDING COMPLEMENTARY AND INTEGRATIVE TREATMENTS. ACCESS
TO NON-OPIOID TREATMENT SHALL BE COMPARABLE TO THAT OF OTHER COVERED
SERVICES. COVERAGE SHALL BE COMPARABLE FOR SERVICES PROVIDED BY LICENSED
PROFESSIONALS.
(B) COVERAGE UNDER THIS SUBSECTION SHALL NOT APPLY FINANCIAL REQUIRE-
MENTS OR TREATMENT LIMITATIONS TO NON-OPIOID TREATMENT OF CHRONIC PAIN
THAT ARE MORE RESTRICTIVE THAN EITHER OF THE FOLLOWING: THE PREDOMINANT
FINANCIAL REQUIREMENTS AND TREATMENT LIMITATIONS APPLIED TO SUBSTANTIAL-
LY ALL MEDICAL BENEFITS COVERED BY THE CONTRACT; AND THE FINANCIAL
REQUIREMENTS AND TREATMENT LIMITATIONS APPLIED TO ANY OPIOID-BASED
TREATMENT OF CHRONIC PAIN.
(C) FOR THE PURPOSES OF THIS PARAGRAPH THE FOLLOWING TERMS SHALL HAVE
THE FOLLOWING MEANINGS:
(I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, CO-PAYMENTS, CO-INSU-
RANCE AND OUT-OF-POCKET EXPENSES;
(II) "PREDOMINANT" MEANS THAT A FINANCIAL REQUIREMENT OR TREATMENT
LIMITATION IS THE MOST COMMON OR FREQUENT OF SUCH TYPE OF LIMIT OR
REQUIREMENT;
(III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
SCOPE OR DURATION OF TREATMENT AND INCLUDES NON-QUANTITATIVE TREATMENT
LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
BENEFITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15062-01-4
A. 9716 2
IS EXPERIMENTAL OR INVESTIGATIONAL; STANDARDS FOR PROVIDER ADMISSION TO
PARTICIPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR
DETERMINING USUAL, CUSTOMARY AND REASONABLE CHARGES; EXCLUSIONS BASED ON
FAILURE TO COMPLETE A COURSE OF TREATMENT; AND RESTRICTIONS BASED ON
GEOGRAPHIC LOCATION, FACILITY TYPE, PROVIDER SPECIALTY, AND OTHER CRITE-
RIA THAT LIMIT THE SCOPE OR DURATION OF BENEFITS FOR SERVICES PROVIDED
UNDER THE CONTRACT; AND
(IV) "CHRONIC PAIN" MEANS PAIN THAT PERSISTS OR RECURS FOR MORE THAN
THREE MONTHS.
§ 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 INSURER DELIVERING A GROUP OR BLANKET POLICY OR ISSUING
A GROUP OR BLANKET POLICY FOR DELIVERY IN THIS STATE THAT PROVIDES
COVERAGE FOR PAIN MANAGEMENT SERVICES SHALL PROVIDE OUTPATIENT COVERAGE
FOR NON-OPIOID TREATMENT OF CHRONIC PAIN INCLUDING COMPLEMENTARY AND
INTEGRATIVE TREATMENTS. ACCESS TO NON-OPIOID TREATMENT SHALL BE COMPARA-
BLE TO THAT OF OTHER COVERED SERVICES. COVERAGE SHALL BE COMPARABLE FOR
SERVICES PROVIDED BY LICENSED PROFESSIONALS.
(B) COVERAGE UNDER THIS SUBSECTION SHALL NOT APPLY FINANCIAL REQUIRE-
MENTS OR TREATMENT LIMITATIONS TO NON-OPIOID TREATMENT OF CHRONIC PAIN
THAT ARE MORE RESTRICTIVE THAN EITHER OF THE FOLLOWING: THE PREDOMINANT
FINANCIAL REQUIREMENTS AND TREATMENT LIMITATIONS APPLIED TO SUBSTANTIAL-
LY ALL MEDICAL BENEFITS COVERED BY THE CONTRACT; AND THE FINANCIAL
REQUIREMENTS AND TREATMENT LIMITATIONS APPLIED TO ANY OPIOID-BASED
TREATMENT OF CHRONIC PAIN.
(C) FOR THE PURPOSES OF THIS PARAGRAPH THE FOLLOWING TERMS SHALL HAVE
THE FOLLOWING MEANINGS:
(I) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, CO-PAYMENTS, CO-INSU-
RANCE AND OUT-OF-POCKET EXPENSES;
(II) "PREDOMINANT" MEANS THAT A FINANCIAL REQUIREMENT OR TREATMENT
LIMITATION IS THE MOST COMMON OR FREQUENT OF SUCH TYPE OF LIMIT OR
REQUIREMENT;
(III) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREAT-
MENT, NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE
SCOPE OR DURATION OF TREATMENT AND INCLUDES NON-QUANTITATIVE TREATMENT
LIMITATIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING
BENEFITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT
IS EXPERIMENTAL OR INVESTIGATIONAL; STANDARDS FOR PROVIDER ADMISSION TO
PARTICIPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR
DETERMINING USUAL, CUSTOMARY AND REASONABLE CHARGES; EXCLUSIONS BASED ON
FAILURE TO COMPLETE A COURSE OF TREATMENT; AND RESTRICTIONS BASED ON
GEOGRAPHIC LOCATION, FACILITY TYPE, PROVIDER SPECIALTY, AND OTHER CRITE-
RIA THAT LIMIT THE SCOPE OR DURATION OF BENEFITS FOR SERVICES PROVIDED
UNDER THE CONTRACT; AND
(IV) "CHRONIC PAIN" MEANS PAIN THAT PERSISTS OR RECURS FOR MORE THAN
THREE MONTHS.
§ 3. Section 4303 of the insurance law is amended by adding a new
subsection (vv) to read as follows:
(VV) (1) EVERY CONTRACT ISSUED BY A HOSPITAL SERVICE CORPORATION,
HEALTH SERVICE CORPORATION OR MEDICAL EXPENSE INDEMNITY CORPORATION THAT
INCLUDES COVERAGE FOR PAIN MANAGEMENT SERVICES SHALL PROVIDE OUTPATIENT
COVERAGE FOR NON-OPIOID TREATMENT OF CHRONIC PAIN INCLUDING COMPLEMENTA-
RY AND INTEGRATIVE TREATMENTS. ACCESS TO NON-OPIOID TREATMENT SHALL BE
COMPARABLE TO THAT OF OTHER COVERED SERVICES. COVERAGE SHALL BE COMPARA-
BLE FOR SERVICES PROVIDED BY LICENSED PROFESSIONALS.
A. 9716 3
(2) COVERAGE UNDER THIS SUBSECTION SHALL NOT APPLY FINANCIAL REQUIRE-
MENTS OR TREATMENT LIMITATIONS TO NON-OPIOID TREATMENT OF CHRONIC PAIN
THAT ARE MORE RESTRICTIVE THAN EITHER OF THE FOLLOWING: THE PREDOMINANT
FINANCIAL REQUIREMENTS AND TREATMENT LIMITATIONS APPLIED TO SUBSTANTIAL-
LY ALL MEDICAL BENEFITS COVERED BY THE CONTRACT; AND THE FINANCIAL
REQUIREMENTS AND TREATMENT LIMITATIONS APPLIED TO ANY OPIOID-BASED
TREATMENT OF CHRONIC PAIN.
(3) FOR THE PURPOSES OF THIS SUBSECTION THE FOLLOWING TERMS SHALL HAVE
THE FOLLOWING MEANINGS:
(A) "FINANCIAL REQUIREMENT" MEANS DEDUCTIBLE, CO-PAYMENTS, CO-INSU-
RANCE AND OUT-OF-POCKET EXPENSES;
(B) "PREDOMINANT" MEANS THAT A FINANCIAL REQUIREMENT OR TREATMENT
LIMITATION IS THE MOST COMMON OR FREQUENT OF SUCH TYPE OF LIMIT OR
REQUIREMENT;
(C) "TREATMENT LIMITATION" MEANS LIMITS ON THE FREQUENCY OF TREATMENT,
NUMBER OF VISITS, DAYS OF COVERAGE, OR OTHER SIMILAR LIMITS ON THE SCOPE
OR DURATION OF TREATMENT AND INCLUDES NON-QUANTITATIVE TREATMENT LIMITA-
TIONS SUCH AS: MEDICAL MANAGEMENT STANDARDS LIMITING OR EXCLUDING BENE-
FITS BASED ON MEDICAL NECESSITY, OR BASED ON WHETHER THE TREATMENT IS
EXPERIMENTAL OR INVESTIGATIONAL; STANDARDS FOR PROVIDER ADMISSION TO
PARTICIPATE IN A NETWORK, INCLUDING REIMBURSEMENT RATES; METHODS FOR
DETERMINING USUAL, CUSTOMARY AND REASONABLE CHARGES; EXCLUSIONS BASED ON
FAILURE TO COMPLETE A COURSE OF TREATMENT; AND RESTRICTIONS BASED ON
GEOGRAPHIC LOCATION, FACILITY TYPE, PROVIDER SPECIALTY, AND OTHER CRITE-
RIA THAT LIMIT THE SCOPE OR DURATION OF BENEFITS FOR SERVICES PROVIDED
UNDER THE CONTRACT; AND
(D) "CHRONIC PAIN" MEANS PAIN THAT PERSISTS OR RECURS FOR MORE THAN
THREE MONTHS.
§ 4. This act shall take effect the first day of January next succeed-
ing the day on which 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.