S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1921--A
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 14, 2025
                                ___________
 
 Introduced  by  M.  of A. PAULIN, LEVENBERG -- read once and referred to
   the Committee on Insurance  --  committee  discharged,  bill  amended,
   ordered reprinted as amended and recommitted to said committee
 
 AN  ACT  to  amend the insurance law, in relation to providing insurance
   coverage for non-opioid treatment of 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 40 to read as follows:
   (40) (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  AND
 NON-OPIOID  DRUGS  APPROVED  BY THE UNITED STATES FOOD AND DRUG ADMINIS-
 TRATION (FDA) FOR THE TREATMENT OF ACUTE  OR  CHRONIC  PAIN.  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.  COVERAGE  UNDER  THIS PARAGRAPH SHALL NOT
 DISADVANTAGE OR DISCOURAGE ANY NON-OPIOID DRUG APPROVED  BY  THE  UNITED
 STATES  FOOD  AND DRUG ADMINISTRATION (FDA) FOR THE TREATMENT OF CHRONIC
 OR ACUTE PAIN RELATIVE TO ANY OPIOID DRUG FOR THE TREATMENT  OF  CHRONIC
 OR  ACUTE  PAIN,  WHERE  IMPERMISSIBLE  DISADVANTAGING OR DISCOURAGEMENT
 INCLUDES, WITHOUT LIMITATION: DESIGNATING ANY SUCH NON-OPIOID DRUG AS  A
 NON-PREFERRED  DRUG  IF  ANY  OPIOID OR NARCOTIC DRUG IS DESIGNATED AS A
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05350-02-5
              

 A. 1921--A                          2
 
 PREFERRED DRUG; OR  ESTABLISHING  MORE  RESTRICTIVE  OR  MORE  EXTENSIVE
 UTILIZATION  CONTROLS INCLUDING, BUT NOT LIMITED TO, MORE RESTRICTIVE OR
 MORE EXTENSIVE FINANCIAL  REQUIREMENTS,  PRIOR  AUTHORIZATION,  OR  STEP
 THERAPY  REQUIREMENTS,  FOR SUCH NON-OPIOID DRUG THAN THE LEAST RESTRIC-
 TIVE OR EXTENSIVE UTILIZATION CONTROLS APPLICABLE TO ANY SUCH OPIOID  OR
 NARCOTIC DRUG.
   (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;
   (IV)  "CHRONIC  PAIN" MEANS PAIN THAT PERSISTS OR RECURS FOR MORE THAN
 THREE MONTHS; AND
   (V) "ACUTE PAIN" MEANS PAIN WHETHER RESULTING FROM DISEASE, ACCIDENTAL
 OR INTENTIONAL TRAUMA, OR OTHER CAUSES THAT IS  REASONABLY  EXPECTED  TO
 LAST ONLY A SHORT PERIOD OF TIME.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 23 to read as follows:
   (23) (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 AND  NON-OPIOID  DRUGS  APPROVED  BY  THE  UNITED
 STATES  FOOD  AND DRUG ADMINISTRATION (FDA) FOR THE TREATMENT OF CHRONIC
 OR ACUTE PAIN. ACCESS TO NON-OPIOID TREATMENT AND DRUGS FOR  THE  TREAT-
 MENT  OF  ACUTE  OR  CHRONIC  PAIN  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.  COVERAGE  UNDER  THIS  PARAGRAPH  SHALL  NOT
 DISADVANTAGE  OR  DISCOURAGE  ANY NON-OPIOID DRUG APPROVED BY THE UNITED
 STATES FOOD AND DRUG ADMINISTRATION (FDA) FOR THE TREATMENT  OF  CHRONIC
 OR  ACUTE  PAIN RELATIVE TO ANY OPIOID DRUG FOR THE TREATMENT OF CHRONIC
 OR ACUTE PAIN,  WHERE  IMPERMISSIBLE  DISADVANTAGING  OR  DISCOURAGEMENT
 INCLUDES,  WITHOUT LIMITATION: DESIGNATING ANY SUCH NON-OPIOID DRUG AS A
 NON-PREFERRED DRUG IF ANY OPIOID OR NARCOTIC DRUG  IS  DESIGNATED  AS  A
 PREFERRED  DRUG;  OR  ESTABLISHING  MORE  RESTRICTIVE  OR MORE EXTENSIVE
 A. 1921--A                          3
 
 UTILIZATION CONTROLS INCLUDING, BUT NOT LIMITED TO, MORE RESTRICTIVE  OR
 MORE  EXTENSIVE  FINANCIAL  REQUIREMENTS,  PRIOR  AUTHORIZATION, OR STEP
 THERAPY REQUIREMENTS, FOR SUCH NON-OPIOID DRUG THAN THE  LEAST  RESTRIC-
 TIVE  OR EXTENSIVE UTILIZATION CONTROLS APPLICABLE TO ANY SUCH OPIOID OR
 NARCOTIC DRUG.
   (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;
   (IV) "CHRONIC PAIN" MEANS PAIN THAT PERSISTS OR RECURS FOR  MORE  THAN
 THREE MONTHS; AND
   (V) "ACUTE PAIN" MEANS PAIN WHETHER RESULTING FROM DISEASE, ACCIDENTAL
 OR  INTENTIONAL  TRAUMA,  OR OTHER CAUSES THAT IS REASONABLY EXPECTED TO
 LAST ONLY A SHORT PERIOD OF TIME.
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ww) to read as follows:
   (WW)  (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,  AND  NON-OPIOID DRUGS APPROVED BY THE
 UNITED STATES FOOD AND DRUG ADMINISTRATION (FDA) FOR  THE  TREATMENT  OF
 ACUTE  OR CHRONIC PAIN. 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.
   (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. COVERAGE  UNDER  THIS  SUBSECTION  SHALL  NOT
 DISADVANTAGE  OR  DISCOURAGE  ANY NON-OPIOID DRUG APPROVED BY THE UNITED
 STATES FOOD AND DRUG ADMINISTRATION (FDA) FOR THE TREATMENT  OF  CHRONIC
 OR  ACUTE  PAIN RELATIVE TO ANY OPIOID DRUG FOR THE TREATMENT OF CHRONIC
 OR ACUTE PAIN,  WHERE  IMPERMISSIBLE  DISADVANTAGING  OR  DISCOURAGEMENT
 INCLUDES, WITHOUT LIMITATION: DESIGNATING ANY SUCH NON-OPIOID DRUG  AS A
 NON-PREFERRED  DRUG  IF  ANY  OPIOID OR NARCOTIC DRUG IS DESIGNATED AS A
 PREFERRED DRUG; OR  ESTABLISHING  MORE  RESTRICTIVE  OR  MORE  EXTENSIVE
 UTILIZATION  CONTROLS INCLUDING, BUT NOT LIMITED TO, MORE RESTRICTIVE OR
 MORE EXTENSIVE FINANCIAL  REQUIREMENTS,  PRIOR  AUTHORIZATION,  OR  STEP
 A. 1921--A                          4
 
 THERAPY  REQUIREMENTS,  FOR SUCH NON-OPIOID DRUG THAN THE LEAST RESTRIC-
 TIVE OR EXTENSIVE UTILIZATION CONTROLS APPLICABLE TO ANY SUCH OPIOID  OR
 NARCOTIC DRUG.
   (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;
   (D) "CHRONIC PAIN" MEANS PAIN THAT PERSISTS OR RECURS  FOR  MORE  THAN
 THREE MONTHS; AND
   (E) "ACUTE PAIN" MEANS PAIN WHETHER RESULTING FROM DISEASE, ACCIDENTAL
 OR  INTENTIONAL  TRAUMA,  OR OTHER CAUSES THAT IS REASONABLY EXPECTED TO
 LAST ONLY A SHORT PERIOD OF TIME.
   § 4. This act shall take effect the first day of January next succeed-
 ing the date 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.