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.