Assembly Bill A2715

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2715
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 22, 2025
                                ___________
 
 Introduced  by M. of A. REYES -- read once and referred to the Committee
   on Health
 
 AN ACT to amend the social services law, in relation to expanding  Medi-
   caid  coverage  to include comprehensive coverage for the treatment of
   obesity
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subdivision 2 of section 365-a of the social services law
 is amended by adding a new paragraph (nn) to read as follows:
   (NN) (I) COMPREHENSIVE COVERAGE FOR TREATMENT  OF  OBESITY,  INCLUDING
 COVERAGE  FOR  INTENSIVE  BEHAVIORAL  THERAPY,  BARIATRIC  SURGERY,  AND
 FDA-APPROVED ANTI-OBESITY MEDICATION, WHEN SUCH SERVICES ARE PROVIDED BY
 A HEALTH CARE PRACTITIONER  LICENSED,  CERTIFIED,  OR  AUTHORIZED  UNDER
 TITLE  EIGHT  OF  THE  EDUCATION  LAW, ACTING WITHIN SUCH PRACTITIONER'S
 LAWFUL SCOPE OF PRACTICE.
   (II)  COVERAGE  CRITERIA  FOR  FDA-APPROVED  ANTI-OBESITY  MEDICATIONS
 PURSUANT  TO  SUBPARAGRAPH  (I)  OF  THIS  PARAGRAPH  SHALL  NOT BE MORE
 RESTRICTIVE THAN THE FDA-APPROVED INDICATIONS FOR SUCH TREATMENTS.
   (III) COVERAGE PROVIDED PURSUANT TO THIS PARAGRAPH  SHALL  BE  NEITHER
 DIFFERENT  NOR  SEPARATE FROM COVERAGE FOR ANY OTHER ILLNESS, CONDITION,
 OR DISORDER FOR PURPOSES OF  DETERMINING  DEDUCTIBLES,  LIFETIME  DOLLAR
 LIMITS,  COPAYMENT AND COINSURANCE FACTORS, AND BENEFIT YEAR MAXIMUM FOR
 DEDUCTIBLES AND COPAYMENT AND COINSURANCE FACTORS.
   (IV) NOTHING IN THIS  PARAGRAPH  SHALL  PRECLUDE  THE  UNDERTAKING  OF
 UTILIZATION  MANAGEMENT TO DETERMINE THE MEDICAL NECESSITY FOR TREATMENT
 OF OBESITY UNDER THIS SECTION, PROVIDED THAT  ALL  SUCH  APPROPRIATENESS
 AND MEDICAL NECESSITY DETERMINATIONS ARE MADE IN THE SAME MANNER AS SUCH
 DETERMINATIONS  ARE  MADE FOR THE TREATMENT OF ANY OTHER ILLNESS, CONDI-
 TION, OR DISORDER COVERED BY THIS SECTION.
   (V) THE MEDICAID PROGRAM SHALL PROVIDE NOTICE TO ITS ENROLLEES REGARD-
 ING THE COVERAGE REQUIRED BY THIS SECTION. THE NOTICE SHALL BE IN  WRIT-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03144-01-5
              

 A. 2715                             2
 
 ING  AND PROMINENTLY POSITIONED IN ANY LITERATURE OR CORRESPONDENCE SENT
 TO ENROLLEES AND SHALL BE TRANSMITTED TO ENROLLEES WHEN ANNUAL  INFORMA-
 TION  IS  MADE AVAILABLE TO ENROLLEES, OR IN ANY OTHER MAILING TO ENROL-
 LEES, PROVIDED THAT SUCH NOTICE IS PROVIDED TO ENROLLEES ENROLLED ON THE
 EFFECTIVE  DATE  OF  THIS  PARAGRAPH  NO  LATER THAN ONE YEAR AFTER SUCH
 EFFECTIVE DATE.
   (VI) FOR THE PURPOSES OF THIS PARAGRAPH,  THE  FOLLOWING  TERMS  SHALL
 HAVE THE FOLLOWING MEANINGS:
   (1)  "COMPREHENSIVE  COVERAGE  FOR TREATMENT OF OBESITY" SHALL INCLUDE
 COVERAGE  FOR  INTENSIVE  BEHAVIORAL  THERAPY,  BARIATRIC  SURGERY,  AND
 FDA-APPROVED ANTI-OBESITY MEDICATION.
   (2)  "FDA-APPROVED  ANTI-OBESITY MEDICATION" SHALL MEAN ANY MEDICATION
 APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION WITH AN  INDICATION
 FOR CHRONIC WEIGHT MANAGEMENT IN PATIENTS WITH OBESITY.
   § 2. This act shall take effect on the one hundred eightieth day after
 it  shall have become a law. Effective immediately, the addition, amend-
 ment and/or repeal of any rule or regulation necessary for the implemen-
 tation of this act on its effective date are authorized to be  made  and
 completed on or before such effective date.