Senate Bill S3185A

2025-2026 Legislative Session

Provides outpatient insurance coverage for non-pharmacological treatments and non-opioid drugs for chronic pain

download bill text pdf

Current Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 07, 2026	print number 3185a
Apr 07, 2026	amend (t) and recommit to insurance
Jan 07, 2026	referred to insurance
May 05, 2025	reported and committed to finance
Jan 24, 2025	referred to insurance

Votes

- May 5, 2025 - Insurance Committee Vote
  S3185A
  
  Aye
  
  9
  
  Nay
  
  0
  
  Aye with Reservations
  
  2
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  
  0
  - - Insurance Committee Vote: May 5, 2025
      
      aye (9)
      
      Addabbo Jr.
      
      Ashby
      
      Bailey
      
      Cooney
      
      Fernandez
      
      Gounardes
      
      Harckham
      
      Sanders Jr.
      
      Skoufis
      
      aye wr (2)
      
      Helming
      
      O'Mara

Bill Amendments

Original

A (Active)

co-Sponsors

2025-S3185 - Details

See Assembly Version of this Bill:: A1921
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2023-2024 Legislative Session:: S9192, A9716

2025-S3185 - Summary

Provides outpatient insurance coverage for non-pharmacological treatments and non-opioid drugs for chronic pain.

2025-S3185 - Sponsor Memo

                                 
BILL NUMBER: S3185

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the insurance law, in relation to providing insurance
coverage for chronic pain

 
PURPOSE OF BILL:

Provides outpatient insurance coverage for non-opioid treatment of
chronic pain including complementary and integrative treatments.

 
SUMMARY OF PROVISIONS:

Section 1 amends subsection (i) of section 3216 of the Insurance Law, by
adding a new paragraph 40 to require policies offering medical, major
medical, or similar comprehensive coverage to include outpatient cover-
age for non-opioid treatment of chronic pain, encompassing complementary
and integrative treatments and this coverage would be on par with other
covered services and provided by licensed professionals. Notably, the
provision prohibits imposing financial requirements or treatment limita-

tions on non-opioid chronic pain treatment that are more restrictive
than those for medical benefits in general or for opioid-based chronic
pain treatment. Key definitions are provided such as "financial require-
ment," "predominant," "treatment limitation," and "chronic pain," to
ensure clarity and consistency in implementation.

Section 2 amends subsection (1) of section 3221 of the Insurance Law, by
adding a new paragraph 23, extending coverage for pain management
services in group or blanket insurance policies, substantially similar
to those outlined in section 1.

Section 3 amends section 4303 of the Insurance law, by adding a new
subsection (ww) to extend coverage for pain management services in
contracts issued by hospital service corporations, health service corpo-
rations, or medical expense indemnity corporations, substantially simi-
lar to those outlined in section 1.

Section 4 provides the effective date.

 
JUSTIFICATION:,:

Chronic pain affects millions of individuals across the United States,
spanning a spectrum of conditions such as arthritis, migraines, cancer,
neuropathic pain, and more. Unfortunately, conventional approaches to
managing chronic pain often rely heavily on opioid medications, despite
their well-documented risks of addiction, overdose, and other adverse
effects. This reliance on opioids not only poses significant health
risks to patients but also contributes to the ongoing opioid epidemic,
which has ravaged communities nationwide.

Fortunately, there exists a diverse array of non-opioid treatments for
chronic pain, which have demonstrated efficacy in managing certain types
of chronic_pain according to the Federal Centers for Disease Control and
Prevention and the National Institutes of Health.  Additionally, non-
pharmacological interventions such as acupuncture and chiropractic care,
physical therapy, and cognitive-behavioral therapy offer alternative

approaches to pain management that can be both effective and safer than
opioids.

However, access to these non-opioid treatments has been limited for many
individuals, often due to barriers such as lack of insurance coverage
and financial constraints. The proposed bill seeks to address this
disparity by mandating insurance coverage for non-opioid treatments for
chronic pain, encompassing both pharmacological and non-pharmacological
interventions. By ensuring that these treatments are readily accessible
and on par with conventional medical benefits, the bill aims to remove
financial barriers and treatment limitations that may prevent individ-
uals from seeking alternative pain management options.

In doing so, the bill not only empowers patients to explore safer and
more effective alternatives to opioids but also promotes a holistic
approach to pain management that considers the individual needs and
preferences of each patient. Moreover, by expanding access to non-opioid
treatments, including medication, the bill has the potential to mitigate
the risks associated with opioid use and contribute to border efforts to
combat the opioid epidemic.

This bill represents a significant step towards addressing a critical
public health issue and advancing the well-being of individuals with
chronic pain across the nation. By promoting evidence-based, patient-
centered care and reducing reliance on opioids, the bill underscores a
commitment to fostering safer, more sustainable approaches to pain
management in The State of New York.

 
LEGISLATIVE HISTORY:

2024: S9192 Rivera / A9716 Paulin

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

Undetermined.

 
EFFECTIVE DATE:
Effective as of the first day of January following the enactment of the
law, applying to all policies, and contracts issued, renewed, modified,
altered, or amended on or after that date.

2025-S3185 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3185
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 24, 2025
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed 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 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. 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05350-01-5

 S. 3185                             2
 
 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.
   § 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. 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 (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. ACCESS TO NON-OPIOID TREATMENT SHALL BE
 S. 3185                             3
 
 COMPARABLE TO THAT OF OTHER COVERED SERVICES. COVERAGE SHALL BE COMPARA-
 BLE 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.
   (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 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.

co-Sponsors

2025-S3185A (ACTIVE) - Details

See Assembly Version of this Bill:: A1921
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2023-2024 Legislative Session:: S9192, A9716

2025-S3185A (ACTIVE) - Summary

Provides outpatient insurance coverage for non-pharmacological treatments and non-opioid drugs for chronic pain.

2025-S3185A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S3185A

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the insurance law, in relation to providing insurance
coverage for non-pharmacological treatments and non-opioid drugs for
chronic pain

 
PURPOSE:

Provides outpatient insurance coverage for non-opioid treatment of
chronic pain including complementary and integrative treatments.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends subsection (i) of section 3216 of the Insurance Law, in
relation to individual accident and health insurance policy provisions,
by requiring policies offering medical, major medical, or similar cover-
age to include outpatient coverage for non-opioid treatment of chronic
pain, including a minimum of two non-opioid drugs as well as at least
three other non-pharmacological treatments.  The three non-pharmacologi-

cal treatments could include massage therapy, cognitive behavioral ther-
apy, or acupuncture; these specific treatments are not required by the
bill, only suggested. Coverage for these non-opioid alternatives would
be on par with other covered services and provided by licensed profes-
sionals. The provision prohibits imposing more restrictive financial
requirements or treatment limitations on non-opioid chronic pain treat-
ment compared to those for general medical benefits or for opioid-based
chronic pain treatment.

Section 2 amends subsection (1) of section 3221 of the Insurance Law, in
relation to group or blanket accident and health insurance policies, by
extending coverage for pain management services in group policies or
insurance policies that cover multiple items, similar to those outlined
in section 1.

Section 3 amends section 4303 of the Insurance Law, in relation to bene-
fits, by extending coverage for pain management services in contracts
issued by hospital, health service, or medical expense indemnity corpo-
rations, similar to those outlined in section 1.

Section 4 provides the effective date.

 
JUSTIFICATION:

Chronic pain affects millions of individuals across the United States,
spanning a spectrum of conditions such as arthritis, migraines, cancer,
neuropathic pain, and more. Unfortunately, conventional approaches to
managing chronic pain often rely heavily on opioid medications, despite
their well-documented risks of addiction, overdose, and other adverse
effects. This reliance on opioids not only poses significant health
risks to patients but also contributes to the ongoing opioid epidemic,
which has ravaged communities nationwide.

Fortunately, there exists a diverse array of non-opioid treatments for
chronic pain, which have demonstrated efficacy in managing certain types
of chronic pain according to the Federal Centers for Disease Control and
Prevention and the National Institutes of Health. The Food and Drug
Administration approved a new non-opioid drug for moderate to acute pain
in 2025. Additionally, non-pharmacological interventions such as
acupuncture and chiropractic care, physical therapy, and cognitive-beha-
vioral therapy offer alternative approaches to pain management that can
be both effective and safer than opioids.

However, access to these non-opioid treatments has been limited for many
individuals, often due to barriers such as lack of insurance coverage
and financial constraints. The proposed bill seeks to address this
disparity by mandating insurance coverage for non-opioid treatments for
chronic pain, encompassing both pharmacological and non-pharmacological
interventions. By ensuring that these treatments are readily accessible
and on par with conventional medical benefits, the bill aims to remove
financial barriers and treatment limitations that may prevent individ-
uals from seeking alternative pain management options.

In doing so, the bill not only empowers patients to explore safer and
more effective alternatives to opioids but also promotes a holistic
approach to pain management that considers the individual needs and
preferences of each patient. Moreover, by expanding access to non-opioid
treatments, including medication, the bill has the potential to mitigate
the risks associated with opioid use and contribute to border efforts to
combat the opioid epidemic.

This bill represents a significant step towards addressing a critical
public health issue and advancing the well-being of individuals with
chronic pain across the nation. By giving patients alternatives for
treatment and management for chronic pain, and promoting evidence-based,
patient-centered care the bill underscores a commitment to fostering
safer, more sustainable approaches to pain management in the State of
New York and reduces our reliance on opioids.

 
LEGISLATIVE HISTORY:

2025: S3185 Rivera / A1921 Paulin - Referred to Insurance

2024: S9192 Rivera / A9716 Paulin - Referred to Insurance

 
FISCAL IMPLICATIONS:

Undetermined.

 
EFFECTIVE DATE:
The first day of January succeeding the date that this law is enacted.

2025-S3185A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  3185--A
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 24, 2025
                                ___________
 
 Introduced by Sens. RIVERA, FERNANDEZ -- read twice and ordered printed,
   and  when  printed  to  be  committed to the Committee on Insurance --
   recommitted to the Committee on Insurance in  accordance  with  Senate
   Rule  6,  sec.  8  --  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-pharmacological treatments and non-opioid drugs 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 42 to read as follows:
   (42) (A) EVERY POLICY THAT PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
 COMPREHENSIVE-TYPE  COVERAGE  THAT  PROVIDES  COVERAGE  FOR  PAIN  SHALL
 PROVIDE  OUTPATIENT  COVERAGE FOR A MINIMUM OF THREE NON-PHARMACOLOGICAL
 TREATMENTS OF CHRONIC PAIN,  AND  A  MINIMUM  OF  TWO  NON-OPIOID  DRUGS
 APPROVED BY THE UNITED STATES FOOD AND DRUG ADMINISTRATION (FDA) FOR THE
 TREATMENT OF ACUTE OR CHRONIC PAIN.  SUCH NON-PHARMACOLOGICAL NON-OPIOID
 TREATMENTS SHALL INCLUDE AT LEAST ONE OF EACH OF THE FOLLOWING TREATMENT
 TYPES:  (I)  RESTORATIVE TREATMENTS SUCH AS MASSAGE THERAPY; (II) BEHAV-
 IORAL TREATMENTS SUCH AS COGNITIVE BEHAVIORAL THERAPY; AND (III) COMPLE-
 MENTARY TREATMENTS SUCH AS ACUPUNCTURE.   ACCESS TO  NON-PHARMACOLOGICAL
 TREATMENTS  AND  NON-OPIOID  DRUGS  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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05350-07-6

 S. 3185--A                          2
 
 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
 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 24 to read as follows:
   (24) (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  SHALL  PROVIDE OUTPATIENT COVERAGE FOR A MINIMUM OF
 THREE NON-PHARMACOLOGICAL TREATMENTS OF CHRONIC PAIN, AND A  MINIMUM  OF
 TWO  NON-OPIOID DRUGS APPROVED BY THE UNITED STATES FOOD AND DRUG ADMIN-
 ISTRATION (FDA) FOR THE TREATMENT OF CHRONIC OR ACUTE PAIN.   SUCH  NON-
 PHARMACOLOGICAL NON-OPIOID TREATMENTS SHALL INCLUDE AT LEAST ONE OF EACH
 OF  THE  FOLLOWING  TREATMENT  TYPES: (I) RESTORATIVE TREATMENTS SUCH AS
 MASSAGE THERAPY; (II) BEHAVIORAL TREATMENTS SUCH AS COGNITIVE BEHAVIORAL
 THERAPY; AND (III) COMPLEMENTARY TREATMENTS SUCH AS ACUPUNCTURE.  ACCESS
 TO NON-PHARMACOLOGICAL TREATMENTS AND NON-OPIOID DRUGS FOR THE TREATMENT
 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
 S. 3185--A                          3
 
 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
 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 (xx) to read as follows:
   (XX) (1) EVERY CONTRACT ISSUED  BY  A  HOSPITAL  SERVICE  CORPORATION,
 HEALTH SERVICE CORPORATION OR MEDICAL EXPENSE INDEMNITY CORPORATION THAT
 INCLUDES COVERAGE FOR PAIN SHALL PROVIDE OUTPATIENT COVERAGE FOR A MINI-
 MUM OF THREE NON-PHARMACOLOGICAL TREATMENTS OF CHRONIC PAIN, AND A MINI-
 MUM  OF TWO NON-OPIOID DRUGS APPROVED BY THE UNITED STATES FOOD AND DRUG
 ADMINISTRATION (FDA) FOR THE TREATMENT OF ACUTE OR CHRONIC PAIN.    SUCH
 NON-PHARMACOLOGICAL  NON-OPIOID TREATMENTS SHALL INCLUDE AT LEAST ONE OF
 EACH OF THE FOLLOWING TREATMENT TYPES: (A) RESTORATIVE  TREATMENTS  SUCH
 AS  MASSAGE  THERAPY; (B) BEHAVIORAL TREATMENTS SUCH AS COGNITIVE BEHAV-
 IORAL THERAPY; AND (C) COMPLEMENTARY  TREATMENTS  SUCH  AS  ACUPUNCTURE.
 ACCESS  TO  NON-PHARMACOLOGICAL  TREATMENTS AND NON-OPIOID DRUGS FOR THE
 TREATMENT OF ACUTE OR CHRONIC PAIN SHALL BE COMPARABLE TO THAT OF  OTHER
 COVERED  SERVICES. COVERAGE SHALL BE COMPARABLE FOR SERVICES PROVIDED BY
 LICENSED PROFESSIONALS.
 S. 3185--A                          4
 
   (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
 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 on the first 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.

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Senate Bill S3185A

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Current Bill Status - In Senate Committee Insurance Committee

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May 5, 2025 - Insurance Committee Vote

Insurance Committee Vote: May 5, 2025

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co-Sponsors

2025-S3185 - Details

2025-S3185 - Summary

2025-S3185 - Sponsor Memo

2025-S3185 - Bill Text download pdf

co-Sponsors

2025-S3185A (ACTIVE) - Details

2025-S3185A (ACTIVE) - Summary

2025-S3185A (ACTIVE) - Sponsor Memo

2025-S3185A (ACTIVE) - Bill Text download pdf

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Sponsored By

Gustavo Rivera

Current Bill Status - In Senate Committee Insurance Committee

Actions

Votes

Bill Amendments

co-Sponsors

Nathalia Fernandez

2025-S3185 - Details

2025-S3185 - Summary

2025-S3185 - Sponsor Memo

2025-S3185 - Bill Text download pdf

co-Sponsors

Nathalia Fernandez

2025-S3185A (ACTIVE) - Details

2025-S3185A (ACTIVE) - Summary

2025-S3185A (ACTIVE) - Sponsor Memo

2025-S3185A (ACTIVE) - Bill Text download pdf

Comments