Bill Text: NY A01921 | 2025-2026 | General Assembly | Amended
Bill Title: Provides outpatient insurance coverage for non-pharmacological treatments and non-opioid drugs for chronic pain.
Sponsorship: Partisan Bill (Democrat 2)
Status: (Introduced - Dead) 2026-01-23 - print number 1921b [A01921 Detail]
Download: New_York-2025-A01921-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 1921--B 2025-2026 Regular Sessions IN ASSEMBLY 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 -- recommitted to the Committee on Insurance in accordance with Assembly Rule 3, sec. 2 -- 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: 1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 42 to read as follows: 3 (42) (A) Every policy that provides medical, major medical, or similar 4 comprehensive-type coverage that provides coverage for pain shall 5 provide outpatient coverage for a minimum of three non-pharmacological 6 treatments of chronic pain, and a minimum of two non-opioid drugs 7 approved by the United States Food and Drug Administration (FDA) for the 8 treatment of acute or chronic pain. Such non-pharmacological non-opioid 9 treatments shall include at least one of each of the following treatment 10 types: (i) restorative treatments such as massage therapy; (ii) behav- 11 ioral treatments such as cognitive behavioral therapy; and (iii) comple- 12 mentary treatments such as acupuncture. Access to non-pharmacological 13 treatments and non-opioid drugs shall be comparable to that of other 14 covered services. Coverage shall be comparable for services provided by 15 licensed professionals. 16 (B) Coverage under this subsection shall not apply financial require- 17 ments or treatment limitations to non-opioid treatment of chronic pain 18 that are more restrictive than either of the following: the predominant 19 financial requirements and treatment limitations applied to substantial- 20 ly all medical benefits covered by the contract; and the financial EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05350-06-6A. 1921--B 2 1 requirements and treatment limitations applied to any opioid-based 2 treatment of chronic pain. Coverage under this paragraph shall not 3 disadvantage or discourage any non-opioid drug approved by the United 4 States Food and Drug Administration (FDA) for the treatment of chronic 5 or acute pain relative to any opioid drug for the treatment of chronic 6 or acute pain, where impermissible disadvantaging or discouragement 7 includes, without limitation: designating any such non-opioid drug as a 8 non-preferred drug if any opioid or narcotic drug is designated as a 9 preferred drug; or establishing more restrictive or more extensive 10 utilization controls including, but not limited to, more restrictive or 11 more extensive financial requirements, prior authorization, or step 12 therapy requirements, for such non-opioid drug than the least restric- 13 tive or extensive utilization controls applicable to any such opioid or 14 narcotic drug. 15 (C) For the purposes of this paragraph the following terms shall have 16 the following meanings: 17 (i) "financial requirement" means deductible, co-payments, co-insu- 18 rance and out-of-pocket expenses; 19 (ii) "predominant" means that a financial requirement or treatment 20 limitation is the most common or frequent of such type of limit or 21 requirement; 22 (iii) "treatment limitation" means limits on the frequency of treat- 23 ment, number of visits, days of coverage, or other similar limits on the 24 scope or duration of treatment and includes non-quantitative treatment 25 limitations such as: medical management standards limiting or excluding 26 benefits based on medical necessity, or based on whether the treatment 27 is experimental or investigational; standards for provider admission to 28 participate in a network, including reimbursement rates; methods for 29 determining usual, customary and reasonable charges; exclusions based on 30 failure to complete a course of treatment; and restrictions based on 31 geographic location, facility type, provider specialty, and other crite- 32 ria that limit the scope or duration of benefits for services provided 33 under the contract; 34 (iv) "chronic pain" means pain that persists or recurs for more than 35 three months; and 36 (v) "acute pain" means pain whether resulting from disease, accidental 37 or intentional trauma, or other causes that is reasonably expected to 38 last only a short period of time. 39 § 2. Subsection (l) of section 3221 of the insurance law is amended by 40 adding a new paragraph 24 to read as follows: 41 (24) (A) Every insurer delivering a group or blanket policy or issuing 42 a group or blanket policy for delivery in this state that provides 43 coverage for pain shall provide outpatient coverage for a minimum of 44 three non-pharmacological treatments of chronic pain, and a minimum of 45 two non-opioid drugs approved by the United States Food and Drug Admin- 46 istration (FDA) for the treatment of chronic or acute pain. Such non- 47 pharmacological non-opioid treatments shall include at least one of each 48 of the following treatment types: (i) restorative treatments such as 49 massage therapy; (ii) behavioral treatments such as cognitive behavioral 50 therapy; and (iii) complementary treatments such as acupuncture. Access 51 to non-pharmacological treatments and non-opioid drugs for the treatment 52 of acute or chronic pain shall be comparable to that of other covered 53 services. Coverage shall be comparable for services provided by licensed 54 professionals. 55 (B) Coverage under this subsection shall not apply financial require- 56 ments or treatment limitations to non-opioid treatment of chronic painA. 1921--B 3 1 that are more restrictive than either of the following: the predominant 2 financial requirements and treatment limitations applied to substantial- 3 ly all medical benefits covered by the contract; and the financial 4 requirements and treatment limitations applied to any opioid-based 5 treatment of chronic pain. Coverage under this paragraph shall not 6 disadvantage or discourage any non-opioid drug approved by the United 7 States Food and Drug Administration (FDA) for the treatment of chronic 8 or acute pain relative to any opioid drug for the treatment of chronic 9 or acute pain, where impermissible disadvantaging or discouragement 10 includes, without limitation: designating any such non-opioid drug as a 11 non-preferred drug if any opioid or narcotic drug is designated as a 12 preferred drug; or establishing more restrictive or more extensive 13 utilization controls including, but not limited to, more restrictive or 14 more extensive financial requirements, prior authorization, or step 15 therapy requirements, for such non-opioid drug than the least restric- 16 tive or extensive utilization controls applicable to any such opioid or 17 narcotic drug. 18 (C) For the purposes of this paragraph the following terms shall have 19 the following meanings: 20 (i) "financial requirement" means deductible, co-payments, co-insu- 21 rance and out-of-pocket expenses; 22 (ii) "predominant" means that a financial requirement or treatment 23 limitation is the most common or frequent of such type of limit or 24 requirement; 25 (iii) "treatment limitation" means limits on the frequency of treat- 26 ment, number of visits, days of coverage, or other similar limits on the 27 scope or duration of treatment and includes non-quantitative treatment 28 limitations such as: medical management standards limiting or excluding 29 benefits based on medical necessity, or based on whether the treatment 30 is experimental or investigational; standards for provider admission to 31 participate in a network, including reimbursement rates; methods for 32 determining usual, customary and reasonable charges; exclusions based on 33 failure to complete a course of treatment; and restrictions based on 34 geographic location, facility type, provider specialty, and other crite- 35 ria that limit the scope or duration of benefits for services provided 36 under the contract; 37 (iv) "chronic pain" means pain that persists or recurs for more than 38 three months; and 39 (v) "acute pain" means pain whether resulting from disease, accidental 40 or intentional trauma, or other causes that is reasonably expected to 41 last only a short period of time. 42 § 3. Section 4303 of the insurance law is amended by adding a new 43 subsection (xx) to read as follows: 44 (xx) (1) Every contract issued by a hospital service corporation, 45 health service corporation or medical expense indemnity corporation that 46 includes coverage for pain shall provide outpatient coverage for a mini- 47 mum of three non-pharmacological treatments of chronic pain, and a mini- 48 mum of two non-opioid drugs approved by the United States Food and Drug 49 Administration (FDA) for the treatment of acute or chronic pain. Such 50 non-pharmacological non-opioid treatments shall include at least one of 51 each of the following treatment types: (A) restorative treatments such 52 as massage therapy; (B) behavioral treatments such as cognitive behav- 53 ioral therapy; and (C) complementary treatments such as acupuncture. 54 Access to non-pharmacological treatments and non-opioid drugs for the 55 treatment of acute or chronic pain shall be comparable to that of otherA. 1921--B 4 1 covered services. Coverage shall be comparable for services provided by 2 licensed professionals. 3 (2) Coverage under this subsection shall not apply financial require- 4 ments or treatment limitations to non-opioid treatment of chronic pain 5 that are more restrictive than either of the following: the predominant 6 financial requirements and treatment limitations applied to substantial- 7 ly all medical benefits covered by the contract; and the financial 8 requirements and treatment limitations applied to any opioid-based 9 treatment of chronic pain. Coverage under this subsection shall not 10 disadvantage or discourage any non-opioid drug approved by the United 11 States Food and Drug Administration (FDA) for the treatment of chronic 12 or acute pain relative to any opioid drug for the treatment of chronic 13 or acute pain, where impermissible disadvantaging or discouragement 14 includes, without limitation: designating any such non-opioid drug as a 15 non-preferred drug if any opioid or narcotic drug is designated as a 16 preferred drug; or establishing more restrictive or more extensive 17 utilization controls including, but not limited to, more restrictive or 18 more extensive financial requirements, prior authorization, or step 19 therapy requirements, for such non-opioid drug than the least restric- 20 tive or extensive utilization controls applicable to any such opioid or 21 narcotic drug. 22 (3) For the purposes of this subsection the following terms shall have 23 the following meanings: 24 (A) "financial requirement" means deductible, co-payments, co-insu- 25 rance and out-of-pocket expenses; 26 (B) "predominant" means that a financial requirement or treatment 27 limitation is the most common or frequent of such type of limit or 28 requirement; 29 (C) "treatment limitation" means limits on the frequency of treatment, 30 number of visits, days of coverage, or other similar limits on the scope 31 or duration of treatment and includes non-quantitative treatment limita- 32 tions such as: medical management standards limiting or excluding bene- 33 fits based on medical necessity, or based on whether the treatment is 34 experimental or investigational; standards for provider admission to 35 participate in a network, including reimbursement rates; methods for 36 determining usual, customary and reasonable charges; exclusions based on 37 failure to complete a course of treatment; and restrictions based on 38 geographic location, facility type, provider specialty, and other crite- 39 ria that limit the scope or duration of benefits for services provided 40 under the contract; 41 (D) "chronic pain" means pain that persists or recurs for more than 42 three months; and 43 (E) "acute pain" means pain whether resulting from disease, accidental 44 or intentional trauma, or other causes that is reasonably expected to 45 last only a short period of time. 46 § 4. This act shall take effect on the first of January next succeed- 47 ing the date on which it shall have become a law and shall apply to all 48 policies and contracts issued, renewed, modified, altered, or amended on 49 or after such date.
