Bill Text: NY S08959 | 2023-2024 | General Assembly | Introduced
Bill Title: Requires comprehensive coverage for treatment of obesity, including coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-04-03 - REFERRED TO HEALTH [S08959 Detail]
Download: New_York-2023-S08959-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 8959 IN SENATE April 3, 2024 ___________ Introduced by Sen. COONEY -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the social services law and the insurance law, in relation to requiring comprehensive coverage for treatment of obesity The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subdivision 2 of section 365-a of the social services law 2 is amended by adding a new paragraph (nn) to read as follows: 3 (nn) (i) Comprehensive coverage for treatment of obesity, which shall 4 include coverage for prevention and wellness, nutrition counseling, 5 intensive behavioral therapy, bariatric surgery, and FDA-approved anti- 6 obesity medication. For purposes of this paragraph, "FDA-approved anti- 7 obesity medication" shall mean any medication approved by the federal 8 food and drug administration with an indication for chronic weight 9 management in patients with obesity. 10 (ii) Coverage criteria for FDA-approved anti-obesity medications 11 provided under this paragraph shall not be more restrictive than the 12 FDA-approved indications for such treatments. 13 (iii) Coverage under this paragraph shall be neither different nor 14 separate from coverage for any other illness, condition, or disorder for 15 purposes of determining deductibles, lifetime dollar limits, copayment 16 and coinsurance factors, and benefit year maximum for deductibles and 17 copayment and coinsurance factors. 18 (iv) Nothing shall preclude the undertaking of utilization management 19 to determine the medical necessity for treatment of obesity under this 20 paragraph, provided that all such appropriateness and medical necessity 21 determinations are made in the same manner as those determinations are 22 made for the treatment of any other illness, condition, or disorder 23 covered by such policy, contract, or plan. 24 (v) The department shall provide notice to eligible persons regarding 25 the coverage required by this paragraph. The notice shall be in writing 26 and shall be prominently positioned in any literature or correspondence 27 sent to members and shall be transmitted to members within the calendar EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD11933-03-4S. 8959 2 1 year when annual information is made available to eligible persons, or 2 in any other mailing or communication to eligible persons. 3 § 2. Subsection (i) of section 3216 of the insurance law is amended by 4 adding a new paragraph 39 to read as follows: 5 (39) (A) Every policy which provides medical, major medical, or simi- 6 lar comprehensive-type coverage shall provide comprehensive coverage for 7 treatment of obesity, which shall include coverage for prevention and 8 wellness, nutrition counseling, intensive behavioral therapy, bariatric 9 surgery, and FDA-approved anti-obesity medication. For purposes of this 10 paragraph, "FDA-approved anti-obesity medication" shall mean any medica- 11 tion approved by the federal food and drug administration with an indi- 12 cation for chronic weight management in patients with obesity. 13 (B) Coverage criteria for FDA-approved anti-obesity medications 14 provided under this paragraph shall not be more restrictive than the 15 FDA-approved indications for those treatments. 16 (C) Coverage under this paragraph shall neither be different nor sepa- 17 rate from coverage for any other illness, condition, or disorder for 18 purposes of determining deductibles, lifetime dollar limits, copayment 19 and coinsurance factors, and benefit year maximum for deductibles and 20 copayment and coinsurance factors. 21 (D) Nothing shall preclude the undertaking of utilization management 22 to determine the medical necessity for treatment of obesity under this 23 paragraph, provided that all such appropriateness and medical necessity 24 determinations are made in the same manner as those determinations are 25 made for the treatment of any other illness, condition, or disorder 26 covered by such policy, contract, or plan. 27 (E) The insurer shall provide notice to covered persons regarding the 28 coverage required by this paragraph. The notice shall be in writing and 29 shall be prominently positioned in any literature or correspondence sent 30 to members and shall be transmitted to members within the calendar year 31 when annual information is made available to covered persons, or in any 32 other mailing or communication to covered persons. 33 § 3. Subsection (l) of section 3221 of the insurance law is amended by 34 adding a new paragraph 22 to read as follows: 35 (22) (A) Every insurer delivering a group or blanket policy for deliv- 36 ery in this state that provides medical, major medical, or similar 37 comprehensive-type coverage shall provide comprehensive coverage for 38 treatment of obesity, which shall include coverage for prevention and 39 wellness, nutrition counseling, intensive behavioral therapy, bariatric 40 surgery, and FDA-approved anti-obesity medication. For purposes of this 41 paragraph, "FDA-approved anti-obesity medication" shall mean any medica- 42 tion approved by the federal food and drug administration with an indi- 43 cation for chronic weight management in patients with obesity. 44 (B) Coverage criteria for FDA-approved anti-obesity medications 45 provided under this paragraph shall not be more restrictive than the 46 FDA-approved indications for those treatments. 47 (C) Coverage under this paragraph shall neither be different nor sepa- 48 rate from coverage for any other illness, condition, or disorder for 49 purposes of determining deductibles, lifetime dollar limits, copayment 50 and coinsurance factors, and benefit year maximum for deductibles and 51 copayment and coinsurance factors. 52 (D) Nothing shall preclude the undertaking of utilization management 53 to determine the medical necessity for treatment of obesity under this 54 paragraph, provided that all such appropriateness and medical necessity 55 determinations are made in the same manner as those determinations areS. 8959 3 1 made for the treatment of any other illness, condition, or disorder 2 covered by such policy, contract, or plan. 3 (E) The insurer shall provide notice to covered persons regarding the 4 coverage required by this paragraph. The notice shall be in writing and 5 shall be prominently positioned in any literature or correspondence sent 6 to members and shall be transmitted to members within the calendar year 7 when annual information is made available to covered persons, or in any 8 other mailing or communication to covered persons. 9 § 4. Section 4303 of the insurance law is amended by adding a new 10 subsection (vv) to read as follows: 11 (vv) (1) Every policy which provides medical, major medical, or simi- 12 lar comprehensive-type coverage shall provide comprehensive coverage for 13 treatment of obesity, which shall include coverage for prevention and 14 wellness, nutrition counseling, intensive behavioral therapy, bariatric 15 surgery, and FDA-approved anti-obesity medication. For purposes of this 16 subsection, "FDA-approved anti-obesity medication" shall mean any medi- 17 cation approved by the federal food and drug administration with an 18 indication for chronic weight management in patients with obesity. 19 (2) Coverage criteria for FDA-approved anti-obesity medications 20 provided under this subsection shall not be more restrictive than the 21 FDA-approved indications for those treatments. 22 (3) Coverage under this subsection shall neither be different nor 23 separate from coverage for any other illness, condition, or disorder for 24 purposes of determining deductibles, lifetime dollar limits, copayment 25 and coinsurance factors, and benefit year maximum for deductibles and 26 copayment and coinsurance factors. 27 (4) Nothing shall preclude the undertaking of utilization management 28 to determine the medical necessity for treatment of obesity under this 29 subsection, provided that all such appropriateness and medical necessity 30 determinations are made in the same manner as those determinations are 31 made for the treatment of any other illness, condition, or disorder 32 covered by such policy, contract, or plan. 33 (5) The insurer shall provide notice to covered persons regarding the 34 coverage required by this subsection. The notice shall be in writing and 35 shall be prominently positioned in any literature or correspondence sent 36 to members and shall be transmitted to members within the calendar year 37 when annual information is made available to covered persons, or in any 38 other mailing or communication to covered persons. 39 § 5. This act shall take effect on the one hundred eightieth day after 40 it shall have become a law and shall apply to any policy issued, deliv- 41 ered, renewed, and/or modified on or after the effective date of this 42 act.
