Bill Text: NY A01815 | 2025-2026 | General Assembly | Introduced

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Bill Title: Requires health insurers to provide coverage for non-opioid treatments utilized for pain management including, but not limited to a drug or biological product that is indicated to produce analgesia without acting upon the body's opioid receptors that has demonstrated the ability to replace, reduce, or avoid opioid use or the quantity of opioids prescribed; or an implantable, reusable, or disposable medical device for the intended use of managing or treating pain that has demonstrated the ability to replace, reduce, or avoid opioid use or the quantity of opioids prescribed.

Spectrum: Bipartisan Bill

Status: (Introduced) 2025-01-14 - referred to insurance [A01815 Detail]

Download: New_York-2025-A01815-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          1815

                               2025-2026 Regular Sessions

                   IN ASSEMBLY

                                    January 14, 2025
                                       ___________

        Introduced  by M. of A. STECK, K. BROWN -- read once and referred to the
          Committee on Insurance

        AN ACT to amend the insurance  law  and  the  social  services  law,  in
          relation  to  requiring health insurers to provide coverage for non-o-
          pioid treatments utilized for pain management

          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 40 to read as follows:
     3    (40) (A) Every policy which provides medical, major medical, or  simi-
     4  lar  comprehensive  type  coverage shall include coverage for non-opioid
     5  treatments utilized for pain management.
     6    (B) As used in this paragraph "non-opioid treatments utilized for pain
     7  management" shall include, but not be limited to:
     8    (i) a drug or biological product that is indicated to produce  analge-
     9  sia  without  acting  upon  the  body's opioid receptors that has demon-
    10  strated the ability to replace, reduce, or avoid opioid use or the quan-
    11  tity of opioids prescribed; or
    12    (ii) an implantable, reusable, or disposable medical  device  for  the
    13  intended  use  of  managing  or  treating pain that has demonstrated the
    14  ability to replace, reduce, or avoid  opioid  use  or  the  quantity  of
    15  opioids prescribed.
    16    (C)  Coverage  provided  under this paragraph may be subject to annual
    17  deductibles and co-insurance as deemed appropriate by the superintendent
    18  and that are consistent with those imposed on other  benefits  within  a
    19  given policy.
    20    § 2. Subsection (l) of section 3221 of the insurance law is amended by
    21  adding a new paragraph 23 to read as follows:
    22    (23)  (A)  Every group or blanket policy which provides medical, major
    23  medical, or similar comprehensive type coverage shall  include  coverage
    24  for non-opioid treatments utilized for pain management.
    25    (B) As used in this paragraph "non-opioid treatments utilized for pain
    26  management" shall include, but not be limited to:

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04543-01-5
        A. 1815                             2

     1    (i)  a drug or biological product that is indicated to produce analge-
     2  sia without acting upon the body's  opioid  receptors  that  has  demon-
     3  strated the ability to replace, reduce, or avoid opioid use or the quan-
     4  tity of opioids prescribed; or
     5    (ii)  an  implantable,  reusable, or disposable medical device for the
     6  intended use of managing or treating  pain  that  has  demonstrated  the
     7  ability  to  replace,  reduce,  or  avoid  opioid use or the quantity of
     8  opioids prescribed.
     9    (C) Coverage provided under this paragraph may be  subject  to  annual
    10  deductibles and co-insurance as deemed appropriate by the superintendent
    11  and  that  are  consistent with those imposed on other benefits within a
    12  given policy.
    13    § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
    14  subsection (ww) to read as follows:
    15    (ww)  (1)  Every contract issued by a medical expense indemnity corpo-
    16  ration, hospital service  corporation,  or  health  service  corporation
    17  which  provides  medical,  major  medical, or similar comprehensive type
    18  coverage shall include coverage for non-opioid treatments  utilized  for
    19  pain management.
    20    (2)  As  used  in  this subsection "non-opioid treatments utilized for
    21  pain management" shall include, but not be limited to:
    22    (A) a drug or biological product that is indicated to produce  analge-
    23  sia  without  acting  upon  the  body's opioid receptors that has demon-
    24  strated the ability to replace, reduce, or avoid opioid use or the quan-
    25  tity of opioids prescribed; or
    26    (B) an implantable, reusable, or disposable  medical  device  for  the
    27  intended  use  of  managing  or  treating pain that has demonstrated the
    28  ability to replace, reduce, or avoid  opioid  use  or  the  quantity  of
    29  opioids prescribed.
    30    (3)  Coverage  provided under this subsection may be subject to annual
    31  deductibles and co-insurance as deemed appropriate by the superintendent
    32  and that are consistent with those imposed on other  benefits  within  a
    33  given policy.
    34    §  4. The social services law is amended by adding a new section 365-q
    35  to read as follows:
    36    § 365-q. Provision of alternative treatment for  pain  management.  1.
    37  The  commissioner  shall  establish  standards  and  guidelines  for the
    38  provision of non-opioid treatments utilized for  pain  management  under
    39  the  medical  assistance  program.  In  establishing  such standards and
    40  guidelines, the commissioner shall consult with providers of  non-opioid
    41  treatments utilized for pain management and other interested parties.
    42    2.  For  purposes  of  this title, "non-opioid treatments utilized for
    43  pain management" shall include, but not be limited to:
    44    (a) a drug or biological product that is indicated to produce  analge-
    45  sia  without  acting  upon  the  body's opioid receptors that has demon-
    46  strated the ability to replace, reduce, or avoid opioid use or the quan-
    47  tity of opioids prescribed; or
    48    (b) an implantable, reusable, or disposable  medical  device  for  the
    49  intended  use  of  managing  or  treating pain that has demonstrated the
    50  ability to replace, reduce, or avoid  opioid  use  or  the  quantity  of
    51  opioids prescribed.
    52    § 5. This act shall take effect on the one hundred twentieth day after
    53  it  shall  have  become  a  law,  and  shall  apply  to all policies and
    54  contracts issued, renewed, modified, altered or amended on or after such
    55  date.