Bill Text: NY S09192 | 2023-2024 | General Assembly | Introduced
Bill Title: Provides outpatient insurance coverage for non-opioid treatment of chronic pain including complementary and integrative treatments.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-05-03 - REFERRED TO INSURANCE [S09192 Detail]
Download: New_York-2023-S09192-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 9192 IN SENATE May 3, 2024 ___________ 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: 1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 39 to read as follows: 3 (39) (A) Every policy that provides medical, major medical, or similar 4 comprehensive-type coverage that provides coverage for pain management 5 services shall provide outpatient coverage for non-opioid treatment of 6 chronic pain including complementary and integrative treatments. Access 7 to non-opioid treatment shall be comparable to that of other covered 8 services. Coverage shall be comparable for services provided by licensed 9 professionals. 10 (B) Coverage under this subsection shall not apply financial require- 11 ments or treatment limitations to non-opioid treatment of chronic pain 12 that are more restrictive than either of the following: the predominant 13 financial requirements and treatment limitations applied to substantial- 14 ly all medical benefits covered by the contract; and the financial 15 requirements and treatment limitations applied to any opioid-based 16 treatment of chronic pain. 17 (C) For the purposes of this paragraph the following terms shall have 18 the following meanings: 19 (i) "financial requirement" means deductible, co-payments, co-insu- 20 rance and out-of-pocket expenses; 21 (ii) "predominant" means that a financial requirement or treatment 22 limitation is the most common or frequent of such type of limit or 23 requirement; 24 (iii) "treatment limitation" means limits on the frequency of treat- 25 ment, number of visits, days of coverage, or other similar limits on the 26 scope or duration of treatment and includes non-quantitative treatment 27 limitations such as: medical management standards limiting or excluding 28 benefits based on medical necessity, or based on whether the treatment EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD15062-01-4S. 9192 2 1 is experimental or investigational; standards for provider admission to 2 participate in a network, including reimbursement rates; methods for 3 determining usual, customary and reasonable charges; exclusions based on 4 failure to complete a course of treatment; and restrictions based on 5 geographic location, facility type, provider specialty, and other crite- 6 ria that limit the scope or duration of benefits for services provided 7 under the contract; and 8 (iv) "Chronic pain" means pain that persists or recurs for more than 9 three months. 10 § 2. Subsection (l) of section 3221 of the insurance law is amended by 11 adding a new paragraph 22 to read as follows: 12 (22) (A) Every insurer delivering a group or blanket policy or issuing 13 a group or blanket policy for delivery in this state that provides 14 coverage for pain management services shall provide outpatient coverage 15 for non-opioid treatment of chronic pain including complementary and 16 integrative treatments. Access to non-opioid treatment shall be compara- 17 ble to that of other covered services. Coverage shall be comparable for 18 services provided by licensed professionals. 19 (B) Coverage under this subsection shall not apply financial require- 20 ments or treatment limitations to non-opioid treatment of chronic pain 21 that are more restrictive than either of the following: the predominant 22 financial requirements and treatment limitations applied to substantial- 23 ly all medical benefits covered by the contract; and the financial 24 requirements and treatment limitations applied to any opioid-based 25 treatment of chronic pain. 26 (C) For the purposes of this paragraph the following terms shall have 27 the following meanings: 28 (i) "financial requirement" means deductible, co-payments, co-insu- 29 rance and out-of-pocket expenses; 30 (ii) "predominant" means that a financial requirement or treatment 31 limitation is the most common or frequent of such type of limit or 32 requirement; 33 (iii) "treatment limitation" means limits on the frequency of treat- 34 ment, number of visits, days of coverage, or other similar limits on the 35 scope or duration of treatment and includes non-quantitative treatment 36 limitations such as: medical management standards limiting or excluding 37 benefits based on medical necessity, or based on whether the treatment 38 is experimental or investigational; standards for provider admission to 39 participate in a network, including reimbursement rates; methods for 40 determining usual, customary and reasonable charges; exclusions based on 41 failure to complete a course of treatment; and restrictions based on 42 geographic location, facility type, provider specialty, and other crite- 43 ria that limit the scope or duration of benefits for services provided 44 under the contract; and 45 (iv) "chronic pain" means pain that persists or recurs for more than 46 three months. 47 § 3. Section 4303 of the insurance law is amended by adding a new 48 subsection (vv) to read as follows: 49 (vv) (1) Every contract issued by a hospital service corporation, 50 health service corporation or medical expense indemnity corporation that 51 includes coverage for pain management services shall provide outpatient 52 coverage for non-opioid treatment of chronic pain including complementa- 53 ry and integrative treatments. Access to non-opioid treatment shall be 54 comparable to that of other covered services. Coverage shall be compara- 55 ble for services provided by licensed professionals.S. 9192 3 1 (2) Coverage under this subsection shall not apply financial require- 2 ments or treatment limitations to non-opioid treatment of chronic pain 3 that are more restrictive than either of the following: the predominant 4 financial requirements and treatment limitations applied to substantial- 5 ly all medical benefits covered by the contract; and the financial 6 requirements and treatment limitations applied to any opioid-based 7 treatment of chronic pain. 8 (3) For the purposes of this subsection the following terms shall have 9 the following meanings: 10 (A) "financial requirement" means deductible, co-payments, co-insu- 11 rance and out-of-pocket expenses; 12 (B) "predominant" means that a financial requirement or treatment 13 limitation is the most common or frequent of such type of limit or 14 requirement; 15 (C) "treatment limitation" means limits on the frequency of treatment, 16 number of visits, days of coverage, or other similar limits on the scope 17 or duration of treatment and includes non-quantitative treatment limita- 18 tions such as: medical management standards limiting or excluding bene- 19 fits based on medical necessity, or based on whether the treatment is 20 experimental or investigational; standards for provider admission to 21 participate in a network, including reimbursement rates; methods for 22 determining usual, customary and reasonable charges; exclusions based on 23 failure to complete a course of treatment; and restrictions based on 24 geographic location, facility type, provider specialty, and other crite- 25 ria that limit the scope or duration of benefits for services provided 26 under the contract; and 27 (D) "chronic pain" means pain that persists or recurs for more than 28 three months. 29 § 4. This act shall take effect the first day of January next succeed- 30 ing the day on which it shall have become a law and shall apply to all 31 policies and contracts issued, renewed, modified, altered, or amended on 32 or after such date.
