S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9716
 
                           I N  A S S E M B L Y
 
                               April 3, 2024
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred 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 39 to read as follows:
   (39) (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
 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD15062-01-4
 A. 9716                             2
 
 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 22 to read as follows:
   (22) (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 (vv) to read as follows:
   (VV)  (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
 COMPARABLE TO THAT OF OTHER COVERED SERVICES. COVERAGE SHALL BE COMPARA-
 BLE FOR SERVICES PROVIDED BY LICENSED PROFESSIONALS.
 A. 9716                             3
 
   (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  day 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.