NY State Senate Bill 2023-S9192

Current Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 03, 2024	referred to insurance

2023-S9192 (ACTIVE) - Details

See Assembly Version of this Bill:: A9716
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L

2023-S9192 (ACTIVE) - Summary

Provides outpatient insurance coverage for non-opioid treatment of chronic pain including complementary and integrative treatments.

2023-S9192 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S9192

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the insurance law, in relation to providing insurance
coverage for chronic pain

 
PURPOSE OF BILL:

Provides outpatient insurance coverage for non-opioid treatment of
chronic pain including complementary and integrative treatments.

 
SUMMARY OF PROVISIONS: OF BILL:

Section 1 amends subsection (i) of section 3216 of the insurance law by
adding a new paragraph 39 to require policies offering medical, major
medical, or similar comprehensive coverage to include outpatient cover-
age for non-opioid treatment of chronic pain, encompassing complementary
and integrative treatments and this coverage would be on par with other
covered services and provided by licensed professionals. Notably, the
provision prohibits imposing financial requirements or treatment limita-

tions on non-opioid chronic pain treatment that are more restrictive
than those for medical benefits in general or for opioid-based chronic
pain treatment. Key definitions are provided such as "financial require-
ment," "predominant," "treatment limitation," and "chronic pain," to
ensure clarity and consistency in implementation.

Section 2 amends subsection (1) of section 3221 of the insurance law by
adding a new paragraph 22, extending coverage for pain management
services in group or blanket insurance policies, substantially similar
to those outlined in section 1.

Section 3 amends subsection 303 of the insurance law by adding a new
subsection (vv) to extend coverage for pain management services in
contracts issued by hospital service corporations, health service corpo-
rations, or medical expense indemnity corporations, substantially simi-
lar to those outlined in section 1.

Section 4 provides the effective date.

 
JUSTIFICATION:

Chronic pain affects millions of individuals across the United States,
spanning a spectrum of conditions such as arthritis, migraines, cancer,
neuropathic pain, and more. Unfortunately, conventional approaches to
managing chronic pain often rely heavily on opioid medications, despite
their well-documented risks of addiction, overdose, and other adverse
effects. This reliance on opioids not only poses significant health
risks to patients but also contributes to the ongoing opioid epidemic,
which has ravaged communities nationwide.

Fortunately, there exists a diverse array of non-opioid treatments for
chronic pain, which have demonstrated efficacy in managing certain types
of chronic pain according to the Federal Centers for Disease Control and
Prevention and the National Institutes of Health.  Additionally, non-
pharmacological interventions such as acupuncture and chiropractic care,
physical therapy, and cognitive-behavioral therapy offer alternative

approaches to pain management that can be both effective and safer than
opioids.

However, access to these non-opioid treatments has been limited for many
individuals, often due to barriers such as lack of insurance coverage
and financial constraints. The proposed bill seeks to address this
disparity by mandating insurance coverage for non-opioid treatments for
chronic pain, encompassing both pharmacological and non-pharmacological
interventions. By ensuring that these treatments are readily accessible
and on par with conventional medical benefits, the bill aims to remove
financial barriers and treatment limitations that may prevent individ-
uals from seeking alternative pain management options.

In doing so, the bill not only empowers patients to explore safer and
more effective alternatives to opioids but also promotes a holistic
approach to pain management that considers the individual needs and
preferences of each patient. Moreover, by expanding access to non-opioid
treatments, including medication, the bill has the potential to mitigate
the risks associated with opioid use and contribute to border efforts to
combat the opioid epidemic.

This bill represents a significant step towards addressing a critical
public health issue and advancing the well-being of individuals with
chronic pain across the nation. By promoting evidence-based, patient-
centered care and reducing reliance on opioids, the bill underscores a
commitment to fostering safer, more sustainable approaches to pain
management in the state of New York.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

Undetermined.

 
EFFECTIVE DATE:
Effective as of the first day of January following the enactment of the
law, applying to all policies, and contracts issues, renewed, modified,
altered or amended on or after that date.

2023-S9192 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9192
 
                             I N  S E N A T E
 
                                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:

   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
 S. 9192                             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.
 S. 9192                             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.

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Senate Bill S9192

Sponsored By

Current Bill Status - In Senate Committee Insurance Committee

2023-S9192 (ACTIVE) - Details

2023-S9192 (ACTIVE) - Summary

2023-S9192 (ACTIVE) - Sponsor Memo

2023-S9192 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S9192

Share this bill

Sponsored By

Gustavo Rivera

Current Bill Status - In Senate Committee Insurance Committee

2023-S9192 (ACTIVE) - Details

2023-S9192 (ACTIVE) - Summary

2023-S9192 (ACTIVE) - Sponsor Memo

2023-S9192 (ACTIVE) - Bill Text download pdf

Comments