S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1815
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             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:
 
   Section  1.  Subsection  (i)  of  section 3216 of the insurance law is
 amended by adding a new paragraph 40 to read as follows:
   (40) (A) EVERY POLICY WHICH PROVIDES MEDICAL, MAJOR MEDICAL, OR  SIMI-
 LAR  COMPREHENSIVE  TYPE  COVERAGE SHALL INCLUDE COVERAGE FOR NON-OPIOID
 TREATMENTS UTILIZED FOR PAIN MANAGEMENT.
   (B) AS USED IN THIS PARAGRAPH "NON-OPIOID TREATMENTS UTILIZED FOR PAIN
 MANAGEMENT" SHALL INCLUDE, BUT NOT BE LIMITED TO:
   (I) A DRUG OR BIOLOGICAL PRODUCT THAT IS INDICATED TO PRODUCE  ANALGE-
 SIA  WITHOUT  ACTING  UPON  THE  BODY'S OPIOID RECEPTORS THAT HAS DEMON-
 STRATED THE ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUAN-
 TITY OF OPIOIDS PRESCRIBED; OR
   (II) 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.
   (C)  COVERAGE  PROVIDED  UNDER THIS PARAGRAPH MAY BE SUBJECT TO ANNUAL
 DEDUCTIBLES AND CO-INSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT
 AND THAT ARE CONSISTENT WITH THOSE IMPOSED ON OTHER  BENEFITS  WITHIN  A
 GIVEN POLICY.
   § 2. Subsection (l) of section 3221 of the insurance law is amended by
 adding a new paragraph 23 to read as follows:
   (23)  (A)  EVERY GROUP OR BLANKET POLICY WHICH PROVIDES MEDICAL, MAJOR
 MEDICAL, OR SIMILAR COMPREHENSIVE TYPE COVERAGE SHALL  INCLUDE  COVERAGE
 FOR NON-OPIOID TREATMENTS UTILIZED FOR PAIN MANAGEMENT.
   (B) AS USED IN THIS PARAGRAPH "NON-OPIOID TREATMENTS UTILIZED FOR PAIN
 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
 
   (I)  A DRUG OR BIOLOGICAL PRODUCT THAT IS INDICATED TO PRODUCE ANALGE-
 SIA WITHOUT ACTING UPON THE BODY'S  OPIOID  RECEPTORS  THAT  HAS  DEMON-
 STRATED THE ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUAN-
 TITY OF OPIOIDS PRESCRIBED; OR
   (II)  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.
   (C) COVERAGE PROVIDED UNDER THIS PARAGRAPH MAY BE  SUBJECT  TO  ANNUAL
 DEDUCTIBLES AND CO-INSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT
 AND  THAT  ARE  CONSISTENT WITH THOSE IMPOSED ON OTHER BENEFITS WITHIN A
 GIVEN POLICY.
   § 3. Section 4303 of the insurance law is  amended  by  adding  a  new
 subsection (ww) to read as follows:
   (WW)  (1)  EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPO-
 RATION, HOSPITAL SERVICE  CORPORATION,  OR  HEALTH  SERVICE  CORPORATION
 WHICH  PROVIDES  MEDICAL,  MAJOR  MEDICAL, OR SIMILAR COMPREHENSIVE TYPE
 COVERAGE SHALL INCLUDE COVERAGE FOR NON-OPIOID TREATMENTS  UTILIZED  FOR
 PAIN MANAGEMENT.
   (2)  AS  USED  IN  THIS SUBSECTION "NON-OPIOID TREATMENTS UTILIZED FOR
 PAIN MANAGEMENT" SHALL INCLUDE, BUT NOT BE LIMITED TO:
   (A) A DRUG OR BIOLOGICAL PRODUCT THAT IS INDICATED TO PRODUCE  ANALGE-
 SIA  WITHOUT  ACTING  UPON  THE  BODY'S OPIOID RECEPTORS THAT HAS DEMON-
 STRATED THE ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUAN-
 TITY OF OPIOIDS PRESCRIBED; OR
   (B) 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.
   (3)  COVERAGE  PROVIDED UNDER THIS SUBSECTION MAY BE SUBJECT TO ANNUAL
 DEDUCTIBLES AND CO-INSURANCE AS DEEMED APPROPRIATE BY THE SUPERINTENDENT
 AND THAT ARE CONSISTENT WITH THOSE IMPOSED ON OTHER  BENEFITS  WITHIN  A
 GIVEN POLICY.
   §  4. The social services law is amended by adding a new section 365-q
 to read as follows:
   § 365-Q. PROVISION OF ALTERNATIVE TREATMENT FOR  PAIN  MANAGEMENT.  1.
 THE  COMMISSIONER  SHALL  ESTABLISH  STANDARDS  AND  GUIDELINES  FOR THE
 PROVISION OF NON-OPIOID TREATMENTS UTILIZED FOR  PAIN  MANAGEMENT  UNDER
 THE  MEDICAL  ASSISTANCE  PROGRAM.  IN  ESTABLISHING  SUCH STANDARDS AND
 GUIDELINES, THE COMMISSIONER SHALL CONSULT WITH PROVIDERS OF  NON-OPIOID
 TREATMENTS UTILIZED FOR PAIN MANAGEMENT AND OTHER INTERESTED PARTIES.
   2.  FOR  PURPOSES  OF  THIS TITLE, "NON-OPIOID TREATMENTS UTILIZED FOR
 PAIN MANAGEMENT" SHALL INCLUDE, BUT NOT BE LIMITED TO:
   (A) A DRUG OR BIOLOGICAL PRODUCT THAT IS INDICATED TO PRODUCE  ANALGE-
 SIA  WITHOUT  ACTING  UPON  THE  BODY'S OPIOID RECEPTORS THAT HAS DEMON-
 STRATED THE ABILITY TO REPLACE, REDUCE, OR AVOID OPIOID USE OR THE QUAN-
 TITY OF OPIOIDS PRESCRIBED; OR
   (B) 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.
   § 5. This act shall take effect on the one hundred twentieth day after
 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.