What's happening
This bill requires insurance policies to cover FDA-approved medical devices and products for treating withdrawal symptoms related to substance use disorders.
Why it matters
Expands insurance coverage. to include not just medications, but also FDA-approved medical devices and products for treating withdrawal symptoms, which could increase treatment options for people with substance use disorders.
Improves access to newer technologies and treatments. by ensuring insurance plans must cover the latest FDA-approved solutions for withdrawal, making it less likely that patients will face out-of-pocket costs for these products.
May encourage the development and use of innovative withdrawal management tools. , since mandated coverage can boost demand and availability for FDA-approved medical devices and products in addiction treatment settings.
Strengthens parity and coverage protections. by explicitly stating that these expanded benefits are subject to the same parity laws as other medical and surgical benefits, helping to ensure substance use disorder treatment is not subject to more restrictive limits.
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Who cares
Headline styles
Require Insurance for Withdrawal Devices
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7141
IN SENATE (Prefiled)
January 3, 2018
Introduced by Sen. BROOKS -- 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 mandating insurance coverage for medical devices to treat withdrawal symptoms
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subparagraph (A) of paragraph 30 of subsection (i) of section 3216 of the insurance law, as amended by section 1 of part B of chapter 71 of the laws of 2016, is amended to read as follows:
(A) Every policy that provides hospital, major medical or similar comprehensive coverage must provide inpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services, including the use of medications, medical devices and products approved by the food and drug administration for the treatment of withdrawal symptoms. Such inpatient coverage shall include unlimited medically necessary treatment for substance use disorder treatment services provided in residential settings as required by the Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a). Further, such inpatient coverage shall not apply financial requirements or treatment limitations, including utilization review requirements, to inpatient substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations applied to substantially all medical and surgical benefits covered by the policy. Further, such coverage shall be provided consistent with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
§ 2. Subparagraph (A) of paragraph 31 of subsection (i) of section 3216 of the insurance law, as added by chapter 41 of the laws of 2014, is amended to read as follows:
(A) Every policy that provides medical, major medical or similar comprehensive-type coverage must provide outpatient coverage for the diagnosis and treatment of substance use disorder, including detoxification and rehabilitation services, including the use of medications,
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD13812-01-7
S. 7141 2
medical devices and products approved by the food and drug administration for the treatment of withdrawal symptoms. Such coverage shall not apply financial requirements or treatment limitations to outpatient substance use disorder benefits that are more restrictive than the predominant financial requirements and treatment limitations applied to substantially all medical and surgical benefits covered by the policy. Further, such coverage shall be provided consistent with the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a).
§ 3. Paragraph 7-a of subsection (l) of section 3221 of the insurance law, as added by section 2 of part B of chapter 69 of the laws of 2016, is amended to read as follows:
(7-a) Every policy that provides medical, major medical or similar comprehensive-type large group coverage shall provide coverage for medication for the detoxification or maintenance treatment, including medical devices or products for the treatment of withdrawal symptoms, of a substance use disorder approved by the food and drug administration for the detoxification or maintenance treatment of substance use disorder.
§ 4. Subsection (l-1) of section 4303 of the insurance law, as added by section 3 of part B of chapter 69 of the laws of 2016, is amended to read as follows:
(l-1) Every contract that provides medical, major medical, or similar comprehensive-type large group coverage shall provide coverage for medication for the detoxification or maintenance treatment, including medical devices or products for the treatment of withdrawal symptoms, of a substance use disorder approved by the food and drug administration for the detoxification or maintenance treatment of substance use disorder.
§ 5. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to policies and contracts issued, renewed, modified, altered or amended on and after such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to mandating insurance coverage for medical devices to treat withdrawal symptoms
Purpose or general idea of bill
Requires insurance companies to cover medications, medical devices or products approved by the Food and Drug Administration to treat with- drawal symptoms.
Summary of specific provisions
Sections 1 through 4 of the bill requires every policy that provides hospital, major medical or similar comprehensive coverage must also provide coverage for medical devices or products that treat withdrawal symptoms.
Justification
In 2016, the Governor signed into law several provisions relating to increasing access to treatment for substance abuse disorders. Specif- ically, Chapter 69 of 2016 requires insurance companies to provide insurance coverage for medications for the treatment of substance use disorder in the event of an emergency condition including the treatment of withdrawal symptoms.
In November 2017, the FDA gave final approval of a device that helps to reduce the symptoms of opioid withdrawal. This battery-powered device is placed behind a patients ear and emits electric pulses into the patients cranial nerves to provide relief for withdrawal symptoms. The device is only available through a prescription and can be used for five days during the withdrawal phase.
Opioid withdrawal symptoms include gastronintestinal issues, bone and joint aches, tremors, insomnia, and anxiety. During testing of the device, it was shown that all patients in the trial saw a reduction in symptoms within 30 minutes of using the device. In addition, 88 percent of patients transitioned to medication assisted therapy after 5 days using the device.
While "medications" are required to be covered, it is unclear whether this "device" would be included in the mandate from the 2016 chapter. Therefore, this bill will clarify that in addition to medications for the treatment of substance use disorders, "medical devices or products" must also be covered.
Prior legislative history
New bill
Fiscal implications
None to the State.
Effective date
First of January next succeeding the date on which it shall become law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.