STATE OF NEW YORK ________________________________________________________________________ 8045 2023-2024 Regular Sessions IN ASSEMBLY September 13, 2023 ___________ Introduced by M. of A. REYES -- read once and referred to the Committee on Insurance AN ACT to amend the social services law and the insurance law, in relation to requiring comprehensive coverage for treatment of obesity The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subdivision 2 of section 365-a of the social services law 2 is amended by adding a new paragraph (mm) to read as follows: 3 (mm) (i) Comprehensive coverage for treatment of obesity, which shall 4 include coverage for prevention and wellness, nutrition counseling, 5 intensive behavioral therapy, bariatric surgery, and FDA-approved anti- 6 obesity medication. For purposes of this paragraph, "FDA-approved anti- 7 obesity medication" shall mean any medication approved by the federal 8 food and drug administration with an indication for chronic weight 9 management in patients with obesity. 10 (ii) Coverage criteria for FDA-approved anti-obesity medications 11 provided under this paragraph shall not be more restrictive than the 12 FDA-approved indications for such treatments. 13 (iii) Coverage under this paragraph shall be neither different nor 14 separate from coverage for any other illness, condition, or disorder for 15 purposes of determining deductibles, lifetime dollar limits, copayment 16 and coinsurance factors, and benefit year maximum for deductibles and 17 copayment and coinsurance factors. 18 (iv) Nothing shall preclude the undertaking of utilization management 19 to determine the medical necessity for treatment of obesity under this 20 paragraph, provided that all such appropriateness and medical necessity 21 determinations are made in the same manner as those determinations are 22 made for the treatment of any other illness, condition, or disorder 23 covered by such policy, contract, or plan. 24 (v) The department shall provide notice to eligible persons regarding 25 the coverage required by this paragraph. The notice shall be in writing EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD11933-01-3
A. 8045 2 1 and shall be prominently positioned in any literature or correspondence 2 sent to members and shall be transmitted to members within the calendar 3 year when annual information is made available to eligible persons, or 4 in any other mailing or communication to eligible persons. 5 § 2. Subsection (i) of section 3216 of the insurance law is amended by 6 adding a new paragraph 39 to read as follows: 7 (39) (A) Every policy which provides medical, major medical, or simi- 8 lar comprehensive-type coverage shall provide comprehensive coverage for 9 treatment of obesity, which shall include coverage for prevention and 10 wellness, nutrition counseling, intensive behavioral therapy, bariatric 11 surgery, and FDA-approved anti-obesity medication. For purposes of this 12 paragraph, "FDA-approved anti-obesity medication" shall mean any medica- 13 tion approved by the federal food and drug administration with an indi- 14 cation for chronic weight management in patients with obesity. 15 (B) Coverage criteria for FDA-approved anti-obesity medications 16 provided under this paragraph shall not be more restrictive than the 17 FDA-approved indications for those treatments. 18 (C) Coverage under this paragraph shall neither be different nor sepa- 19 rate from coverage for any other illness, condition, or disorder for 20 purposes of determining deductibles, lifetime dollar limits, copayment 21 and coinsurance factors, and benefit year maximum for deductibles and 22 copayment and coinsurance factors. 23 (D) Nothing shall preclude the undertaking of utilization management 24 to determine the medical necessity for treatment of obesity under this 25 paragraph, provided that all such appropriateness and medical necessity 26 determinations are made in the same manner as those determinations are 27 made for the treatment of any other illness, condition, or disorder 28 covered by such policy, contract, or plan. 29 (E) The insurer shall provide notice to covered persons regarding the 30 coverage required by this paragraph. The notice shall be in writing and 31 shall be prominently positioned in any literature or correspondence sent 32 to members and shall be transmitted to members within the calendar year 33 when annual information is made available to covered persons, or in any 34 other mailing or communication to covered persons. 35 § 3. Subsection (l) of section 3221 of the insurance law is amended by 36 adding a new paragraph 22 to read as follows: 37 (22) (A) Every insurer delivering a group or blanket policy for deliv- 38 ery in this state that provides medical, major medical, or similar 39 comprehensive-type coverage shall provide comprehensive coverage for 40 treatment of obesity, which shall include coverage for prevention and 41 wellness, nutrition counseling, intensive behavioral therapy, bariatric 42 surgery, and FDA-approved anti-obesity medication. For purposes of this 43 paragraph, "FDA-approved anti-obesity medication" shall mean any medica- 44 tion approved by the federal food and drug administration with an indi- 45 cation for chronic weight management in patients with obesity. 46 (B) Coverage criteria for FDA-approved anti-obesity medications 47 provided under this paragraph shall not be more restrictive than the 48 FDA-approved indications for those treatments. 49 (C) Coverage under this paragraph shall neither be different nor sepa- 50 rate from coverage for any other illness, condition, or disorder for 51 purposes of determining deductibles, lifetime dollar limits, copayment 52 and coinsurance factors, and benefit year maximum for deductibles and 53 copayment and coinsurance factors. 54 (D) Nothing shall preclude the undertaking of utilization management 55 to determine the medical necessity for treatment of obesity under this 56 paragraph, provided that all such appropriateness and medical necessity
A. 8045 3 1 determinations are made in the same manner as those determinations are 2 made for the treatment of any other illness, condition, or disorder 3 covered by such policy, contract, or plan. 4 (E) The insurer shall provide notice to covered persons regarding the 5 coverage required by this paragraph. The notice shall be in writing and 6 shall be prominently positioned in any literature or correspondence sent 7 to members and shall be transmitted to members within the calendar year 8 when annual information is made available to covered persons, or in any 9 other mailing or communication to covered persons. 10 § 4. Section 4303 of the insurance law is amended by adding a new 11 subsection (vv) to read as follows: 12 (vv) (1) Every policy which provides medical, major medical, or simi- 13 lar comprehensive-type coverage shall provide comprehensive coverage for 14 treatment of obesity, which shall include coverage for prevention and 15 wellness, nutrition counseling, intensive behavioral therapy, bariatric 16 surgery, and FDA-approved anti-obesity medication. For purposes of this 17 subsection, "FDA-approved anti-obesity medication" shall mean any medi- 18 cation approved by the federal food and drug administration with an 19 indication for chronic weight management in patients with obesity. 20 (2) Coverage criteria for FDA-approved anti-obesity medications 21 provided under this subsection shall not be more restrictive than the 22 FDA-approved indications for those treatments. 23 (3) Coverage under this subsection shall neither be different nor 24 separate from coverage for any other illness, condition, or disorder for 25 purposes of determining deductibles, lifetime dollar limits, copayment 26 and coinsurance factors, and benefit year maximum for deductibles and 27 copayment and coinsurance factors. 28 (4) Nothing shall preclude the undertaking of utilization management 29 to determine the medical necessity for treatment of obesity under this 30 subsection, provided that all such appropriateness and medical necessity 31 determinations are made in the same manner as those determinations are 32 made for the treatment of any other illness, condition, or disorder 33 covered by such policy, contract, or plan. 34 (5) The insurer shall provide notice to covered persons regarding the 35 coverage required by this subsection. The notice shall be in writing and 36 shall be prominently positioned in any literature or correspondence sent 37 to members and shall be transmitted to members within the calendar year 38 when annual information is made available to covered persons, or in any 39 other mailing or communication to covered persons. 40 § 5. This act shall take effect on the one hundred eightieth day after 41 it shall have become a law and shall apply to any policy issued, deliv- 42 ered, renewed, and/or modified on or after the effective date of this 43 act.