New York A 4211: Requires comprehensive coverage for treatment of obesity

Bill Text

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A04211 Summary:

BILL NOA04211 

&nbsp

SAME ASSAME AS S03104

&nbsp

SPONSORReyes

&nbsp

COSPNSRButtenschon, Glick, Shimsky, Lavine, Lunsford, Hevesi, Simon, Jackson, Lucas, Sayegh, Zaccaro, De
 Los Santos, Hyndman

&nbsp

MLTSPNSR

&nbsp

Amd §365-a, Soc Serv L; amd §§3216, 3221 & 4303, Ins L

&nbsp

Requires comprehensive coverage for treatment of obesity, including coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication.

Go to top A04211 Actions:

BILL NOA04211 

&nbsp

01/31/2025referred to insurance

01/07/2026referred to insurance

Go to topA04211 Committee&nbspVotes:

Go to topA04211 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topA04211 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 4211

 2025-2026 Regular Sessions

 IN ASSEMBLY

 January 31, 2025
 ___________

 Introduced by M. of A. REYES, BUTTENSCHON, GLICK, SHIMSKY, LAVINE, LUNS-
 FORD, HEVESI, SIMON, JACKSON, LUCAS, SAYEGH, ZACCARO, DE LOS SANTOS,
 HYNDMAN -- 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 (nn) to read as follows:
 3 (nn) (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.

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD02785-01-5

 A. 4211 2

 1 (v) The department shall provide notice to eligible persons regarding
 2 the coverage required by this paragraph. The notice shall be in writing
 3 and shall be prominently positioned in any literature or correspondence
 4 sent to members and shall be transmitted to members within the calendar
 5 year when annual information is made available to eligible persons, or
 6 in any other mailing or communication to eligible persons.
 7 § 2. Subsection (i) of section 3216 of the insurance law is amended by
 8 adding a new paragraph 40 to read as follows:
 9 (40) (A) Every policy which provides medical, major medical, or simi-
 10 lar comprehensive-type coverage shall provide comprehensive coverage for
 11 treatment of obesity, which shall include coverage for prevention and
 12 wellness, nutrition counseling, intensive behavioral therapy, bariatric
 13 surgery, and FDA-approved anti-obesity medication. For purposes of this
 14 paragraph, "FDA-approved anti-obesity medication" shall mean any medica-
 15 tion approved by the federal food and drug administration with an indi-
 16 cation for chronic weight management in patients with obesity.
 17 (B) Coverage criteria for FDA-approved anti-obesity