Text to be removed highlighted in red.
1 Statement of Findings and Purpose.
I. The general court recognizes the following:
(a) The causes of the opioid crisis are complex and multifactorial.
(b) One of the major causes was the failure of the health care system, as a whole, to provide meaningful access to a broad range of non-opioid, non-interventional evidence-based therapies including complimentary alternative medicine provided by licensed professionals as either single modality therapy or integrative care for those who suffer from acute, chronic, and/or end of life pain.
(c) Executive and legislative entities both at the federal and state level pursued public health polices to combat the crisis which, in effect, abandoned those in pain, particularly those on opioid therapies, by creating barriers to opioid therapy without creating access to non-opioid therapies resulting in unnecessary and extensive morbidity and mortality for those patients.
(d) While government based and commercial insurers do provide some access to these therapies, the availability is limited and insufficient to address the scope of the problem.
(e) While the litmus test for what therapies should be made available is evidence-based, it is concerning that a double standard is used between therapies provided by allopathic and non-allopathic providers in determining strength of evidence required, and this double standard unfairly favors allopathic providers.
II. The purpose of this act is to both increase access to these therapies in a cost-effective, evidence-based manner in the commercial insurance market and to level the evidence-based standards used in deciding which therapies should be available.
2 New Section; Accident and Health Insurance; Coverage for Pain Management Services; Individual Coverage. Amend RSA 415 by inserting after section 6-a1 the following new section:
415:6-bb Coverage for Pain Management Services.
I. Each insurer that issues or renews any individual policy, plan or contract of accident or health insurance providing benefits for medical or hospital expenses shall provide to persons covered by such insurance who are residents of this state coverage for a broad spectrum of pain management services by providers practicing in a licensed profession, in addition to currently covered pharmacologic and interventionalist treatments. Such services shall include:
(a) Behavioral health interventions, including but not limited to pain self-management training, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), mindfulness and/or other meditation training, support groups, and pain education.
(b) Manual treatments, including, but not limited to: chiropractic treatment of spine, peripheral joints, and soft tissues; osteopathic manipulation of joints and tissues; and massage therapy and manual physical therapy treatments.
(c) Movement therapies, including, but not limited to therapeutic exercises administered by physical therapists and chiropractors.
(d) Acupuncture.
(e) Massage therapy.
II. Policies issued or renewed pursuant to this section shall provide for at least 12 visits for each of the preceding categories of pain management services and shall include coverage for coordination of pain management services during the plan year for each of the preceding pain management services to manage pain by the policy holder's beneficiaries' licensed providers to ensure that the provided services are both well integrated and multi-modal.
III. Each insurer that issues or renews any individual policy, plan or contract of accident or health insurance providing benefits for medical or hospital expenses shall produce and submit to the insurance commissioner for approval a comprehensive pain services management plan which shall contain a description of the covered pain management services in accordance with rules adopted by the insurance commissioner under RSA 541-A. Upon approval by the insurance commissioner, the insurers shall promptly post their pain management services plan approved by the insurance commissioner and detailed descriptions of covered services to their public websites in an easily accessible location.
IV. Each insurer that issues or renews any individual policy, plan or contract of accident or health insurance providing benefits for medical or hospital expenses shall provide with each renewed or issued policy of health insurance, educational materials to policy holder beneficiaries and all in-network providers of pain management services. Educational materials shall include pain self-management information and a description of the full range of pharmacological and non-pharmacological methods and treatments for managing pain, including those methods and treatments covered by the insurer's pain management plan.
V. No insurer shall establish utilization controls, including prior authorization or step therapy requirements, for clinically appropriate nonopioid therapies, medicinal drugs or drug products approved by the federal Food and Drug Administration for the treatment or management of pain that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.
VI. In this section:
(a) "Pain" means an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
(b) "Pain management services plan" means a comprehensive written plan by insurers for provision of pain management services.
(c) "Pain management services" mean a broad spectrum of pain relief services and treatments for residents of this state experiencing pain.
(d) "Pain education" means education aimed at understanding the neuroscience of pain, the biopsychosocial nature of pain, and the rationale for use of diverse approaches to effectively manage pain.
(e) "Self-management training" means training that engages patients in self-regulation of physical, cognitive, and emotional processes to reduce pain and improve function.
(f) "Multi-modal" means utilization of a number of diverse approaches expected to have a synergistic or complementary effect in achieving effective pain management.
3 New Section; Accident and Health Insurance; Coverage for Pain Management Services; Group. Amend RSA 415 by inserting after section 18-gg the following new section:
415:18-hh Coverage for Pain Management Services.
I. Each insurer that issues or renews a policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall provide to persons covered by such insurance who are residents of this state coverage for a broad spectrum of pain management services by providers practicing in a licensed profession, in addition to currently covered pharmacologic and interventionalist treatments. Such services shall include:
(a) Behavioral health interventions, including but not limited to pain self-management training, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), mindfulness and/or other meditation training, support groups, and pain education.
(b) Manual treatments, including, but not limited to: chiropractic treatment of spine, peripheral joints, and soft tissues; osteopathic manipulation of joints and tissues; and massage therapy and manual physical therapy treatments.
(c) Movement therapies, including, but not limited to therapeutic exercises administered by physical therapists and chiropractors, independent therapeutic exercise, aquatic therapy, yoga, qi gong, and tai chi.
(d) Acupuncture.
(e) Massage Therapy
II. Policies issued or renewed pursuant to this section shall provide for at least 12 visits for each of the preceding pain management categories and shall include coverage for coordination of pain management services during the plan year for each of the preceding pain management services to manage pain by the policy holder's beneficiaries' licensed providers to ensure that the provided services are both well integrated and multi-modal.
III. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall produce and submit to the insurance commissioner for approval a comprehensive pain services management plan which shall contain a description of the covered pain management services in accordance with rules adopted by the insurance commissioner under RSA 541-A. Upon approval by the insurance commissioner, the insurers shall promptly post their pain management services plan approved by the insurance commissioner and detailed descriptions of covered services to their public websites in an easily accessible location.
IV. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall provide with each renewed or issued policy of health insurance, educational materials to policy holder beneficiaries and all in-network providers of pain management services. Educational materials shall include pain self-management information and a description of the full range of pharmacological and non-pharmacological methods and treatments for managing pain, including those methods and treatments covered by the insurer's pain management plan.
V. No insurer shall establish utilization controls, including prior authorization or step therapy requirements, for clinically appropriate nonopioid therapies, medicinal drugs or drug products approved by the federal Food and Drug Administration for the treatment or management of pain that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.
VI. In this section:
(a) "Pain" means an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
(b) "Pain management services plan" means a comprehensive written plan by insurers for provision of pain management services.
(c) "Pain management services" mean a broad spectrum of pain relief services and treatments for residents of this state experiencing pain.
(d) "Pain education" means education aimed at understanding the neuroscience of pain, the biopsychosocial nature of pain, and the rationale for use of diverse approaches to effectively manage pain.
(e) "Self-management training" means training that engages patients in self-regulation of physical, cognitive, and emotional processes to reduce pain and improve function.
(f) "Multi-modal" means utilization of a number of diverse approaches expected to have a synergistic or complementary effect in achieving effective pain management.
4 Health Services Corporations; Applicable Statutes. Amend RSA 420-A:2 to read as follows:
420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:6-z, RSA 415:6-a1, RSA 415:18, V, RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-i, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415:18-dd, RSA 415:18-ee, RSA 415:18-ff, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
5 Health Maintenance Organizations; Statutory Construction. Amend RSA 420-B:20, III to read as follows:
III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:6-z, RSA 415:6-a1, RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-i, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415:18-dd, RSA 415:18-ee, RSA 415:18-ff, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
6 Effective Date. This act shall take effect July 1, 2025.
Text to be added highlighted in green.
1 Statement of Findings and Purpose.
I. The general court recognizes the following:
(a) The causes of the opioid crisis are complex and multifactorial.
(b) One of the major causes was the failure of the health care system, as a whole, to provide meaningful access to a broad range of non-opioid, non-interventional evidence-based therapies including complimentary alternative medicine provided by licensed professionals as either single modality therapy or integrative care for those who suffer from acute, chronic, and/or end of life pain.
(c) Executive and legislative entities both at the federal and state level pursued public health polices to combat the crisis which, in effect, abandoned those in pain, particularly those on opioid therapies, by creating barriers to opioid therapy without creating access to non-opioid therapies resulting in unnecessary and extensive morbidity and mortality for those patients.
(d) While government based and commercial insurers do provide some access to these therapies, the availability is limited and insufficient to address the scope of the problem.
(e) While the litmus test for what therapies should be made available is evidence-based, it is concerning that a double standard is used between therapies provided by allopathic and non-allopathic providers in determining strength of evidence required, and this double standard unfairly favors allopathic providers.
II. The purpose of this act is to both increase access to these therapies in a cost-effective, evidence-based manner in the commercial insurance market and to level the evidence-based standards used in deciding which therapies should be available.
2 New Section; Accident and Health Insurance; Coverage for Pain Management Services; Individual Coverage. Amend RSA 415 by inserting after section 6-a1 the following new section:
415:6-bb Coverage for Pain Management Services.
I. Each insurer that issues or renews any individual policy, plan or contract of accident or health insurance providing benefits for medical or hospital expenses shall provide to persons covered by such insurance who are residents of this state coverage for a broad spectrum of pain management services by providers practicing in a licensed profession, in addition to currently covered pharmacologic and interventionalist treatments. Such services shall include:
(a) Behavioral health interventions, including but not limited to pain self-management training, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), mindfulness and/or other meditation training, support groups, and pain education.
(b) Manual treatments, including, but not limited to: chiropractic treatment of spine, peripheral joints, and soft tissues; osteopathic manipulation of joints and tissues; and massage therapy and manual physical therapy treatments.
(c) Movement therapies, including, but not limited to therapeutic exercises administered by physical therapists and chiropractors.
(d) Acupuncture.
(e) Massage therapy.
II. Policies issued or renewed pursuant to this section shall provide for at least 12 visits for each of the preceding categories of pain management services and shall include coverage for coordination of pain management services during the plan year for each of the preceding pain management services to manage pain by the policy holder's beneficiaries' licensed providers to ensure that the provided services are both well integrated and multi-modal.
III. Each insurer that issues or renews any individual policy, plan or contract of accident or health insurance providing benefits for medical or hospital expenses shall produce and submit to the insurance commissioner for approval a comprehensive pain services management plan which shall contain a description of the covered pain management services in accordance with rules adopted by the insurance commissioner under RSA 541-A. Upon approval by the insurance commissioner, the insurers shall promptly post their pain management services plan approved by the insurance commissioner and detailed descriptions of covered services to their public websites in an easily accessible location.
IV. Each insurer that issues or renews any individual policy, plan or contract of accident or health insurance providing benefits for medical or hospital expenses shall provide with each renewed or issued policy of health insurance, educational materials to policy holder beneficiaries and all in-network providers of pain management services. Educational materials shall include pain self-management information and a description of the full range of pharmacological and non-pharmacological methods and treatments for managing pain, including those methods and treatments covered by the insurer's pain management plan.
V. No insurer shall establish utilization controls, including prior authorization or step therapy requirements, for clinically appropriate nonopioid therapies, medicinal drugs or drug products approved by the federal Food and Drug Administration for the treatment or management of pain that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.
VI. In this section:
(a) "Pain" means an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
(b) "Pain management services plan" means a comprehensive written plan by insurers for provision of pain management services.
(c) "Pain management services" mean a broad spectrum of pain relief services and treatments for residents of this state experiencing pain.
(d) "Pain education" means education aimed at understanding the neuroscience of pain, the biopsychosocial nature of pain, and the rationale for use of diverse approaches to effectively manage pain.
(e) "Self-management training" means training that engages patients in self-regulation of physical, cognitive, and emotional processes to reduce pain and improve function.
(f) "Multi-modal" means utilization of a number of diverse approaches expected to have a synergistic or complementary effect in achieving effective pain management.
3 New Section; Accident and Health Insurance; Coverage for Pain Management Services; Group. Amend RSA 415 by inserting after section 18-gg the following new section:
415:18-hh Coverage for Pain Management Services.
I. Each insurer that issues or renews a policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall provide to persons covered by such insurance who are residents of this state coverage for a broad spectrum of pain management services by providers practicing in a licensed profession, in addition to currently covered pharmacologic and interventionalist treatments. Such services shall include:
(a) Behavioral health interventions, including but not limited to pain self-management training, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), mindfulness and/or other meditation training, support groups, and pain education.
(b) Manual treatments, including, but not limited to: chiropractic treatment of spine, peripheral joints, and soft tissues; osteopathic manipulation of joints and tissues; and massage therapy and manual physical therapy treatments.
(c) Movement therapies, including, but not limited to therapeutic exercises administered by physical therapists and chiropractors, independent therapeutic exercise, aquatic therapy, yoga, qi gong, and tai chi.
(d) Acupuncture.
(e) Massage Therapy
II. Policies issued or renewed pursuant to this section shall provide for at least 12 visits for each of the preceding pain management categories and shall include coverage for coordination of pain management services during the plan year for each of the preceding pain management services to manage pain by the policy holder's beneficiaries' licensed providers to ensure that the provided services are both well integrated and multi-modal.
III. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall produce and submit to the insurance commissioner for approval a comprehensive pain services management plan which shall contain a description of the covered pain management services in accordance with rules adopted by the insurance commissioner under RSA 541-A. Upon approval by the insurance commissioner, the insurers shall promptly post their pain management services plan approved by the insurance commissioner and detailed descriptions of covered services to their public websites in an easily accessible location.
IV. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall provide with each renewed or issued policy of health insurance, educational materials to policy holder beneficiaries and all in-network providers of pain management services. Educational materials shall include pain self-management information and a description of the full range of pharmacological and non-pharmacological methods and treatments for managing pain, including those methods and treatments covered by the insurer's pain management plan.
V. No insurer shall establish utilization controls, including prior authorization or step therapy requirements, for clinically appropriate nonopioid therapies, medicinal drugs or drug products approved by the federal Food and Drug Administration for the treatment or management of pain that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.
VI. In this section:
(a) "Pain" means an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
(b) "Pain management services plan" means a comprehensive written plan by insurers for provision of pain management services.
(c) "Pain management services" mean a broad spectrum of pain relief services and treatments for residents of this state experiencing pain.
(d) "Pain education" means education aimed at understanding the neuroscience of pain, the biopsychosocial nature of pain, and the rationale for use of diverse approaches to effectively manage pain.
(e) "Self-management training" means training that engages patients in self-regulation of physical, cognitive, and emotional processes to reduce pain and improve function.
(f) "Multi-modal" means utilization of a number of diverse approaches expected to have a synergistic or complementary effect in achieving effective pain management.
4 Health Services Corporations; Applicable Statutes. Amend RSA 420-A:2 to read as follows:
420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:6-z, RSA 415:6-a1, RSA 415:6-bb, RSA 415:18, V, RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-i, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415:18-dd, RSA 415:18-ee, RSA 415:18-ff, RSA 415:18-gg, RSA 415:18-hh, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
5 Health Maintenance Organizations; Statutory Construction. Amend RSA 420-B:20, III to read as follows:
III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:6-z, RSA 415:6-a1, RSA 415:6-bb, RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-i, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415:18-dd, RSA 415:18-ee, RSA 415:18-ff, RSA 415:18-gg, RSA 415:18-hh, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
6 Effective Date. This act shall take effect July 1, 2025.