Committee hears plan to require limited coverage for integrative pain services as alternatives to opioids

Representative Dave Nagel, a medical doctor and sponsor of House Bill 241, told the House Commerce Committee that the bill would require carriers in the fully insured individual and small-group markets to cover a defined package of integrative, evidence-based pain services (including acupuncture, chiropractic care, behavioral health therapies, massage/manual therapies, and restorative therapies such as physical therapy) for a limited number of visits per year.

Nagel framed the proposal as a cost-effective, preventive approach that would reduce reliance on opioids and high-cost interventions such as spine surgery. ‘‘There are chapters on here that on issues that we will be discussing today,’’ he said, adding that the bill’s intent is to front-load less invasive, evidence-based care. He described the bill as a template intended to prompt payers to cover initial modalities that can, in combination, reduce pain sufficiently to improve function.

Patient advocates, acupuncture and psychology organizations, and the U.S. Pain Foundation testified in favor. Roberta Blades, a Concord resident and support-group leader with the U.S. Pain Foundation, told lawmakers that treatments such as aquatic therapy, mindfulness, targeted massage and acupuncture had helped her regain function after a severe injury and that out‑of‑pocket costs and access barriers remained.

University and hospital representatives urged caution. Lauren Banker and Lisonbee Rich of the University System of New Hampshire and University of New Hampshire athletics told the panel that campuses already provide some NIL-like (note: testimony used NIL earlier for a different bill) or support services, and the university cautioned against a fragmented patchwork of state mandates that could make it harder for in‑state institutions to recruit and retain students and athletes.

Insurers and the Insurance Department said many services listed are already covered in at least some plans, but the department flagged the need for clearer clinical guidelines and warned a mandate could increase premiums if carriers were required to cover services not in the state benchmark plan. Harvard Pilgrim told the committee it already covers a broad range of non‑opioid treatments and urged careful, targeted drafting; Anthem said it covers many nonpharmacologic options but raised network, coding and implementation questions.

No vote was taken; committee members asked sponsors and stakeholders to work on precise definitions, limits, and clinical guidelines before subcommittee consideration.

Speakers - Representative Dave Nagel — prime sponsor, medical doctor and longtime pain-care advocate. 1st ref: s14736.035–14744.436 - Roberta Blades — Concord resident, U.S. Pain Foundation volunteer and support-group leader (testimony). 1st ref: s16925.86–16969.05 - Amy Odell Wilson — Licensed acupuncturist, New Hampshire Acupuncture and Asian Medicine Association (NAHAMA), testified in support. 1st ref: s17581.621–17601.42 - John DeJoy — New Hampshire Psychological Association (testified in support). 1st ref: s18156.154–18161.775 - Cindy Steinberg — U.S. Pain Foundation (national patient organization). 1st ref: s18307.611–18316.324 - Michelle Heaton — Director, Life & Health, New Hampshire Insurance Department (informational). 1st ref: s18993.959–19007.346 - Andrew Hosmer — Harvard Pilgrim Health Care (carrier testimony, later in hearing). 1st ref: s19191.07–19192.43

Authorities - Centers for Disease Control and Prevention reports and the National Pain Strategy were referenced repeatedly in sponsor testimony as policy context; committee members and witnesses said those federal documents recommend multimodal care.

Discussion vs. Decision - Discussion only: detailed debate on evidence thresholds, visit limits (sponsor suggested a cap such as 12 visits per year), clinical guidelines and whether the state benchmark should change to require the benefit. No committee vote recorded.

Clarifying details - category:"visit limits","detail":"Sponsor discussed limiting covered modalities to a fixed number of visits per year (example language in the file referenced '12 visits'); committee asked for clinical guidance on appropriate limits","value":"12 (example discussed)","units":"visits","approximate":true,"source_speaker":"Representative Dave Nagel"},{"category":"evidence base","detail":"Sponsor and supporters cited acupuncture evidence project and other sources to justify inclusion of specific modalities; insurers asked for specific guideline language","value":"not specified","source_speaker":"Amy Odell Wilson"}],

proper_names:[{"name":"U.S. Pain Foundation","type":"organization"},{"name":"University of New Hampshire (UNH)","type":"school"},{"name":"Harvard Pilgrim Health Care","type":"business"}],

community_relevance:{"geographies":["statewide"],"funding_sources":[],"impact_groups":["patients with chronic pain","veterans","hospice and palliative care patients","insurers"]},

meeting_context:{"engagement_level":{"speakers_count":25,"duration_minutes":240,"items_count":1},"implementation_risk":"medium","history":[{"date":"2019","note":"HHS best-practice guidance cited by witnesses; several federal reports have recommended multimodal pain care."}]},

searchable_tags:["HB241","pain management","acupuncture","chiropractic","behavioral health","integrative care"],

provenance:{"transcript_segments":[{"block_id":"14705.936-14736.035","local_start":0,"local_end":96,"evidence_excerpt":"Let's take up house bill 241...I'm honored to, present House Bill 241 from 2025. Thank you for the opportunity to do this.","reason_code":"topicintro"},{"block_id":"20111.895-20111.895","local_start":0,"local_end":46,"evidence_excerpt":"So thank you, Paul. Okay. Thank you. So representative, we do have 1 more bill we gotta get through here. But this will... the committee closed the public hearing.","reason_code":"topicfinish"}] ,

topics:[{"name":"opioid alternatives","justification":"Bill is explicitly designed to expand insurer coverage of nonpharmacologic pain care to reduce opioid reliance and downstream high-cost procedures.","scoring":{"topic_relevance":1.00,"depth_score":0.95,"opinionatedness":0.10,"controversy":0.65,"civic_salience":0.85,"impactfulness":0.80,"geo_relevance":0.90}}],

salience:{"overall":0.80,"overall_justification":"High public-health salience because of opioid-era transitions, large affected population estimates for chronic pain, and potential health-cost impacts.","impact_scope":"regional","impact_scope_justification":"Would affect in-state insured patients and carriers; veteran and hospice programs referenced as models.","attention_level":"high","attention_level_justification":"Broad stakeholder participation (patients, practitioners, insurers, universities) and multiple technical questions raised.","novelty":0.50,"novelty_justification":"Many payers already cover elements of the package; the bill's novelty is in bundling and a statutory visit cap and explicit coverage mandate.","timeliness_urgency":0.70,"timeliness_urgency_justification":"Active national interest in reducing opioid harms and improving multimodal pain care.