SB0273

Summary

Biomarker testing coverage. Requires a health plan (which includes a policy of accident and sickness insurance, a health maintenance organization contract, the Medicaid risk based managed care program, and a state employee health plan) to provide coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition when biomarker testing is supported by medical and scientific evidence. Requires the office of Medicaid policy and planning to provide biomarker testing as a Medicaid program service, and to apply to the United States Department of Health and Human Services for approval of any waiver necessary under the federal Medicaid program for the purpose of providing biomarker testing. Provides that coverage is not required for biomarker testing for screening purposes. Provides that if a prior authorization requirement applies to biomarker testing, the health plan or a third party acting on behalf of the health plan must: (1) approve or deny a request for prior authorization; and (2) notify the covered individual of the approval or denial; in not more than five business days in the case of a nonurgent request or in not more than 48 hours in the case of an urgent request. Requires the office of the secretary of family and social services to report certain information to the budget committee on Medicaid reimbursement rates provided for biomarker testing.

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