Stricken language would be deleted from and underlined language would be added to present law.
Act 860 of the Regular Session
*ANS096* 04-02-2025 11:48:52 ANS096
State of Arkansas As Engrossed: H1/30/25 H3/17/25 S4/2/25 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1079 3
4
By: Representatives F. Allen, Wooten, K. Ferguson, J. Richardson 5
By: Senator D. Wallace 6
7
For An Act To Be Entitled 8
AN ACT TO MANDATE COVERAGE FOR GENETIC TESTING FOR AN 9
INHERITED GENE MUTATION FOR CERTAIN INDIVIDUALS; TO 10
MANDATE COVERAGE FOR EVIDENCE -BASED CANCER IMAGING 11
FOR CERTAIN INDIVIDUALS; AND FOR OTHER PURPOSES. 12
13
14
Subtitle 15
TO MANDATE COVERAGE FOR GENETIC TESTING 16
FOR AN INHERITED GENE MUTATION FOR 17
CERTAIN INDIVIDUALS; AND TO MANDATE 18
COVERAGE FOR EVIDENCE -BASED CANCER 19
IMAGING FOR CERTAIN INDIVIDUALS. 20
21
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 22
23
SECTION 1. Arkansas Code Title 23, Chapter 79, is amended to add an 24
additional subchapter to read as follows: 25
26
Subchapter 29 — Coverage for Genetic Testing for Inherited Gene Mutation and 27
Evidence-based Cancer Imaging 28
29
23-79-2901. Definitions. 30
As used in this subchapter: 31
(1)(A) "Clinical utility" means a test result that provides 32
information that is used in the formulation of a treatment or monitoring 33
strategy that informs a patient's outcome and impacts the clinical decision. 34
(B) "Clinical utility" includes the most appropriate test 35
that may include both information that is actionable and some information 36 As Engrossed: H1/30/25 H3/17/25 S4/2/25 HB1079
2 04-02-2025 11:48:52 ANS096
that cannot be immediately used in the formulation of a clinical decision; 1
(2) "Evidence-based cancer imaging" means appropriate preventive 2
screening and imaging supported by evidence; 3
(3) "Genetic testing for an inherited gene mutation" means 4
testing for an inherited gene mutation associated with an increased risk of 5
cancer; 6
(4)(A) "Health benefit plan" means an individual, blanket, or 7
group plan, policy, or contract for healthcare services issued, renewed, or 8
extended in this state by a healthcare insurer, health maintenance 9
organization, hospital medical service corporation, or self -insured 10
governmental or church plan in this state. 11
(B) “Health benefit plan” includes: 12
(i) Indemnity and managed care plans; and 13
(ii) Nonfederal governmental plans as defined in 29 14
U.S.C. § 1002(32), as it existed on January 1, 2025. 15
(C) “Health benefit plan” does not include: 16
(i) A plan that provides only dental benefits or eye 17
and vision care benefits; 18
(ii) A disability income plan; 19
(iii) A credit insurance plan; 20
(iv) Insurance coverage issued as a supplement to 21
liability insurance; 22
(v) Medical payments under an automobile or 23
homeowners insurance plan; 24
(vi) A health benefit plan provided under Arkansas 25
Constitution, Article 5, § 32, the Workers' Compensation Law, § 11 -9-101 et 26
seq., or the Public Employee Workers' Compensation Act, § 21 -5-601 et seq.; 27
(vii) A plan that provides only indemnity for 28
hospital confinement; 29
(viii) An accident-only plan; 30
(ix) A specified disease plan; or 31
(x) A long-term-care-only plan; 32
(5)(A) "Healthcare insurer" means any insurance company, 33
hospital and medical service corporation, or health maintenance organization 34
that issues or delivers health benefit plans in this state and is subject to 35
any of the following laws: 36 As Engrossed: H1/30/25 H3/17/25 S4/2/25 HB1079
3 04-02-2025 11:48:52 ANS096
(i) The insurance laws of this state; 1
(ii) Section 23-75-101 et seq., pertaining to 2
hospital and medical service corporations; or 3
(iii) Section 23-76-101 et seq., pertaining to 4
health maintenance organizations. 5
(B) "Healthcare insurer" does not include an entity that 6
provides only dental benefits or eye and vision care benefits; 7
(6) "Healthcare provider" means a person who is licensed, 8
certified, or otherwise authorized by the laws of this state to administer 9
healthcare services; and 10
(7) "Nationally recognized clinical practice guidelines" means 11
evidence-based clinical practice guidelines that: 12
(A) Are developed by independent organizations or medical 13
professional societies: 14
(i) Using a transparent methodology and reporting 15
structure; and 16
(ii) With a conflict of interest policy; and 17
(B) Establish standards of care that are informed by: 18
(i) A systemic review of evidence; and 19
(ii) An assessment of the benefits and costs of 20
alternative care options that includes without limitation recommendations 21
intended to optimize patient care. 22
23
23-79-2902. Coverage for genetic testing for inherited gene mutation 24
and evidence-based cancer imaging. 25
(a) Beginning on and after January 1, 2026, a health benefit plan that 26
is offered, issued, or renewed in this state shall provide coverage for: 27
(1) Genetic testing for an inherited gene mutation in a clinical 28
setting for an individual with a personal or family history of cancer if the 29
genetic testing for an inherited gene mutation: 30
(A) Provides clinical utility; and 31
(B) Is ordered or recommended by a healthcare provider and 32
is supported by medical and scientific evidence, including without 33
limitation: 34
(i) The National Comprehensive Cancer Network 35
clinical practice recommendations that are level 2a or higher; 36 As Engrossed: H1/30/25 H3/17/25 S4/2/25 HB1079
4 04-02-2025 11:48:52 ANS096
(ii) Centers for Medicare & Medicaid Services 1
national coverage determinations or Medicare administrative contractor local 2
coverage determinations; or 3
(iii) Nationally recognized clinical practice 4
guidelines; and 5
(2) Evidence-based cancer imaging for an individual at an 6
increased risk of developing cancer if the evidence -based cancer imaging: 7
(A) Provides clinical utility; and 8
(B) Is ordered or recommended by a healthcare provider 9
according to: 10
(i) The National Comprehensive Cancer Network 11
clinical practice recommendations that are level 2a or higher; or 12
(ii) Nationally recognized clinical practice 13
guidelines. 14
(b)(1) Except as provided in subdivision (b)(2) of this section, the 15
coverage for genetic testing for inherited gene mutation and evidence -based 16
cancer imaging under subsection (a) of this section: 17
(A) Is not subject to an annual deductible, copayment, or 18
coinsurance limit as established for other covered benefits under a health 19
benefit plan; and 20
(B) Does not diminish or limit benefits otherwise allowable 21
under a health benefit plan. 22
(2) This subsection does not apply to: 23
(A) A plan providing health benefits to state and public 24
school employees under § 21 -5-401 et seq.; or 25
(B) A self-funded governmental plan. 26
(c)(1) If application of this section would result in health savings 27
account ineligibility under guidance issued by the United States Department 28
of the Treasury under 26 U.S.C. § 223, as it existed on January 1, 2025, then 29
this section shall apply only to health savings accounts with qualified high 30
deductible health plans with respect to the deductible of a health benefit 31
plan after the individual has satisfied the minimum deductible. 32
(2) This section does apply to items or services that are 33
considered to be preventive care under 26 U.S.C. § 223(c)(2)(C), as it 34
existed on January 1, 2025, whether or not the minimum deductible has been 35
satisfied. 36 As Engrossed: H1/30/25 H3/17/25 S4/2/25 HB1079
5 04-02-2025 11:48:52 ANS096
1
23-79-2903. Rules. 2
The Insurance Commissioner shall promulgate rules to implement and 3
administer this subchapter. 4
5
/s/F. Allen 6
7
8
APPROVED: 4/17/25 9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36