HASBSB104 MCCLOUDT 2918
SENATE SUMMARY OF HOUSE AMENDMENTS
SB 104 2023 Regular Session Stine
KEYWORD AND SUMMARY AS RETURNED TO THE SENATE
GENETICS: Provides for health insurance coverage of genetic testing for diseases and other
medical conditions. (See Act) (EG2 INCREASE GF EX See Note)
SUMMARY OF HOUSE AMENDMENTS TO THE SENATE BILL
1. Add that a biomarker test may identify any other medical condition.
2. Delete the definition of "consensus statements" and applicable references.
3. Define "clinical utility" and provides applicable references.
4. Add that proposed law does not require a health coverage plan to cover biomarker
testing for screening purposes.
5. Add that the process for making exceptions to coverage can also be clearly outlined
in a notification of adverse determination.
6. Make effectiveness of proposed law subject to appropriation of monies by the
legislature for the implementation of proposed law.
7. Change application of proposed law relative to new policies and contracts from on
and after January 1, 2024 to on and after the January first immediately following the
effective date of proposed law.
8. Change date by which existing policies and contracts are required to conform to
proposed law from no later than January 1, 2025 to no later than the first January
first that is at least one year from the effective date of proposed law.
9. Make technical changes.
DIGEST OF THE SENATE BILL AS RETURNED TO THE SENATE
SB 104 Engrossed 2023 Regular Session Stine
Proposed law outlines legislative findings and requires any health coverage plan renewed,
delivered, or issued for delivery in this state to include coverage for biomarker testing for
the purpose of the diagnosis, treatment, appropriate management, or ongoing monitoring of
an individual's disease or condition when the test provides clinical utility as demonstrated
by medical and scientific evidence, including any one of the following:
(1)Labeled indications for diagnostic tests approved or cleared by the U.S. Food and
Drug Administration (FDA) or indicated diagnostic tests for a drug approved by the
FDA.
(2)Warnings and precautions listed on a FDA-approved drug label.
(3)National Coverage Determinations of the Centers for Medicare and Medicaid
Services or Local Coverage Determinations of Medicare Administrative Contractors.
(4)Nationally recognized clinical practice guidelines. HASBSB104 MCCLOUDT 2918
Proposed law provides that coverage may be subject to annual deductibles, coinsurance, and
copayment provisions as are consistent with those established under the health coverage
plan.
Proposed law requires individuals and healthcare providers to have access to a clear, readily
accessible, convenient process to request exceptions to a coverage policy or adverse
determination of a health coverage plan. Further requires the process to be included on a
health coverage plan's website or be clearly outlined in the notification of adverse
determination.
Proposed law requires a health coverage plan to ensure that coverage in proposed law is
provided in a manner that limits disruptions in care, including the need for multiple biopsies
or biospecimen samples.
Proposed law defines "biomarker", "biomarker testing", "clinical utility", "health coverage
plan", and "nationally recognized clinical practice guidelines".
Proposed law applies to any new policy, contract, program, or health coverage plan issued
on and after the January first immediately following the effective date of proposed law.
Further requires any policy, contract, or health coverage plan in effect prior to the effective
date of proposed law to convert to conform to proposed law on before the renewal date, but
no later than the first January first that is at least one year after the effective date of this Act.
Effective subject to appropriation of monies by the legislature for the implementation of
proposed law.
(Adds R.S. 22:1028.5)
______________________
Beth O'Quin
Attorney