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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
COMMITTEE SUBSTITUTE
FOR
SENATE BILL 1264 By: Stanley of the Senate
and
Miller of the House
COMMITTEE SUBSTITUTE
An Act relating to health insurance; defining terms;
requiring coverage of certain genetic testing and
cancer imaging; specifying terms of coverage;
providing certain exclusions; providing for
codification; and providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.5b of Title 36, unless
there is created a d uplication in numbering, reads as follows:
A. For the purposes of this sect ion:
1. “Clinical utility” means the test result provides
information that is used in the formulation of a treatment or
monitoring strategy that informs a patient ’s outcome and impacts the
clinical decision. The most appropriate test may include both
information that is action able and some information that cannot be
immediately used in the formulation of a clinical decision;
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2. “Evidence-based cancer imaging ” means evidence-based cancer
imaging modalities in accordance with the most recent version of the
National Comprehensive Canc er Network (NCCN) clinical practice
guidelines;
3. “Genetic testing for a n inherited mutation” means germline
multi-gene testing for an inher ited mutation associated with an
increased risk of cancer in accordance with NCCN clinical practice
guidelines;
4. “Health benefit plan” means a health benefit plan as defined
pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes ; and
5. “Health care provider” means any physician, hospital, or
other entity or person that is licensed or otherwise authorized in
this state to furnish health care services .
B. Any health benefit plan including the Oklahoma E mployees
Insurance Plan that is offered, issued, or renewed in this state on
or after the effective date of this act shall provide coverage for :
1. Clinical genetic testing for an inherited gene mutation for
individuals with a personal or family history of cancer that is
recommended by a health care provider in accordance with NCCN
clinical practice guideline , when such test provides clinical
utility as demonstrated by medical a nd scientific evidence
including, but not limited to:
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a. labeled indications for tests that are approved or
cleared by the United States Food and Drug
Administration,
b. Centers for Medicare and Medicaid Se rvices national
coverage determinations or Medicare administrative
contractor local coverage determinations, or
c. nationally recognized clinical practice guidelines;
and
2. Evidence-based cancer imaging for indiv iduals with an
increased risk of cancer as recommended by the NCCN clinical
practice guidelines.
C. Coverage under this section shall not be subject to any
annual deductibles, copayments, or coi nsurance limits as established
for all covered benefits under the health benefit plan.
D. If application of this section would result in health
savings account ineligibility under Section 223 of the federal
Internal Revenue Code, as ame nded, the provisions of this secti on
shall only apply to health savings accounts with qualified high
deductible health plans with respect to the deduct ible of such a
plan after the enrollee has satisfied the minimum de ductible.
Provided, however, the provisions of this section shall apply to
items or services that are preventive care pursuant to Section
223(c)(2)(C) of the federal Internal Re venue Code, as amended,
regardless of whether the minimum deductible has been satisfied.
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SECTION 2. This act shall become effective Novem ber 1, 2024.
59-2-3514 RD 2/20/2024 4:12:11 PM