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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
COMMITTEE SUBSTITUTE
FOR ENGROSSED
SENATE BILL NO. 1264 By: Stanley of the Senate
and
Miller of the House
COMMITTEE SUBSTITUTE
[ health insurance - genetic testing - cancer imaging
- coverage – exclusions – codification - 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, un less
there is created a duplication in numbering, reads as follows:
A. For the purposes of this section:
1. “Clinical utility” means clinical utility as defined
pursuant to Section 6060.5a of Title 36 of the Oklahoma Statutes;
2. “Evidence-based cancer imaging” means appropriate
preventative screening and imagi ng supported by evidence;
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3. “Genetic testing for an inherited mutation ” means multi-gene
testing for an inherited mutation associated with an increased risk
of cancer;
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 includin g the Oklahoma Employees
Insurance Plan that is o ffered, 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 when such
test provides clinical utility and when orde red or recommended by a
health care provider in accordance with medical and scientific
evidence including, but not lim ited to:
a. the most recent version of the National Compreh ensive
Cancer Network (NCCN) clinical practice
recommendations that are level 2 a or higher,
b. Centers for Medicare and Medicaid Services national
coverage determinations or Medicare administrative
contractor local coverage determinations, or
c. nationally recognized clinical practice guidelines;
and
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2. Evidence-based cancer imaging for individuals with an
increased risk of cancer when such test provides clinical utility
and when ordered or recomme nded by a health care provider in
accordance with the most recent version of the NCCN clinical
practice recommendations that are level 2a or higher, or in
accordance with other nationally recognized clinical practice
guidelines.
C. Coverage under this sec tion shall not be subject to any
annual deductibles, copayments, or coinsurance limits as established
for all covered benefits under the h ealth benefit plan.
D. If application of this section would result in health
savings account ineligibility under Sect ion 223 of the federal
Internal Revenue Code, as amended, the provisions of this section
shall only apply to health savings accounts with qualified high
deductible health plans with respect to the deductible of such a
plan after the enrollee has satisfied the minimum deductible.
Provided, however, the provisions of this section shall apply to
items or services that are preventive care pursu ant to Section
223(c)(2)(C) of the federal Internal Revenue Code, as amended,
regardless of whether the minimum deduct ible has been satisfied.
SECTION 2. This act shall become effective November 1, 2024.
59-2-10960 JM 04/11/24
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