Stricken language would be deleted from and underlined language would be added to present law.
1 State of Arkansas
2 94th General Assembly A Bill
3 Regular Session, 2023 SENATE BILL 490
4
5 By: Senator G. Leding
6 By: Representative L. Johnson
7
8 For An Act To Be Entitled
9 AN ACT CONCERNING COVERAGE FOR GENETIC TESTING FOR
10 INHERITED CANCER MUTATIONS; TO CREATE THE GENETIC
11 TESTING ACT; AND FOR OTHER PURPOSES.
12
13
14 Subtitle
15 CONCERNING COVERAGE FOR GENETIC TESTING
16 FOR INHERITED CANCER MUTATIONS; AND TO
17 CREATE THE GENETIC TESTING ACT.
18
19
20 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
21
22 SECTION 1. Arkansas Code Title 23, Chapter 79, is amended to add an
23 additional subchapter to read as follows:
24 Subchapter 24 — Genetic Testing Act
25
26 23-79-2401. Title.
27 This subchapter shall be known and may be cited as the "Genetic Testing
28 Act".
29
30 23-79-2402. Definitions.
31 As used in this subchapter:
32 (1) "Cost sharing" means a deductible payment, coinsurance
33 amount, or any similar out-of-pocket expense;
34 (2) "Enrollee” means an individual entitled to coverage of
35 healthcare services from a healthcare insurer;
36 (3) "Evidence-based screening" means a screening mammography,
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1 breast screening magnetic resonance imaging, or any additional screening
2 modalities according to nationally recognized clinical practice guidelines;
3 (4) "Genetic testing for inherited cancer mutations" means a
4 genetic test for germline mutations that is conducted according to evidence-
5 based screening and nationally recognized clinical practice guidelines
6 specifically addressing genetic testing, screening, and management of
7 individuals with inherited mutations associated with increased cancer risk;
8 (5)(A) "Health benefit plan" means any individual, blanket, or
9 group plan, policy, or contract for healthcare services issued or delivered
10 by a healthcare insurer in this state.
11 (B) "Health benefit plan" does not include:
12 (i) Accident-only plans;
13 (ii) Specified disease plans;
14 (iii) Disability income plans;
15 (iv) Plans that provide only for indemnity for
16 hospital confinement;
17 (v) Long-term-care-only plans that do not include
18 pharmacy benefits;
19 (vi) Other limited-benefit health insurance policies
20 or plans;
21 (vii) Health benefit plans provided under Arkansas
22 Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et
23 seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;
24 (viii) The Arkansas Medicaid Program;
25 (ix) A program established by the Arkansas Health
26 and Opportunity for Me Act of 2021, § 23-61-1001 et seq.; or
27 (x) Any state or local governmental employee plan;
28 (6)(A) "Healthcare insurer" means a:
29 (i) Health insurance issuer that:
30 (a) Is subject to state law regulating
31 insurance; and
32 (b) Offers health insurance coverage under 42
33 U.S.C. § 300gg-91, as it existed on January 1, 2023;
34 (ii) Health maintenance organization; or
35 (iii) Hospital and medical service corporation.
36 (B) "Healthcare insurer" does not include an entity that
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1 provides only dental benefits or eye and vision care benefits;
2 (7) "Healthcare professional" means a person who is licensed,
3 certified, or otherwise authorized by the laws of this state to administer
4 health care in the ordinary course of the practice of his or her profession;
5 and
6 (8)(A) "Nationally recognized clinical practice guidelines"
7 means evidence-based clinical practice guidelines that:
8 (i) Are developed by independent organizations or
9 medical professional societies using a:
10 (a) Transparent methodology and reporting
11 structure; and
12 (b) Conflict of interest policy; and
13 (ii) Establish standards of care that are informed
14 by:
15 (a) A systemic review of evidence; and
16 (b) An assessment of benefits and costs of
17 alterative care options that includes recommendations intended to optimize
18 patient care.
19 (B) "Nationally recognized clinical practice guidelines"
20 includes those produced by a national recognized oncology professional
21 organization, including without limitation the National Comprehensive Cancer
22 Network or the American Society of Clinical Oncology.
23
24 23-79-2403. Coverage for genetic testing for inherited cancer
25 mutations.
26 (a) A health benefit plan that is offered, issued, or renewed in this
27 state shall provide coverage for:
28 (1) Genetic testing for inherited cancer mutations for an
29 enrollee with a personal or family history of breast cancer if the genetic
30 testing is recommended by a healthcare professional; and
31 (2) Evidenced-based screenings for an enrollee with an inherited
32 cancer risk as recommended under nationally recognized clinical practice
33 guidelines.
34 (b) The coverage under subsection (a) of this section is not subject
35 to any cost-sharing requirements under other applicable law.
36
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