Bill > S3098

This bill mandates that various health insurance providers, including hospital service corporations, medical service corporations, health service corporations, individual and group health insurance policies, health benefits plans, health maintenance organizations (HMOs), and state-administered programs like Medicaid, must cover biomarker precision medical testing. Biomarker precision medical testing involves analyzing biological samples for specific characteristics (biomarkers) that can indicate disease processes or predict response to treatment, and it is used for diagnosis, treatment, management, or monitoring of conditions, but not for asymptomatic screening. Coverage is required when the test's effectiveness is recognized by FDA-approved indications, FDA-approved drugs, FDA drug label warnings, Medicare coverage decisions, or nationally recognized clinical practice guidelines. The bill also specifies that coverage should minimize disruption to patient care, outlines procedures for utilization review and appeals, and ensures that benefits are provided equally to other medical conditions, including cost-sharing provisions. For Medicaid beneficiaries, this testing will be provided without any out-of-pocket costs.

Budget and Finance, Business and Industry

https://www.njleg.state.nj.us/bill-search/2024/S3098