Bill > S809

This bill aims to ensure comprehensive access to biomarker testing across various health insurance programs in Massachusetts. Specifically, it requires the Group Insurance Commission, Medicaid, and private health insurance providers to cover biomarker testing for diagnosing, treating, managing, or monitoring a patient's medical condition when the testing is supported by scientific evidence. Biomarker testing is defined as analyzing a patient's tissue, blood, or other samples to identify specific biological characteristics like gene mutations or protein expressions, which can help determine the most appropriate medical treatment. The bill mandates that such testing be covered based on criteria such as FDA-approved test indications, drug warnings, Medicare coverage determinations, and recognized clinical practice guidelines. Additionally, the legislation establishes strict requirements for prior authorization, requiring insurance carriers to respond to testing requests within 72 hours (or 24 hours in urgent cases), and mandates that carriers provide a clear, accessible process for patients and doctors to appeal coverage decisions. The goal is to ensure patients have timely access to advanced diagnostic tools that can help personalize and improve medical treatment across different health insurance platforms.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S809