Bill > H1227

This bill mandates comprehensive coverage for biomarker testing across various Massachusetts health insurance programs, including state employee, Medicaid, private insurance, hospital service plans, medical service agreements, and health maintenance organizations. A biomarker is defined as a measurable characteristic indicating biological processes or responses to therapeutic interventions, such as gene mutations or protein expressions. The bill requires these insurance providers to cover biomarker testing for diagnosis, treatment, management, or monitoring of a patient's condition when the testing is supported by scientific evidence, such as FDA-approved test indications, drug warnings, Medicare coverage determinations, or recognized clinical practice guidelines. The legislation also establishes strict guidelines for prior authorization, mandating that insurance carriers must approve or deny requests within 72 hours (or 24 hours in urgent cases), and if no response is received within the specified timeframe, the request is automatically granted. Additionally, the bill ensures that patients and practitioners have accessible processes to request exceptions to coverage policies, with these processes to be clearly displayed on the carrier's website. The goal is to improve patient access to advanced diagnostic and personalized medical testing, particularly in cancer care, by reducing administrative barriers and ensuring comprehensive insurance coverage.

Business and Industry

https://malegislature.gov/Bills/194/H1227