Bill > SB606

This bill mandates that health insurance plans and the state's Medicaid program, which is a government-funded health insurance program for low-income individuals, must cover biomarker testing. Biomarker testing involves analyzing a patient's biological samples, like tissue or blood, to identify specific characteristics (biomarkers) that can indicate normal biological processes, diseases, or how a patient might respond to a particular treatment. This testing is considered medically necessary for diagnosing, treating, managing, or monitoring a patient's condition when the results have "clinical utility," meaning they provide useful information for a doctor's treatment decisions. The bill outlines specific types of evidence that can demonstrate this utility, including FDA-approved test indications, drug labels, national coverage decisions from CMS (Centers for Medicare and Medicaid Services), and recognized clinical practice guidelines. The bill also sets requirements for prior authorization, ensuring timely decisions for both urgent and non-urgent requests, and establishes a process for beneficiaries and providers to request exceptions to coverage policies. These provisions are intended to improve patient care by ensuring access to advanced diagnostic and treatment information, with the Medicaid coverage provisions taking effect provided sufficient funding is included in the budget for the biennium ending June 30, 2029, and the overall act becomes effective July 1, 2027.

Health and Social Services

https://gc.nh.gov/bill_Status/billinfo.aspx?id=1252&inflect=2