Amendments for SB24-124
Senate Journal, April 11
After consideration on the merits, the Committee recommends that SB24-124 be amended
as follows, and as so amended, be referred to the Committee on Appropriations with
favorable recommendation.
Amend printed bill, page 2, strike lines 5 through 8 and substitute "rules.
(27) Biomarker testing. (a) ALL LARGE GROUP HEALTH BENEFIT PLANS AND,
TO THE EXTENT THAT SUCH COVERAGE IS NOT IN ADDITION TO THE BENEFITS
PROVIDED PURSUANT TO THE BENCHMARK PLAN, ALL INDIVIDUAL AND SMALL
GROUP HEALTH BENEFIT PLANS SHALL PROVIDE COVERAGE FOR BIOMARKER
TESTING PURSUANT TO THIS SUBSECTION (27).".
Page 2, line 12, strike "IS SUPPORTED" and substitute "PROVIDES CLINICAL
UTILITY AS DEMONSTRATED".
Page 3, lines 5 and 6, strike "GUIDELINES AND CONSENSUS STATEMENTS." and
substitute "GUIDELINES, CONSENSUS STATEMENTS, AND PEER-REVIEWED
STUDIES.".
Page 3, after line 20 insert:
"(g) (I) THE DIVISION SHALL SUBMIT TO THE FEDERAL DEPARTMENT OF
HEALTH AND HUMAN SERVICES:
(A) A DETERMINATION AS TO WHETHER THE BENEFIT SPECIFIED IN THIS
SUBSECTION (27) IS IN ADDITION TO ESSENTIAL HEALTH BENEFITS AND WOULD
BE SUBJECT TO DEFRAYAL BY THE STATE PURSUANT TO 42 U.S.C. SEC. 18031
(d)(3)(B); AND
(B) A REQUEST THAT THE FEDERAL DEPARTMENT OF HEALTH AND
HUMAN SERVICES CONFIRM THE DIVISION'S DETERMINATION WITHIN SIXTY DAYS
AFTER RECEIPT OF THE DIVISION'S REQUEST AND SUBMISSION OF ITS
DETERMINATION.
(II) THIS SUBSECTION (27) APPLIES TO, AND THE DIVISION SHALL
IMPLEMENT THE PROVISIONS OF THIS SUBSECTION (27) FOR, LARGE EMPLOYER
HEALTH BENEFIT PLANS ISSUED OR RENEWED IN THIS STATE ON OR AFTER
JANUARY 1, 2025.
(III) THIS SUBSECTION (27) APPLIES TO, AND THE DIVISION SHALL
IMPLEMENT THE REQUIREMENTS OF THIS SUBSECTION (27) FOR, INDIVIDUAL AND
SMALL GROUP HEALTH BENEFIT PLANS ISSUED OR RENEWED IN THIS STATE
TWELVE MONTHS AFTER THE EARLIER OF THE FOLLOWING:
(A) THE DIVISION RECEIVES CONFIRMATION FROM THE FEDERAL
DEPARTMENT OF HEALTH AND HUMAN SERVICES THAT THE COVERAGE SPECIFIED
IN THIS SUBSECTION (27) DOES NOT CONSTITUTE AN ADDITIONAL BENEFIT THAT
REQUIRES DEFRAYAL BY THE STATE PURSUANT TO 42 U.S.C. SEC. 18031
(d)(3)(B);
(B) THE FEDERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES HAS
OTHERWISE INFORMED THE DIVISION THAT THE COVERAGE DOES NOT REQUIRE
STATE DEFRAYAL PURSUANT TO 42 U.S.C. SEC. 18031 (d)(3)(B); OR
(C) MORE THAN THREE HUNDRED SIXTY-FIVE DAYS HAVE PASSED SINCE
THE DIVISION SUBMITTED ITS DETERMINATION AND REQUEST FOR
CONFIRMATION THAT THE COVERAGE SPECIFIED IN THIS SUBSECTION (27) IS NOT
AN ADDITIONAL BENEFIT THAT REQUIRES STATE DEFRAYAL PURSUANT TO 42
U.S.C. SEC. 18031 (d)(3)(B), AND THE FEDERAL DEPARTMENT OF HEALTH AND
HUMAN SERVICES HAS FAILED TO RESPOND TO THE REQUEST WITHIN THAT
PERIOD, IN WHICH CASE THE DIVISION SHALL CONSIDER THE FEDERAL
DEPARTMENT OF HEALTH AND HUMAN SERVICES' UNREASONABLE DELAY A
PRECLUSION FROM REQUIRING DEFRAYAL BY THE STATE.".
Reletter succeeding paragraphs accordingly.
Page 4, after line 10 insert:
"(III) "CLINICAL UTILITY" MEANS THE TEST RESULT PROVIDES
INFORMATION THAT IS USED IN THE FORMULATION OF A TREATMENT OR
MONITORING STRATEGY THAT INFORMS A PATIENT'S OUTCOME AND IMPACTS
THE CLINICAL DECISION. THE MOST APPROPRIATE TEST MAY INCLUDE BOTH
INFORMATION THAT IS ACTIONABLE AND SOME INFORMATION THAT CANNOT BE
IMMEDIATELY USED IN THE FORMULATION OF A CLINICAL DECISION.".
Renumber succeeding subparagraphs accordingly.
Page 6, strike lines 1 through 20.
Page 6, line 21, after "(2)" insert "(a)", and strike "2025," and substitute
"2024,".
Page 6, strike lines 22 through 27 and substitute "PROGRAM MUST COVER
BIOMARKER TESTING PURSUANT TO THE ESTABLISHED PROCESSES FOR
DETERMINING COVERAGE OF SERVICES BASED ON CLINICAL UTILITY.".
Page 7, strike lines 1 through 11.
Page 7, line 16, strike "RECIPIENTS" and substitute "MEMBERS".
Page 7, line 19, strike "(4)" and substitute "(3)".
Page 7, line 20, strike "RECIPIENT." and substitute "MEMBER.".
Page 7, line 21, strike "(5)" and substitute "(4)".
Page 7, line 22, strike "RECIPIENT" and substitute "MEMBER".
Page 7, line 24, strike "RECIPIENTS" and substitute "MEMBERS".
House Journal, May 3
46 SB24-124 be amended as follows, and as so amended, be referred to
47 the Committee of the Whole with favorable
48 recommendation:
49
50
51 Amend reengrossed bill, page 6, strike lines 15 through 27.
52
53 Strike page 7.
54
55 Page 8, strike lines 1 through 5.