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Arkansas Code Title 23. Public Utilities and Regulated Industries § 23-79-2602. Coverage for biomarker testing for early detection and management for cancer diagnoses

Current as of March 28, 2024 | Updated by Findlaw Staff

(a) A health benefit plan that is offered, issued, or renewed in this state shall provide coverage for biomarker testing.

(b) The evidence of coverage document provided with a health benefit plan under this subchapter shall include biomarker testing for the purpose of diagnosis, treatment, appropriate management, or ongoing monitoring of a subscriber's disease or condition to guide treatment decisions when the biomarker test is supported by medical and scientific evidence, including without limitation:

(1) Labeled indications for tests that are approved or cleared by the United States Food and Drug Administration;

(2) Indicated tests for a drug that is approved by the United States Food and Drug Administration;

(3) Warnings and precautions on United States Food and Drug Administration-approved drug labels;

(4) Centers for Medicare & Medicaid Services national coverage determinations or Medicare administrative contractor local coverage determinations; or

(5) Nationally recognized clinical practice guidelines and consensus statements.

(c) A health benefit plan shall ensure that coverage is provided in a manner that limits disruptions in care, including the need for multiple biopsies and biospecimen samples as determined by a healthcare professional.

(d)(1) A subscriber and a subscriber's healthcare professional shall have access to a clear, readily available, and convenient process to request an exception to a health benefit plan under this subchapter.

(2) The process under subdivision (d)(1) of this section shall be readily accessible on the health benefit plan's website.

(3) This section shall not be construed to require a separate process if the health benefit plan's existing process complies with subdivision (d)(1) of this section.

(e) A utilization review entity shall make a determination on a request for coverage of biomarker testing at the same scope, duration, and frequency as the health benefit plan otherwise provides to subscribers.

(f) If prior authorization is required for biomarker testing, the utilization review entity shall approve or deny a prior authorization request and notify the subscriber, the subscriber's healthcare professional, and any entity requesting prior authorization of the healthcare service:

(1) Within seventy-two (72) hours for requests for nonurgent healthcare services; or

(2) Within twenty-four (24) hours for requests for urgent healthcare services.

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Cite this article: FindLaw.com - Arkansas Code Title 23. Public Utilities and Regulated Industries § 23-79-2602. Coverage for biomarker testing for early detection and management for cancer diagnoses - last updated March 28, 2024 | https://codes.findlaw.com/ar/title-23-public-utilities-and-regulated-industries/ar-code-sect-23-79-2602/

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