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BILL # HB 2144 |
TITLE: health insurance coverage; biomarker testing |
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SPONSOR: Cobb |
STATUS: As Introduced |
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PREPARED BY: Maggie Rocker |
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The bill would require health insurers to provide coverage for biomarker testing for diagnosis, treatment, and monitoring of disease. AHCCCS's contracted health plans and the state employee health plan would both be affected by the proposed legislation.
Estimated Impact
Based on current Medicaid coverage of biomarker testing, AHCCCS does not expect the bill would yield a significant fiscal impact to its health plans. We concur with AHCCCS's rationale.
ADOA has not yet provided a response regarding the fiscal impact on the state employee health plan.
Biomarker testing is the analysis of blood, other body fluids, and/or tissue for the presence of biomarkers, which can be defined as objectively measurable characteristics that help measure one's biological state, including the presence and progress of disease. Examples of biomarkers include blood pressure, blood glucose, and tumor size. Biomarker testing has been applied in the diagnosis and monitoring of numerous conditions, including cancer, cardiovascular disease, infections, and genetic disorders.
The bill would require coverage for biomarker testing in all health plans, including Medicaid contracted health plans and the state employee health plan, otherwise known as the Health Insurance Trust Fund (HITF).
AHCCCS does not expect the bill to generate a significant cost to its contracted health plans. According to AHCCCS, the agency currently covers all but 2 biomarker codes for tests that the Centers for Medicare and Medicaid Services deems useful for clinical management of a patient. Thus, the bill would not present an immediate and substantial increase in the number of tests covered by AHCCCS. However, to the extent AHCCCS would need to cover new biomarkers that are released, AHCCCS anticipates there could be cost increases associated with an increase in administrative workload.
At the time of this writing, we have not received a response from ADOA regarding the bill's impact to HITF.
Local Government Impact
None
1/31/22