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REFERENCE TITLE: cancer screening; coverage; gene mutation |
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State of Arizona House of Representatives Fifty-sixth Legislature First Regular Session 2023
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HB 2783 |
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Introduced by Representatives Schwiebert: Contreras P, Gutierrez, Quiñonez, Terech
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An Act
amending title 20, chapter 4, article 3, Arizona Revised Statutes, by adding section 20-841.14; amending title 20, chapter 4, article 9, Arizona Revised Statutes, by adding section 20-1057.20; amending title 20, chapter 6, article 4, Arizona Revised Statutes, by adding section 20-1376.11; amending title 20, chapter 6, article 5, Arizona Revised Statutes, by adding section 20-1406.11; amending title 32, chapter 32, article 1, Arizona Revised Statutes, by adding section 32-3230.02; amending title 36, chapter 29, article 1, Arizona Revised Statutes, by adding section 36-2907.16; relating to health care coverage.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 4, article 3, Arizona Revised Statutes, is amended by adding section 20-841.14, to read:
20-841.14. Genetic testing; genetic counseling; cancer; coverage; definitions
A. A hospital service corporation or medical service corporation that issues, delivers or renews a subscription contract in this state on or after January 1, 2024 shall provide coverage for subscribers as follows:
1. Under circumstances WHERE increased screening, genetic counseling or testing is necessary based on nationally recognized clinical standards or when a family history of cancer is present.
2. for genetic counseling, genetic testing, single-gene germline mutation testing or multigene Germline mutation testing based on nationally recognized clinical standards, if the subscriber has a personal history or family history of cancer or gene mutation.
B. A hospital service corporation or medical service corporation shall ensure that the benefits required by this section are made available to a subscriber through a health care provider who is a member of the provider network of the hospital service corporation or medical service corporation.
C. for the purposes of this section:
1. "BRCA genes" means BRCA 1 or BRCA 2 genes that, when mutated, cause an increased risk of breast, ovarian, prostate, pancreatic and melanoma cancerS.
2. "Germline mutation testing" means testing for inherited genetic mutations, INCLUDING BRCA genes, that are associated with an increased cancer risk based on evidence-based, clinical practice guidelines that address genetic counseling and testing, screening and management of individuals who have an inherited genetic mutation associated with an increased cancer risk.
3. "Health care provider" means a person who is licensed or certified pursuant to title 32, chapter 13, 15, 17, 25 or 29.
Sec. 2. Title 20, chapter 4, article 9, Arizona Revised Statutes, is amended by adding section 20-1057.20, to read:
20-1057.20. Genetic testing; genetic counseling; cancer; coverage; definitions
A. A health care services organization that issues, delivers or renews an evidence of coverage in this state on or after January 1, 2024 shall provide coverage for enrollees as follows:
1. Under circumstances WHERE increased screening, genetic counseling or testing is necessary based on nationally recognized clinical standards or when a family history of cancer is present.
2. for genetic counseling, genetic testing, single-gene germline mutation testing or multigene Germline mutation testing based on nationally recognized clinical standards, if the enrollee has a personal history or family history of cancer or gene mutation.
B. A health care services organization shall ensure that the benefits required by this section are made available to an enrollee through a health care provider who is a member of the provider network of the health care services corporation.
C. for the purposes of this section:
1. "BRCA genes" means BRCA 1 or BRCA 2 genes that, when mutated, cause an increased risk of breast, ovarian, prostate, pancreatic and melanoma cancerS.
2. "Germline mutation testing" means testing for inherited genetic mutations, INCLUDING BRCA genes, that are associated with an increased cancer risk based on evidence-based, clinical practice guidelines that address genetic counseling and testing, screening and management of individuals who have an inherited genetic mutation associated with an increased cancer risk.
3. "Health care provider" means a person who is licensed or certified pursuant to title 32, chapter 13, 15, 17, 25 or 29.
Sec. 3. Title 20, chapter 6, article 4, Arizona Revised Statutes, is amended by adding section 20-1376.11, to read:
20-1376.11. Genetic testing; genetic counseling; cancer; coverage; definitions
A. A disability insurer that issues, delivers or renews a disability insurance policy in this state on or after January 1, 2024 shall provide coverage for insureds as follows:
1. Under circumstances WHERE increased screening, genetic counseling or testing is necessary based on nationally recognized clinical standards or when a family history of cancer is present.
2. for genetic counseling, genetic testing, single-gene germline mutation testing or multigene Germline mutation testing based on nationally recognized clinical standards, if the insured has a personal history or family history of cancer or gene mutation.
B. A disability insurer shall ensure that the benefits required by this section are made available to an insured through a health care provider who is a member of the provider network of the disability insurer.
C. for the purposes of this section:
1. "BRCA genes" means BRCA 1 or BRCA 2 genes that, when mutated, cause an increased risk of breast, ovarian, prostate, pancreatic and melanoma cancerS.
2. "Germline mutation testing" means testing for inherited genetic mutations, INCLUDING BRCA genes, that are associated with an increased cancer risk based on evidence-based, clinical practice guidelines that address genetic counseling and testing, screening and management of individuals who have an inherited genetic mutation associated with an increased cancer risk.
3. "Health care provider" means a person who is licensed or certified pursuant to title 32, chapter 13, 15, 17, 25 or 29.
Sec. 4. Title 20, chapter 6, article 5, Arizona Revised Statutes, is amended by adding section 20-1406.11, to read:
20-1406.11. Genetic testing; genetic counseling; cancer; coverage; definitions
A. A group disability insurer or blanket disability insurer that issues, delivers or renews a group disability contract or blanket disability contract in this state on or after January 1, 2024 shall provide coverage for insureds as follows:
1. Under circumstances WHERE increased screening, genetic counseling or testing is necessary based on nationally recognized clinical standards or when a family history of cancer is present.
2. for genetic counseling, genetic testing, single-gene germline mutation testing or multigene Germline mutation testing based on nationally recognized clinical standards, if the insured has a personal history or family history of cancer or gene mutation.
B. A group disability insurer or blanket disability insurer shall ensure that the benefits required by this section are made available to an insured through a health care provider who is a member of the provider network of the group disability insurer or blanket disability insurer.
C. for the purposes of this section:
1. "BRCA genes" means BRCA 1 or BRCA 2 genes that, when mutated, cause an increased risk of breast, ovarian, prostate, pancreatic and melanoma cancerS.
2. "Germline mutation testing" means testing for inherited genetic mutations, INCLUDING BRCA genes, that are associated with an increased cancer risk based on evidence-based, clinical practice guidelines that address genetic counseling and testing, screening and management of individuals who have an inherited genetic mutation associated with an increased cancer risk.
3. "Health care provider" means a person who is licensed or certified pursuant to title 32, chapter 13, 15, 17, 25 or 29.
Sec. 5. Title 32, chapter 32, article 1, Arizona Revised Statutes, is amended by adding section 32-3230.02, to read:
32-3230.02. Primary care providers; genetic testing; genetic counseling; cancer; definitions
A. A primary care provider shall attempt to determine whether each adult patient to whom the primary care provider provides care has either:
1. a personal or family history of melanoma, breast, ovarian, tubal, peritoneal, endometrial, colorectal, pancreatic or prostate cancer.
2. an ancestry associated with a harmful mutation in the BRCA genes or meets any other criteria for hereditary cancer genetic testing as outlined in guidelines prescribed by the national comprehensive cancer network or a similar medical professional organization.
B. if the primary care provider determines that an adult patient to whom the primary care provider provides care meets the criteria prescribed in subsection A, paragraph 1 of this section, the patient shall be provided or referred for genetic counseling or germline mutation testing, or both, as applicable, based on nationally recognized clinical standards.
C. If the primary care provider determines that an adult patient to whom the primary care provider provides care meets the criteria prescribed in subsection A, paragraph 1 of this section and the patient has not previously tested positive for a mutation in the BRCA genes or other genes associated with an increased cancer risk, the primary care provider shall use an appropriate familial risk assessment tool to screen for the risk of such a mutation. If this screening indicates that the patient is at risk of a harmful mutation in the BRCA genes or other genes associated with an increased cancer risk, the primary care provider shall do all of the following:
1. Provide the patient with written notice of the need to discuss genetic counseling and testing with the primary care provider.
2. Provide genetic counseling to the patient or refer the patient for genetic counseling.
3. If a genetic test for harmful mutations in the BRCA genes or other genes associated with an increased cancer risk is clinically indicated as a result of the genetic counseling, administer a genetic test to the patient or refer the patient for genetic testing.
D. A primary care provider who fails to comply with this section is not subject to criminal penalties or professional discipline for the noncompliance.
E. for the purposes of this section:
1. "BRCA genes" means BRCA 1 or BRCA 2 genes that, when mutated, cause an increased risk of breast, ovarian, prostate, pancreatic and melanoma cancerS.
2. "Germline mutation testing" means testing for inherited genetic mutations, INCLUDING BRCA genes, that are associated with an increased cancer risk based on evidence-based, clinical practice guidelines that address genetic counseling and testing, screening and management of individuals who have an inherited genetic mutation associated with an increased cancer risk.
3. "Health care provider" means a person who is licensed or certified pursuant to title 32, chapter 13, 15, 17, 25 or 29.
Sec. 6. Title 36, chapter 29, article 1, Arizona Revised Statutes, is amended by adding section 36-2907.16, to read:
36-2907.16. Genetic testing; genetic counseling; cancer
The administration and its contractors, to the extent authorized by federal law, shall provide screening, genetic counseling, genetic testing and germline mutation testing for harmful inherited genetic mutations in the BRCA genes or other genes that cause an increased cancer risk for members when indicated pursuant to section 32-3230.02.