SENATE DOCKET, NO. 1084        FILED ON: 2/11/2021

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 808

The Commonwealth of Massachusetts

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PRESENTED BY:

Susan L. Moran

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to cancer patient access to biomarker testing to provide appropriate therapy.

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PETITION OF:

SENATE DOCKET, NO. 1084        FILED ON: 2/11/2021

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 808

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-Second General Court
(2021-2022)

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An Act relative to cancer patient access to biomarker testing to provide appropriate therapy.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after section 17Q, the following section:- 

Section 17R. Any coverage offered by the commission to an active or retired employee of the commonwealth insured under the group insurance commission, shall not require prior authorization for biomarker testing for an enrollee with advanced or metastatic stage 3 or 4 cancer, nor shall prior authorization be required for biomarker testing of cancer progression or recurrence in the insured with advanced or metastatic stage 3 or 4 cancer.

For purposes of this section, “biomarker test” means a diagnostic test of the cancer patient’s biospecimen, such as tissue, blood, and/or other bodily fluids, for DNA and/or RNA alterations to identify an individual with a subtype of cancer in order to guide patient treatment.

SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after section 10L, the following section:- 

Section 10M. The division shall not require prior authorization for biomarker testing for an enrollee with advanced or metastatic stage 3 or 4 cancer, nor shall prior authorization be required for biomarker testing of cancer progression or recurrence in the insured with advanced or metastatic stage 3 or 4 cancer.

For purposes of this section, “biomarker test” means a diagnostic test of the cancer patient’s biospecimen, such as tissue, blood, and/or other bodily fluids, for DNA and/or RNA alterations to identify an individual with a subtype of cancer in order to guide patient treatment.

SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after section 47KK, the following section:- 

Section 47LL. The following shall not require prior authorization for biomarker testing for an enrollee with advanced or metastatic stage 3 or 4 cancer, nor shall prior authorization be required for biomarker testing of cancer progression or recurrence in the insured with advanced or metastatic stage 3 or 4 cancer.: (i) any policy of accident and sickness insurance, as described in section 108, which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and policyholder in the commonwealth; (ii) any blanket or general policy of insurance described in subdivision (A), (C) or (D) of section 110 which provides hospital expense and surgical expense insurance and which is delivered, issued or subsequently renewed by agreement between the insurer and the policyholder in or outside of the commonwealth; or (iii) any employees health and welfare fund which provides hospital expense and surgical expense benefits and which is delivered, issued or renewed to any person or group of persons in the commonwealth.

For purposes of this section, “biomarker test” means a diagnostic test of the cancer patient’s biospecimen, such as tissue, blood, and/or other bodily fluids, for DNA and/or RNA alterations to identify an individual with a subtype of cancer in order to guide patient treatment.

SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after section 8MM, the following section:-

Section 8NN. Any contract between a subscriber and the corporation under an individual or group hospital service plan which is delivered, issued or renewed within the commonwealth shall not require prior authorization for biomarker testing for an enrollee with advanced or metastatic stage 3 or 4 cancer, nor shall prior authorization be required for biomarker testing of cancer progression or recurrence in the insured with advanced or metastatic stage 3 or 4 cancer.

For purposes of this section, “biomarker test” means a diagnostic test of the cancer patient’s biospecimen, such as tissue, blood, and/or other bodily fluids, for DNA and/or RNA alterations to identify an individual with a subtype of cancer in order to guide patient treatment.

SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after section 4MM, the following section:- 

Section 4NN. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall not require prior authorization for biomarker testing for an enrollee with advanced or metastatic stage 3 or 4 cancer, nor shall prior authorization be required for biomarker testing of cancer progression or recurrence in the insured with advanced or metastatic stage 3 or 4 cancer.

For purposes of this section, “biomarker test” means a diagnostic test of the cancer patient’s biospecimen, such as tissue, blood, and/or other bodily fluids, for DNA and/or RNA alterations to identify an individual with a subtype of cancer in order to guide patient treatment.

SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after section 4EE, as so appearing, the following section:- 

Section 4FF. Any individual or group health maintenance contract shall not require prior authorization for biomarker testing for an enrollee with advanced or metastatic stage 3 or 4 cancer, nor shall prior authorization be required for biomarker testing of cancer progression or recurrence in the insured with advanced or metastatic stage 3 or 4 cancer.

For purposes of this section, “biomarker test” means a diagnostic test of the cancer patient’s biospecimen, such as tissue, blood, and/or other bodily fluids, for DNA and/or RNA alterations to identify an individual with a subtype of cancer in order to guide patient treatment.