HB1079
To Mandate Coverage For Genetic Testing For An Inherited Gene Mutation For Certain Individuals; And To Mandate Coverage For Evidence-based Cancer Imaging For Certain Individuals.
AI-Generated Summary
This Arkansas bill, HB 1079, proposes to mandate that health benefit plans provide coverage for genetic testing for inherited gene mutations associated with increased cancer risk. It also requires coverage for evidence-based cancer imaging for individuals at increased risk of developing cancer. The coverage must be for genetic testing ordered or recommended by a healthcare provider and supported by medical and scientific evidence, including specific national guidelines. Similarly, cancer imaging must be ordered by a healthcare provider and adhere to national guidelines. Importantly, this coverage is to be exempt from annual deductibles, copayments, or coinsurance, unless specific exceptions related to health savings accounts and state/public school employee plans are met. The bill defines key terms such as "clinical utility," "evidence-based cancer imaging," and "health benefit plan." The Insurance Commissioner is tasked with promulgating rules to implement these mandates. The provisions are set to take effect on January 1, 2026.
Potential Impact Analysis
Who Might Benefit?
Individuals with a personal or family history of cancer, or those identified as being at an increased risk of developing cancer, would directly benefit from this bill. This is because it mandates that health insurance plans cover genetic testing for inherited gene mutations and evidence-based cancer imaging without additional out-of-pocket costs like deductibles, copayments, or coinsurance. Healthcare providers who order these tests and imaging would also benefit through increased patient access and potentially streamlined payment processes. Healthcare insurers, while potentially facing increased costs, would have clear guidelines on what services must be covered.
Who Might Suffer?
Healthcare insurers and organizations offering health benefit plans in Arkansas could be negatively impacted due to the mandated coverage, especially if these services are costly and not fully offset by premium adjustments. While the bill specifies exemptions for certain governmental plans (state and public school employees, self-funded governmental plans), other health benefit plans, including those offered by private employers, would be subject to these new coverage requirements. The impact on these entities would be an increase in covered services and potential associated costs, which could lead to adjustments in premium rates or plan offerings. Furthermore, entities that provide only limited benefits, such as dental or vision care, are explicitly excluded and therefore not directly affected.