California Health and Safety Code

§ 1367.667

HSC § 1367.667 Effective Jan 1, 2024Div. 2 · Ch. 2.2 · Art. 5

Statute text

(a)A health care service plan contract, except for a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after July 1, 2024, shall cover medically necessary biomarker testing, subject to utilization review management, pursuant to this section. Biomarker testing shall be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee’s disease or condition to guide treatment decisions. Coverage shall include biomarker tests that meet any of the following:

(1)A labeled indication for a test that has been approved or cleared by the United States Food and Drug Administration (FDA) or is an indicated test for an FDA-approved drug.

(2)A national coverage determination made by the federal Centers for Medicare and Medicaid Services.

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Legislative history

Added by Stats. 2023, Ch. 401, Sec. 1. (SB 496) Effective January 1, 2024.