AN ACT ESTABLISHING AN ALZHEIMER'S DISEASE AND DEMENTIA TASK FORCE, REQUIRING HEALTH INSURANCE COVERAGE FOR BIOMARKER TESTING AND CONCERNING TRANSFERS AND DISCHARGES IN RESIDENTIAL CARE HOMES, TUITION WAIVERS FOR NURSING HOME RESIDENTS WHO TAKE COURSES AT REGIONAL COMMUNITY-TECHNICAL COLLEGES AND CLOSURES AND EVACUATIONS OF RESIDENTIAL CARE HOMES AND NURSING HOMES.
What changed between versions
Added new definitions for 'Clinical utility', 'Consensus statements', and 'Nationally recognized clinical practice guidelines' to establish clear standards for what qualifies as medically necessary biomarker testing.
Modified coverage requirements to mandate that biomarker testing must provide clinical utility demonstrated by FDA approval, Medicare coverage determinations, or nationally recognized clinical guidelines and consensus statements.
Added requirements for insurers to establish accessible processes for requesting coverage exceptions or disputing utilization review determinations, and to post these processes on their websites.
Added specific timelines for prior authorization decisions: seven days for non-urgent requests and seventy-two hours for urgent requests.
Changed the bill type from 'Raised Bill' to 'Substitute Bill' and updated page numbering from 3 pages to 5 pages, indicating additional content was added during the legislative process.