CT SB00307

Commissioner of Social Services shall provide Medicaid coverage for biomarker testing for diagnosis, treatment, management, or monitoring of enrollees' diseases or conditions, effective July 1, 2024.

Coverage determination must be medically necessary and supported by evidence including FDA approval, drug label recommendations, Medicare coverage determinations, or nationally recognized clinical practice guidelines and consensus statements.

Department may require prior authorization to ensure testing requests meet coverage standards under this section.

Medicaid enrollees adversely affected by department coverage decisions may request a hearing under section 17b-60 of the general statutes.

Clinical practice guidelines and consensus statements serve as informational guidelines only and cannot be the sole basis for final medical necessity determinations.