Senate Commerce Committee Statement to Senate, No. 3098 — State of New Jersey (December 12, 2024)

Summary

A Senate Commerce Committee statement to the Senate on Senate Bill No. 3098, State of New Jersey, dated December 12, 2024, reporting the bill favorably with committee amendments. As amended, the bill requires health insurance carriers, including entities administering the State Health Benefits Program and School Employees' Health Benefits Program, and Medicaid, to cover biomarker testing for diagnosis, treatment or monitoring when supported by medical and scientific evidence. The listed evidence includes FDA labeling, Centers for Medicare and Medicaid Services coverage determinations and clinical practice guidelines. The amendments tie utilization review to the "Ensuring Transparency in Prior Authorization Act" and remove the definition of "consensus statement"; the bill is identical to Assembly Bill No. 4163 (1R).

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SENATE COMMERCE COMMITTEE

STATEMENT TO

SENATE, No.
3098

with
committee amendments

STATE
OF NEW JERSEY

DATED: DECEMBER
12, 2024

The Senate Commerce Committee reports favorably and
with committee amendments Senate Bill No. 3098.

As amended, this bill requires health insurers to
cover biomarker testing. Under the bill, health insurance carriers (including
health service corporations, hospital service corporations, medical service
corporations, commercial individual and group health insurers, health
maintenance organizations, entities contracted to administer health benefits in
connection with the State Health Benefits Program and School Employees’ Health
Benefits Program, and Medicaid) are to cover testing for the purposes of
diagnosis, treatment, appropriate management, or ongoing monitoring of an
individual’s disease or condition when the test is supported by medical and
scientific evidence. The evidence includes, but is not limited to: (1) labeled
indications for an FDA-approved or -cleared test; (2) indicated tests for an
FDA-approved drug; (3) warnings and precautions on FDA-approved drug labels;
(4) Centers for Medicare and Medicaid Services National Coverage Determinations
or Medicare Administrative Contractor Local Coverage Determinations; or (5) nationally
recognized clinical practice guidelines and consensus statements. Coverage is
to be provided in a manner that limits disruption, including multiple biopsies
or biospecimen samples, in the care of an individual.

The bill also stipulates that utilization review
decisions concerning coverage provided under the bill are to be made in
accordance with guidelines and timeframes already present in current law.

As amended and reported by the committee, Senate Bill
No. 3098 is identical to Assembly Bill No. 4163 (1R).

COMMITTEE AMENDMENTS

The committee amended the bill to:

(1) require carriers to provide biomarker testing to
covered persons pursuant to guidelines and timeframes set forth in the
“Ensuring Transparency in Prior Authorization Act,” if utilization review is
required;

(2) remove the definition of “consensus statement;”
and

(3) make a technical correction.

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