relative to insurance coverage for biomarker testing.

All requirements for private health carriers (insurers) to cover biomarker testing were deleted. The original bill required every health carrier issuing plans on or after January 1, 2027 to include biomarker testing coverage. The amended version applies only to the New Hampshire Medicaid program.

A 'medically necessary' determination by the New Hampshire Medicaid program was added as a prerequisite for coverage in both the RSA 420-J:28 and RSA 167:4-g sections. Previously, coverage was triggered by clinical utility and supporting evidence alone.

Specific prior authorization turnaround time deadlines (14 days for non-urgent requests, 72 hours for urgent requests) were removed from the utilization review paragraph.

A new paragraph was added to RSA 167:4-g requiring risk-bearing entities contracted under the state Medicaid plan to provide biomarker testing at the same scope, duration, and frequency as the Medicaid program otherwise provides to enrollees.

The requirement that coverage be provided in a manner that limits disruptions in care, including the need for multiple biopsies or biospecimen samples, was removed.

The requirement that patients and prescribing practitioners have access to a clear, readily accessible process to request exceptions to coverage policies or adverse utilization review determinations (including posting on the carrier's website) was deleted.