Oklahoma § 56-4003 - Biomarker testing coverage

§ 56-4003. Biomarker testing coverage

A. As used in this section:

1. "Biomarker", "biomarker testing", "consensus statement", and

"nationally recognized clinical practice guidelines" shall have the

same meaning as provided by Section 1 of this act; and

2. "Contracted entity" shall have the same meaning as provided

by Section 4002.2 of Title 56 of the Oklahoma Statutes.

B. The state Medicaid program shall cover biomarker testing in

accordance with the requirements provided by this section.

C. Biomarker testing shall be covered for the purposes of

diagnosis, treatment, appropriate management, or ongoing monitoring

of a member’s disease or condition when the test is supported by

medical and scientific evidence, including, but not limited to:

Oklahoma Statutes - Title 56. Poor Persons

1. Labeled indications for a United States Food and Drug

Administration (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 (CMS) national

coverage determinations or Medicare Administrative Contractor (MAC)

local coverage determinations; or

5. Nationally recognized clinical practice guidelines and

consensus statements.

D. Contracted entities under the state Medicaid program shall

provide biomarker testing at the same scope, duration, and frequency

as the Medicaid program otherwise provides to members.

E. If prior authorization is required for biomarker testing,

the contracted entity shall approve or deny a prior authorization

request and notify the member, the member’s provider, and any entity

requesting authorization of the service within seventy-two (72)

hours for non-urgent requests or within twenty-four (24) hours for

urgent requests.

F. The member and the member’s provider shall have access to

clear, readily accessible, and convenient processes to request an

exception to a coverage policy for biomarker testing of the state

Medicaid program. The process shall be made readily accessible to

all participating providers and members online.

Added by Laws 2023, c. 331, § 3, eff. Jan. 1, 2024.