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HB 1079

Vaccinations; Vaccine Transparency and Informed Consent Act; purpose; transparency and disclosure requirements; informed consent standards; civil penalties; confidentiality of records; severability; effective date.

2025 Regular Session Introduced by Derrick Hildebrant and 1 co-sponsor

Arkansas requires health plans to cover genetic testing for inherited cancer-risk mutations and evidence-based cancer imaging without cost-sharing when clinically useful and guidel

Referred to Public Health
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Bill Summary · HB 1079

Summary — HB 1079 (Arkansas, 2025 session)

Title: To mandate coverage for genetic testing for an inherited gene mutation for certain individuals; to mandate coverage for evidence‑based cancer imaging for certain individuals

Purpose / Intent

Require health benefit plans sold, issued, or renewed in Arkansas to cover (1) genetic testing for inherited gene mutations associated with increased cancer risk and (2) evidence‑based cancer screening/imaging for people at increased cancer risk — without application of the plan’s annual deductible, copayment, or coinsurance — when the testing or imaging is clinically useful and ordered per accepted evidence-based criteria.

Key provisions

  • Coverage required beginning January 1, 2026, for:
    • Genetic testing for inherited gene mutations that (a) provide clinical utility and (b) are ordered/recommended by a health care provider and supported by medical/scientific evidence. Examples of acceptable evidence include National Comprehensive Cancer Network (NCCN) recommendations at level 2A or higher, CMS national coverage determinations or Medicare administrative contractor local coverage determinations, or other nationally recognized clinical practice guidelines.
    • Evidence‑based cancer imaging for individuals at increased cancer risk when imaging provides clinical utility and is ordered per the same evidence standards (NCCN 2A+ or equivalent guidelines).
  • Cost‑sharing prohibition: such testing and imaging “shall not” be subject to the plan’s annual deductible, copayment, or coinsurance.
  • Health Savings Account (HSA) rule: if applying the prohibition would make a plan HSA‑ineligible under federal guidance (26 U.S.C. §223), the state rule applies only with respect to the deductible of qualified high deductible health plans after the minimum deductible is met; items considered preventive under §223(c)(2)(C) apply regardless of deductible status.
  • Insurance Commissioner directed to adopt rules to implement the subchapter.
  • Definitions provided for “clinical utility,” “genetic testing for an inherited gene mutation,” “evidence‑based cancer imaging,” “health benefit plan,” and “nationally recognized clinical practice guidelines.”

Who is affected

  • Primary: health insurers, HMOs, hospital service corporations, and other carriers issuing individual or group health benefit plans in Arkansas.
  • Secondary: insured individuals with a personal or family history of cancer (eligible for testing/imaging per criteria), health care providers who order tests and imaging.
  • Exclusions: the statute lists plan types not considered “health benefit plans” (e.g., dental/vision‑only plans, disability income, accident‑only, long‑term care, certain workers’ compensation and other statutory plans). Legislative amendments also carve out (exclude) certain state/public school employee plans and self‑funded governmental plans from the coverage requirement.

Fiscal / Actuarial impact

  • Pre‑amendment actuarial estimate (Employee Benefits Division, EBD): covering these services at 100% of cost was estimated to increase EBD medical claims by approximately $2.0–$2.5 million annually (about 0.4% of projected claims), based on 2022 member cost‑sharing of roughly $1.5 million and expected utilization increases.
  • Subsequent amendment (March 17, 2025): clarified that the bill’s requirements do not apply to EBD; the actuarial statement with that amendment reported no financial impact to EBD.

Procedural / Timeline notes

  • Effective date for required coverage: January 1, 2026 (per the bill text).
  • Insurance Commissioner must promulgate implementing rules.
  • Multiple floor and committee amendments refined scope and exclusions (including removal of “multi‑gene” language, HSA carve‑out language, and explicit exclusion of certain governmental/self‑insured plans).

Practical effect

If implemented for a given plan, eligible individuals could receive covered genetic testing for inherited cancer‑risk mutations and recommended cancer imaging without patient cost‑sharing (subject to federal HSA rules and state exclusions), provided the services meet clinical utility criteria and are ordered according to the enumerated evidence standards.

Compiled from official sources — confirm details with the bill’s official record.

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