| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to health benefit plan coverage for certain biomarker |
|
|
testing. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 1372.003(a), Insurance Code, is amended |
|
|
to read as follows: |
|
|
(a) Subject to Subsection (b), a health benefit plan must |
|
|
provide coverage for biomarker testing for the purpose of |
|
|
diagnosis, treatment, appropriate management, or ongoing |
|
|
monitoring of an enrollee's disease or condition, including an |
|
|
enrollee's condition of having received an organ transplant, to |
|
|
guide treatment when the test is supported by the following kinds of |
|
|
medical and scientific evidence: |
|
|
(1) a labeled indication for a test approved or |
|
|
cleared by the United States Food and Drug Administration; |
|
|
(2) an indicated test for a drug approved by the United |
|
|
States Food and Drug Administration; |
|
|
(3) a national coverage determination made by the |
|
|
Centers for Medicare and Medicaid Services or a local coverage |
|
|
determination made by a Medicare administrative contractor; |
|
|
(4) nationally recognized clinical practice |
|
|
guidelines; or |
|
|
(5) consensus statements. |
|
|
SECTION 2. If before implementing any provision of this Act |
|
|
a state agency determines that a waiver or authorization from a |
|
|
federal agency is necessary for implementation of that provision, |
|
|
the agency affected by the provision shall request the waiver or |
|
|
authorization and may delay implementing that provision until the |
|
|
waiver or authorization is granted. |
|
|
SECTION 3. The change in law made by this Act applies only |
|
|
to a health benefit plan that is delivered, issued for delivery, or |
|
|
renewed on or after January 1, 2026. A health benefit plan |
|
|
delivered, issued for delivery, or renewed before January 1, 2026, |
|
|
is governed by the law as it existed immediately before the |
|
|
effective date of this Act, and that law is continued in effect for |
|
|
that purpose. |
|
|
SECTION 4. This Act takes effect September 1, 2025. |