bill covering biomarker testing for transplant patients

The text as introduced · 311 words

89R9454 MEW-F

By: Howard
H.B. No. 5178

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.