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April 19, 2024 SB 24-124
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Revised Fiscal Note
(replaces fiscal note dated February 20, 2024)
Drafting Number:
Prime Sponsors:
LLS 24-0481
Sen. Michaelson Jenet; Rich
Rep. Hartsook
Date:
Bill Status:
Fiscal Analyst:
April 19, 2024
Senate Appropriations
Kristine McLaughlin | 303-866-4776
kristine.mclaughlin@coleg.gov
Bill Topic: HEALTH-CARE COVERAGE FOR BIOMARKER TESTING
Summary of
Fiscal Impact:
☐ State Revenue
☒ State Expenditure
☐ State Transfer
☐ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill requires state-regulated health plans to cover certain biomarker tests. The bill
minimally increases state workload on an ongoing basis.
Appropriation
Summary:
No appropriation is required.
Fiscal Note
Status:
The fiscal note reflects the introduced bill.
Summary of Legislation
The bill requires state-regulated health insurance plans to cover certain biomarker tests outlined
in the bill. Under the bill, all tests supported by medical and scientific evidence must be covered
for the purpose of guiding treatment decisions. The coverage applies to large group plans
issued or renewed after January 1, 2025 and to individual and small group plans issued or
renewed after it is determined that no state defrayal is necessary.
Finally, the bill codifies current practice for Medicaid coverage of biomarker tests.
Background and Assumptions
Current Medicaid coverage. The Department of Health Care Policy and Financing (HCPF)
currently covers 216 tests biomarker tests. They are used for a wide range of purposes and rates
range from $37 per test to $3,873 per test. Program costs for current allowable biomarker tests
total around $19 million per year.
Tests covered under the federal Medicare program. Medicare, which frequently expands its
biomarker testing, currently covers a wider variety of biomarker tests, with around 600 tests
assumed to fall under the bill’s definition of biomarker tests. Covered tests under Medicare are
used for a wide range of purposes and rates range from $8 per test to $12,000 per test. Page 2
April 19, 2024 SB 24-124
According to a 2019 report, 85 percent of Medicare expenditure on genetic testing (a
subcategory of biomarker testing) was generated by 25 covered tests.
State Expenditures
The bill increases workload and potentially costs for state agencies, as outlined below.
Department of Regulatory Agencies. The Division of Insurance in the Department of
Regulatory Agencies will have increased workload to review rates and coverage to ensure that
state-regulated health plans are providing the required coverage. It is assumed that this work
will occur as part of the regular annual rate filing. On an ongoing basis, the division will have
additional workload to address consumer complaints and inquiries regarding the required
coverage. It is assumed that this workload can be accomplished within existing resources.
State Employee Insurance. By requiring coverage for certain biomarker testing, the bill may
result in increased costs for state employees’ health care, which may result in higher insurance
premiums. State employee health premiums are shared by state agencies and employees. Given
that insurance premiums are affected by a large number of factors and that future cost sharing
between the state and employees is unknown, it is assumed that any cost increase in the state
share of employee health insurance premiums will be addressed through the annual budget
process.
Department of Health Care Policy and Financing. The bill codifies current practice for
Medicaid coverage of biomarker testing by the Department of Health Care Policy and Financing
(HCPF). No change is appropriations is required.
Effective Date
The bill takes effect upon signature of the Governor, or upon becoming law without his
signature.
State and Local Government Contacts
Health Care Policy and Financing Information Technology Law
Personnel Regulatory Agencies
The revenue and expenditure impacts in this fiscal note represent changes from current law under the bill for each
fiscal year. For additional information about fiscal notes, please visit the General Assembly website.