LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 6648 NOTE PREPARED: Jan 18, 2024
BILL NUMBER: SB 273 BILL AMENDED: Jan 18, 2024
SUBJECT: Biomarker Testing Coverage.
FIRST AUTHOR: Sen. Charbonneau BILL STATUS: CR Adopted - 1
st
House
FIRST SPONSOR:
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
XFEDERAL
Summary of Legislation: (Amended) This bill requires a health plan (which includes a policy of accident
and sickness insurance, a health maintenance organization contract, the Medicaid risk based managed care
program, and a state employee health plan) to provide coverage for biomarker testing for the purposes of
diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition
when biomarker testing is supported by medical and scientific evidence.
This bill requires the Office of Medicaid Policy and Planning to provide biomarker testing as a Medicaid
program service, and to apply to the United States Department of Health and Human Services for approval
of any waiver necessary under the federal Medicaid program for the purpose of providing biomarker testing.
This bill provides that coverage is not required for biomarker testing for screening purposes. It also provides
that if a prior authorization requirement applies to biomarker testing, the health plan or a third party acting
on behalf of the health plan must: (1) approve or deny a request for prior authorization; and (2) notify the
covered individual of the approval or denial; in not more than five business days in the case of a nonurgent
request or in not more than 48 hours in the case of an urgent request.
Effective Date: July 1, 2024.
Explanation of State Expenditures: (Revised) Expanding coverage of biomarker testing to meet the
requirements of this bill is expected to increase the number of covered procedures under the state’s employee
health plans (SEHP) and the state Medicaid program. Any resulting impact to the SEHP is expected to be
minimal since the Indiana Health Coverage Programs already include coverage of certain biomarker tests,
under certain conditions and subject to utilization management, including HER2, BRCA1, BRCA2, and gene
SB 273 1 expression profiling. However, any change in SEHP expenditures resulting from this bill will ultimately
depend on the utilization of biomarker testing, the cost of the testing, and the impact that such testing may
have on the care regime of covered individuals.
This bill will have an indeterminate impact to state Medicaid expenditures as certain biomarker tests and
analysis services are not currently covered. Any change in Medicaid expenditures resulting from this bill will
ultimately depend on the utilization of biomarker testing, the cost of the testing, and the impact that such
testing may have on the care regime of covered individuals. [This fiscal note may be updated when further
information is received from FSSA.]
State Mandates: Federal law governing health exchanges includes state reimbursement of health costs
resulting from state mandates enacted after December 2011 that exceed the essential health benefits (EHB).
The state identifies these state mandates and the qualified health plans determine the actuarially adjusted cost
of providing the state mandated benefit. If coverage of any biomarker testing, as required in the bill, exceeds
the EHB, the state may be responsible for defrayment of costs to the insured or to a qualified health plans
on behalf of the insured. [Currently, the state does not have any state mandates and makes no defrayment
payments.]
Workload: The Family and Social Services Administration (FSSA) must apply for a Medicaid waiver and
file an affidavit with the Governor, as required in the bill. The FSSA and State Personnel Department (SPD)
must post information on the appropriate websites explaining how covered individuals and practitioners may
request an exemption to a coverage policy or a prior authorization determination that is adverse to the
coverage of biomarker testing for the covered individual. These requirements are within the routine
administrative functions of the FSSA and the SPD and should be able to be implemented with no additional
appropriations, assuming near customary agency staffing and resource levels.
The Department of Insurance (DOI) must ensure that all policies of accident and sickness insurance and
health maintenance organization contracts, as defined in the bill, include coverage for biomarker testing. This
is within the DOI’s routine administrative functions and should be able to be implemented with no additional
appropriations, assuming near customary agency staffing and resource levels. [The DOI is funded through
a dedicated agency fund.]
Additional Information: Medicaid and the Children’s Health Insurance Program (CHIP) are jointly funded
between the state and federal governments. The state share of costs for most Medicaid medical services for
FFY 2024 is 34%, 10% for the age 19 to 64 expansion population within the Healthy Indiana Plan (HIP), and
24% for CHIP. The state share of administrative costs is 50%. The state share of most Medicaid and CHIP
expenditures is paid from General Fund appropriations, and state dedicated funds primarily cover HIP costs.
Explanation of State Revenues: If health care insurance premiums collections in the state increase as the
result of providing coverage for biomarker testing, revenue to the state General Fund could increase from
either corporate Adjusted Gross Income Tax or Insurance Premium Tax collections.
Explanation of Local Expenditures: If including coverage for biomarker testing for the purposes of
diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition
results in an increase in premiums, local units providing health care coverage may incur increased costs for
health care coverage. However, state laws only pertain to state-regulated health plans, such as those sold on
the individual market and fully-insured plans. State laws do not apply to health coverage regulated under the
Employee Retirement Income Security Act (ERISA) of 1974.
SB 273 2 Explanation of Local Revenues:
State Agencies Affected: Family and Social Services Administration; State Personnel Department;
Department of Insurance.
Local Agencies Affected: Local units providing health care benefits.
Information Sources: Indiana Health Coverage Programs Provider Reference Module: Genetic Testing,
https://www.in.gov/medicaid/providers/files/modules/genetic-testing.pdf; IHCP bulletins BT2023165 and
BT2023182; Christy Tittle, SPD.
Fiscal Analyst: Jason Barrett, 317-232-9809.
SB 273 3