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.