| 1 | 1 | | 89R9454 MEW-F |
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| 2 | 2 | | By: Hinojosa of Hidalgo S.B. No. 2674 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to health benefit plan coverage for certain biomarker |
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| 10 | 10 | | testing. |
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| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 12 | 12 | | SECTION 1. Section 1372.003(a), Insurance Code, is amended |
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| 13 | 13 | | to read as follows: |
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| 14 | 14 | | (a) Subject to Subsection (b), a health benefit plan must |
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| 15 | 15 | | provide coverage for biomarker testing for the purpose of |
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| 16 | 16 | | diagnosis, treatment, appropriate management, or ongoing |
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| 17 | 17 | | monitoring of an enrollee's disease or condition, including an |
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| 18 | 18 | | enrollee's condition of having received an organ transplant, to |
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| 19 | 19 | | guide treatment when the test is supported by the following kinds of |
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| 20 | 20 | | medical and scientific evidence: |
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| 21 | 21 | | (1) a labeled indication for a test approved or |
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| 22 | 22 | | cleared by the United States Food and Drug Administration; |
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| 23 | 23 | | (2) an indicated test for a drug approved by the United |
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| 24 | 24 | | States Food and Drug Administration; |
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| 25 | 25 | | (3) a national coverage determination made by the |
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| 26 | 26 | | Centers for Medicare and Medicaid Services or a local coverage |
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| 27 | 27 | | determination made by a Medicare administrative contractor; |
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| 28 | 28 | | (4) nationally recognized clinical practice |
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| 29 | 29 | | guidelines; or |
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| 30 | 30 | | (5) consensus statements. |
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| 31 | 31 | | SECTION 2. If before implementing any provision of this Act |
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| 32 | 32 | | a state agency determines that a waiver or authorization from a |
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| 33 | 33 | | federal agency is necessary for implementation of that provision, |
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| 34 | 34 | | the agency affected by the provision shall request the waiver or |
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| 35 | 35 | | authorization and may delay implementing that provision until the |
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| 36 | 36 | | waiver or authorization is granted. |
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| 37 | 37 | | SECTION 3. The change in law made by this Act applies only |
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| 38 | 38 | | to a health benefit plan that is delivered, issued for delivery, or |
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| 39 | 39 | | renewed on or after January 1, 2026. A health benefit plan |
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| 40 | 40 | | delivered, issued for delivery, or renewed before January 1, 2026, |
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| 41 | 41 | | is governed by the law as it existed immediately before the |
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| 42 | 42 | | effective date of this Act, and that law is continued in effect for |
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| 43 | 43 | | that purpose. |
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| 44 | 44 | | SECTION 4. This Act takes effect September 1, 2025. |
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