Relating to insurance coverage for biomarker testing

Topics:Health care Insurance Medicaid

Same legislation: SSB 3001, SF 2159, HF 2492, HF 2668

Write your legislators about itWhat changed before it passed

Official bill page Lobbyist declarations One-pager to print

Where it is now

Done: IntroducedJanuary 25, 2024
Done: SubcommitteeJanuary 31, 2024
Done: House committeeFebruary 8, 2024
Skipped: Passes the HouseContinued as HF 2492
Next: Senate committee
Next: Passes the Senate
Next: To the Governor
Next: Signed into law

Became HF 2492 → Its progress continues under the new number. Go to HF 2492 What’s a funnel?

What’s in it

AI summary Health insurance companies in Iowa would be required to cover certain tests that look for specific markers in a person's blood or tissue. These tests must be used to help diagnose, treat, or monitor cancer. Insurance providers must also create a way on their websites for doctors and patients to ask for exceptions to these rules.¹

Read the official explanation

This bill relates to health insurance coverage for biomarker testing. The bill defines “biomarker testing” as an analysis of an individual’s tissue, blood, or other biospecimen for the presence of a biomarker. “Biomarker” is also defined in the bill. The bill requires a health carrier that offers individual, group, or small group contracts, policies, or plans in this state that provide for third-party payment or prepayment of health or medical expenses to offer coverage for biomarker testing for purposes of diagnosing, treating, appropriately managing, or monitoring cancer in a covered person when the test has demonstrated clinical utility as detailed in the bill. “Clinical utility” is defined in the bill. Coverage shall be provided in a manner which limits disruptions in a person’s care. The bill requires a health carrier to provide a process on its internet site for a person and the person’s health care professional to seek an exception to coverage required under the bill. The bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2025, by the third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance which are not subject to the bill’s coverage requirements. The bill applies to the medical assistance program under Code chapter 249A, the healthy and well kids in Iowa (Hawki) program under Code chapter 514I, and a managed care organization acting pursuant to a contract with the department of health and human services to administer either the medical assistance program or the Hawki program. The commissioner of insurance may adopt rules to administer the bill.

Changed since by amendments S-5124, S-5123; see Amendments.

Full bill text · What changed before it passed²

House subcommittee

Named January 31, 2024. On February 6, 2024 it recommended amendment and passage. Vote Total: 3-0.

Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part

5 written public comments to its subcommittee: March 12, 2024 (1), February 6, 2024 (3), January 17, 2024 (1) · on the Legislature’s site

Fiscal note

AI summary This bill requires insurance plans to cover biomarker testing for certain purposes when the testing has shown clinical utility. It is estimated to increase costs to the state by approximately $86,000 in fiscal year 2025 and $171,000 annually beginning in fiscal year 2026. While increased access to testing may generate long-term savings, the amount cannot be estimated with currently available data.³

Read the fiscal note

Description

House File 2668 relates to insurance coverage for biomarker testing and does the following:

Requires a policy, contract, or plan providing third-party payment or prepayment of medical expenses to provide coverage for biomarker testing for select purposes when the biomarker testing has demonstrated clinical utility.
Provides requirements for demonstrating clinical utility in biomarker testing.
Provides additional coverage requirements for biomarker testing covered by the Bill.
Provides applicability standards to policies, contracts, or plans delivered, issued for delivery, continued, or renewed in the State on or after January 1, 2025.
Requires the Department of Health and Human Services (HHS) to report before November 1, 2025, the number and resulting cost of biomarker tests provided during FY 2025 to individuals as a result of the Bill that are covered by the medical assistance program under Iowa Code chapter 249A and the Healthy and Well Kids in Iowa (Hawki) program under Iowa Code chapter 514I.

Background

The Bill defines “biomarker testing” as an analysis of an individual’s tissue, blood, or other biospecimen for the presence of a biomarker. The Bill defines “biomarker” as a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. Federal fiscal year (FFY) 2025 Federal Medical Assistance Percentage (FMAP) rates are based on per capita personal incomes for calendar years 2020 through 2022. Iowa’s FFY 2025 FMAP rate decreased by 0.88% to 63.25%, meaning that beginning October 1, 2024, for every dollar spent on the Medicaid program, the federal government will pay $0.6325 and Iowa will pay $0.3675.

Assumptions

For State FY 2025, the State share for provider reimbursement is approximately 36.53%, which is a blended FMAP rate consisting of 25.0% of the FFY 2024 FMAP rate and 75.0% of the FFY 2025 FMAP rate. In FY 2025, the enhanced rate to providers is expected to cost $302,000 total, with the State paying $86,000 and the federal government paying $216,000.
For State FY 2026, the State share for provider reimbursement is approximately 36.75%, or the State share of FY 2025 Medicaid costs via the FMAP rate. Beginning in FY 2026 and continuing annually, the enhanced rate is expected to cost $603,000 total, with the State paying $171,000 and the federal government paying $432,000.
An increase in the General Fund appropriation to the HHS for Medicaid will be necessary to pay for the costs in the Bill.
According to the HHS, potential contracting updates that may be required could be absorbed by the HHS.
According to the HHS, increased access to biomarker testing may generate savings in the long term as a result of earlier intervention. Data to estimate potential cost savings is not currently available to estimate the amount; therefore, potential cost savings as a result of the Bill are not included.
According to the Milliman Cost Study, it is estimated that expanding biomarker testing coverage may increase Medicaid premiums between $0.05 and $0.09 per member, per month. For this Fiscal Note, it is assumed premiums will increase $0.08 per member, per month.

Fiscal Impact

House File 2668 is estimated to increase costs to the State by approximately $86,000 in FY 2025 and $171,000 annually beginning in FY 2026. Data to estimate potential cost savings is not currently available; therefore, potential cost savings as a result of the Bill are not included. Figure 1 — Annual Fiscal Impact Summary of HF 2668