FL H0885

State group health insurance plans issued on or after January 1, 2025, must cover biomarker testing for diagnosis, treatment, management, or ongoing monitoring of a disease or condition when supported by medical and scientific evidence of clinical utility, such as FDA-approved tests, CMS coverage determinations, or nationally recognized clinical practice guidelines.

The Agency for Health Care Administration is authorized to pay for biomarker testing as an optional Medicaid service, subject to specific appropriations, under the same evidence-based criteria applied to state employee plans, and may seek federal approval to implement these payments.

Medicaid managed care plans under contract with the agency must provide coverage for biomarker testing at the same scope, duration, and frequency as other medically necessary treatments, effective October 1, 2024, with the rate impact included in managed medical assistance and long-term care program rates.

"Biomarker testing" is defined to include single analyte tests, multiplex panel tests, protein expression, and whole exome/genome/transcriptome sequencing, performed at CLIA-certified or CLIA-waivered in-network laboratory facilities.

All plans must provide a clear, convenient, and readily accessible online process for providers and enrollees to request authorization for biomarker testing; coverage for screening purposes is explicitly excluded.