H.B. 2223 Summary

• Requires all health insurance policies, hospital/medical service plans, and health maintenance organizations issued or renewed on or after January 1, 2025, to provide coverage for medically necessary biomarker testing for diagnosis, treatment, management, or monitoring of disease or conditions.

• Biomarker testing coverage must include FDA-approved or FDA-cleared tests, tests indicated for FDA-approved drugs, warnings and precautions on FDA drug labels, CMS coverage determinations, and nationally recognized clinical practice guidelines and consensus statements.

• Coverage must limit care disruptions including multiple biopsies, allow patients and healthcare providers to request exceptions through clear and accessible processes, and impose cost-sharing (copayments, deductibles, coinsurance) no less favorable than other covered medical services.

• Applies biomarker testing coverage requirements to all Medicaid managed care health plans in Hawaii, with the Department of Human Services required to submit amendments to the Hawaii Medicaid state plan to the Centers for Medicare and Medicaid Services.

• Insurers and mutual benefit societies must provide written notice to policyholders regarding biomarker testing coverage by December 31, 2025; does not apply to limited benefit health insurance.