HI HB1971

Requires all health insurers, mutual benefit societies, and health maintenance organizations in Hawaii to cover biomarker testing for diagnosis, treatment, management, and ongoing monitoring of diseases beginning January 1, 2027.

Biomarker testing must be covered when supported by FDA-approved indications, Medicare coverage determinations, or nationally recognized clinical practice guidelines and consensus statements.

Coverage must be provided in a manner that limits disruptions in care, including reducing the need for multiple biopsies, with copayments no less favorable than for other covered medical services.

Insurers restricting coverage must provide patients and prescribing providers a clear, accessible exception request process available on their websites.

Extends biomarker testing coverage requirements to Medicaid managed care plans, requiring the Department of Human Services to submit necessary state plan amendments to CMS.