MN HF1978

Health plan companies must provide coverage for biomarker testing used to diagnose, treat, manage, and monitor illness or disease if the test provides clinical utility, effective January 1, 2025.

Clinical utility for biomarker tests may be demonstrated through nationally recognized clinical practice guidelines, consensus statements, FDA-approved or FDA-cleared test labels, or Centers for Medicare and Medicaid Services coverage determinations.

Coverage must be provided in a manner that limits disruption of care, including minimizing the need for multiple biopsies or biospecimen samples.

Health plan companies may still require prior authorization or impose other utilization controls when approving biomarker testing coverage.

Medical assistance (Medicaid) coverage for biomarker testing must meet the same requirements as health plan companies, effective January 1, 2025, or upon federal approval, whichever is later.