H.B. 608 Summary

• Requires all health benefit plans issued, renewed, or modified in Ohio to cover biomarker testing for diagnosis, treatment and management, and ongoing monitoring of diseases or conditions.

• Defines biomarker testing as analysis of tissue, blood, or biospecimens for biomarkers including gene mutations and protein expressions, encompassing single-analyte tests, multiplex panel tests, and whole genome sequencing.

• Coverage is mandatory when tests are supported by medical and scientific evidence including FDA-approved tests, Medicare national coverage determinations, local coverage determinations, nationally recognized clinical practice guidelines, or consensus statements.

• Requires health plan issuers to limit care disruptions by avoiding multiple unnecessary biopsies or biospecimen samples when providing coverage.

• Extends the same biomarker testing coverage requirements to the Ohio Medicaid program with appeals handled under section 5160.31, and requires appeal processes be accessible to providers and recipients in writing and online.