Fiscal Note
Fiscal Services Division
SF 2159 – Health Insurance Coverage, Biomarker Testing (LSB5095SV)
Staff Contact: Xavier Leonard (515.725.0509) xavier.leonard@legis.iowa.gov
Fiscal Note Version – New
Description
Senate File 2159 relates to insurance coverage for biomarker testing and does the following:
• Requires a policy, contract, or plan providing third-party payment or prepayment of medical
expenses to provide coverage for biomarker testing for select purposes when the biomarker
testing has demonstrated clinical utility.
• Provides requirements for demonstrating clinical utility in biomarker testing.
• Provides additional coverage requirements for biomarker testing covered by the Bill.
• Provides applicability standards to policies, contracts, or plans delivered, issued for delivery,
continued, or renewed in the State on or after January 1, 2025.
• Requires the Commissioner of Insurance to adopt rules to administer the Bill.
Background
The Bill defines “biomarker testing” as an analysis of an individual’s tissue, blood, or other
biospecimen for the presence of a biomarker. The Bill defines “biomarker” as a characteristic
that is objectively measured and evaluated as an indicator of normal biological processes,
pathogenic processes, or pharmacologic responses to a specific therapeutic intervention.
Federal fiscal year (FFY) 2025 Federal Medical Assistance Percentage (FMAP) rates are based
on per capita personal incomes for calendar years 2020 through 2022. Iowa’s FFY 2025 FMAP
rate decreased by 0.88% to 63.25%, meaning that beginning October 1, 2024, for every dollar
spent on the Medicaid program, the federal government will pay $0.6325 and Iowa will pay
$0.3675.
Assumptions
• For State FY 2025, the State share for provider reimbursement is approximately 36.53%,
which is a blended FMAP rate consisting of 25.0% of the FFY 2024 FMAP rate and 75.0%
of the FFY 2025 FMAP rate. In FY 2025, the enhanced rate to providers is expected to cost
$2.4 million total, with the State paying $874,000 and the federal government paying
$1.5 million.
• For State FY 2026, the State share for provider reimbursement is approximately 36.75%, or
the State share of FY 2025 Medicaid costs via the FMAP rate. Beginning in FY 2026 and
continuing annually, the enhanced rate is expected to cost $2.4 million total, with the State
paying $880,000 and the federal government paying $1.5 million.
• An increase in the General Fund appropriation to the Department of Health and Human
Services (HHS) for Medicaid will be necessary to pay for the costs in the Bill.
• According to the HHS, potential contracting updates that may be required could be
absorbed by the HHS.
• According to the HHS, increased access to biomarker testing may generate savings in the
long term as a result of earlier intervention. Data to estimate potential cost savings is not
currently available; therefore, potential cost savings as a result of the Bill are not included.
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Fiscal Impact
Senate File 2159 is estimated to increase costs to the State by approximately $874,000 in
FY 2025 and $880,000 annually beginning in FY 2026.
Figure 1 — Annual Fiscal Impact Summary of SF 2159
Cost FY 2025 FY 2026
State $ 874,000 $ 880,000
State + Federal 2,394,000 2,394,000
Sources
Department of Health and Human Services
Legislative Services Agency analysis
/s/ Jennifer Acton
February 28, 2024
Doc ID 1447339
The fiscal note for this Bill was prepared pursuant to Joint Rule 17 and the Iowa Code. Data used in developing this
fiscal note is available from the Fiscal Services Division of the Legislative Services Agency upon request.
www.legis.iowa.gov
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