SB 1795 - This act requires the MO HealthNet program to cover biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of a participant's disease or condition to guide treatment decisions when the test provides clinical utility to the patient as demonstrated by medical and scientific evidence, including, but not limited to labeled indications for a test approved by the U.S. Food and Drug Administration (FDA) or indicated tests for an FDA approved drug, Centers for Medicare and Medicaid Services national coverage determination or Medicare administrative contractor local coverage determinations, or nationally recognized clinical practice guidelines.

MO HealthNet managed care organizations contracted to deliver services to participants shall provide biomarker testing at the same scope, duration, and frequency as MO HealthNet otherwise provides to participants.

Health insurers, nonprofit health service plans, and health maintenance organizations issuing, amending, delivering, or renewing a health insurance contract on or after August 28, 2026, shall include coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person's disease or condition to guide treatment decisions when the test provides clinical utility to the patient as demonstrated by medical and scientific evidence, including, but not limited to labeled indications for a test approved by the FDA or indicated tests for an FDA approved drug, centers for Medicare and Medicaid Services national coverage determination or Medicare administrative contractor local coverage determinations, or nationally recognized clinical practice guidelines. Such coverage shall be provided in a manner that shall limit disruptions in care, including the need for multiple biopsies or biospecimen samples.

The patient or prescribing practitioner shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy. Such process shall be readily accessible on the health insurer's, nonprofit health service plan's, or heath maintenance organization's website.

Nothing in this act shall be construed to require coverage of biomarker testing for screening purposes.

TAYLOR MIDDLETON