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AN ACT
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relating to health benefit plan coverage for certain biomarker |
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testing. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
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by adding Chapter 1372 to read as follows: |
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CHAPTER 1372. COVERAGE FOR BIOMARKER TESTING |
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Sec. 1372.001. DEFINITIONS. In this chapter: |
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(1) "Biomarker" means a characteristic that is |
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objectively measured and evaluated as an indicator of normal |
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biological processes, pathogenic processes, or pharmacologic |
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responses to a specific therapeutic intervention. The term |
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includes: |
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(A) gene mutations; and |
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(B) protein expression. |
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(2) "Biomarker testing" means the analysis of a |
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patient's tissue, blood, or other biospecimen for the presence of a |
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biomarker. The term includes: |
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(A) single-analyte tests; |
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(B) multiplex panel tests; and |
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(C) whole genome sequencing. |
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(3) "Consensus statements" means statements that: |
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(A) address specific clinical circumstances |
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based on the best available evidence for the purpose of optimizing |
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clinical care outcomes; and |
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(B) are developed by an independent, |
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multidisciplinary panel of experts that uses a transparent |
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methodology and reporting structure and is subject to a conflict of |
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interest policy. |
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(4) "Nationally recognized clinical practice |
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guidelines" means evidence-based clinical practice guidelines |
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that: |
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(A) establish a standard of care informed by a |
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systematic review of evidence and an assessment of the benefits and |
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costs of alternative care options; |
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(B) include recommendations intended to optimize |
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patient care; and |
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(C) are developed by an independent organization |
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or medical professional society that uses a transparent methodology |
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and reporting structure and is subject to a conflict of interest |
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policy. |
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Sec. 1372.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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| Statutes affected:
Introduced: ()
Senate Committee Report: ()
Engrossed: ()
House Committee Report: ()
Enrolled: ()