H.B. No. 5178 amends the Texas Insurance Code to require health benefit plans to provide coverage for biomarker testing aimed at diagnosing, treating, managing, or monitoring an enrollee's disease or condition. Notably, the bill expands the definition of covered conditions to include those related to organ transplants, ensuring that treatment guidance is supported by specific medical and scientific evidence. This evidence can include FDA-approved tests, national coverage determinations from Medicare, recognized clinical guidelines, and consensus statements.

The bill stipulates that if a state agency needs a waiver or authorization from a federal agency to implement any provision, it may delay implementation until such approval is obtained. The changes will apply only to health benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2026, while plans renewed before this date will continue to be governed by the previous law. The act is set to take effect on September 1, 2025.

Statutes affected:
Introduced: Insurance Code 1372.003 (Insurance Code 1372)
House Committee Report: Insurance Code 1372.003 (Insurance Code 1372)