The bill, H.B. No. 5178, amends Section 1372.003(a) of the Texas Insurance Code to require health benefit plans to provide coverage for biomarker testing. This coverage is specifically for the diagnosis, treatment, management, or ongoing monitoring of an enrollee's disease or condition, including cases where the enrollee has received an organ transplant. The bill stipulates that the biomarker testing must be supported by various forms of medical and scientific evidence, such as FDA-approved tests, national coverage determinations, clinical practice guidelines, or consensus statements.

Additionally, the bill includes a provision that allows state agencies to request waivers or authorizations from federal agencies if necessary for the implementation of any part of the Act. 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)