New Hampshire SB 606: relative to insurance coverage for biomarker testing.

Bill Text

SB 606-FN - AS AMENDED BY THE SENATE

02/19/2026 0689s

2026 SESSION

 26-2063

 05/08

SENATE BILL 606-FN

AN ACT relative to insurance coverage for biomarker testing.

SPONSORS: Sen. Birdsell, Dist 19; Sen. Innis, Dist 7

COMMITTEE: Health and Human Services

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AMENDED ANALYSIS

 This bill requires the New Hampshire Medicaid program to provide coverage for biomarker testing under certain circumstances.

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Explanation: Matter added to current law appears in bold italics.

 Matter removed from current law appears [in brackets and struckthrough.]

 Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

02/19/2026 0689s 26-2063

 05/08

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Twenty-Six

AN ACT relative to insurance coverage for biomarker testing.

Be it Enacted by the Senate and House of Representatives in General Court convened:

 1 New Subdivision; Managed Care Law; Biomarker Testing. Amend RSA 420-J by inserting after section 26 the following new subdivision:

Biomarker Testing

 420-J:27 Definitions. In this subdivision:

 I. “Biomarker” means 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, including known gene-drug interactions for medications being considered for use or already being administered. Biomarkers include but are not limited to gene mutations, characteristics of genes, or protein expression.

 II. “Biomarker testing” means the analysis of a patient’s tissue, blood, or other biospecimen for the presence of a biomarker. Biomarker testing includes but is not limited to single-analyte tests, multi-plex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing.

 III. "Clinical utility" means a biomarker test result that provides information used in the formulation of a treatment or monitoring strategy that informs a covered person's outcomes and impacts the treating provider's clinical decisions. The most appropriate test may include both information that is actionable and some information that cannot be immediately used in the formulation of a clinical decision.

 IV. “Consensus statements” mean statements developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure and with a conflict of interest policy. These statements are aimed at specific clinical circumstances and base the statements on the best available evidence for the purpose of optimizing the outcomes of clinical care.

 V. “Nationally recognized clinical practice guidelines” mean evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict of interest policy. Clinical practice guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

 420-J:28 Biomarker Testing; State Medicaid Plan Coverage Requirements. 

 I. Biomarker testing shall be covered by the New Hampshire Medicaid program for beneficiaries when the biomarker test is determined as medically necessary by the New Hampshire Medicaid program for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee’s disease or condition when the test provides clinical utility and is demonstrated by the following medical and scientific evidence, including but not limited to any of the following: 

 (a) Labeled indications for an FDA-approved or -cleared test;

 (b) Indicated tests for an FDA-approved drug;

 (c) Warnings and precautions on FDA-approved drug labels;

 (d) Centers for Medicare and Medicaid Services (CMS) National Coverage Determinations or Medicare Administrative Contractor (MAC) Local Coverage Determinations; or

 (e) Nationally recognized clinical practice guidelines and consensus statements. 

 II. If utilization review, including but not limited to prior authorization, is required, the utilization review entity, or any third party acting on behalf of the New Hampshire Medicaid program shall approve or deny a prior authorization request and notify the beneficiary, and the ordering health care provider. 

 2 New Section; Medicaid Coverage of Biomarker Testing. Amend RSA 167 by inserting after section 4-f the following new section: 

 167:4-g Biomarker Testing; Medicaid Coverage Requirements. 

 I. The state Medicaid plan shall cover biomarker testing, as defined in RSA