Vermont S 154: An act relating to miscellaneous banking provisions

Bill Text

BILLAS INTRODUCED AND PASSED BY SENATE S.154
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S.154
Introduced by Senators Gulick, Brock, Major and Vyhovsky
Referred to Committee on Finance
Date: May 9, 2025
Subject: Health; health insurance; Medicaid; biomarker testing
Statement of purpose of bill as introduced: This bill proposes to require health
insurance and Medicaid coverage for biomarker testing.
An act relating to health insurance coverage for biomarker testing
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 8 V.S.A. § 4088n is added to read:
§ 4088n. COVERAGE FOR BIOMARKER TESTING
(a) As used in this section:
(1) “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 gene mutations,
characteristics of genes, and protein expression.
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BILLAS INTRODUCED AND PASSED BY SENATE S.154
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(2) “Biomarker testing” means the analysis of a patient’s tissue, blood,
or other biospecimen for the presence of a biomarker. Biomarker testing
includes single-analyte tests, multiplexpanel tests, protein expression analysis,
and whole exome, whole genome, and whole transcriptome sequencing.
(3) “Consensus statements” means 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 the
statements are based on the best available evidence for the purpose of
optimizing the outcomes of clinical care.
(4) “Health insurance plan” means any health insurance policy or health
benefit plan offered by a health insurer, as defined in 18 V.S.A. § 9402. The
term does not include policies or plans providing coverage for a specified
disease or other limited benefit coverage.
(5) “Nationally recognized clinical practice guidelines” means 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.
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BILLAS INTRODUCED AND PASSED BY SENATE S.154
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(b) A health insurance plan shall provide coverage for the services of
biomarker testing for the purposes of diagnosis, treatment, appropriate
management, and ongoing monitoring of a patient’s disease or condition when
the test is supported by medical and scientific evidence, including:
(1) labeled indications for a test approved or cleared by the U.S. Food
and Drug Administration (FDA);
(2) indicated tests for an FDA-approved drug;
(3) warnings and precautions on FDA-approved drug labels;
(4) Centers for Medicare and Medicaid Services national coverage
determinations or Medicare Administrative Contractor local coverage
determinations; or
(5) nationally recognized clinical practice guidelines and consensus
statements.
(c) The coverage required in subsection (b) of this section shall be
provided in a manner that limits disruptions in care, including the need for
multiple biopsies or biospecimen samples.
Sec. 2. 33 V.S.A. § 1901n is added to read:
§ 1901n. MEDICAID COVERAGE FOR BIOMARKER TESTING
(a) As used in this section:
(1) “Biomarker” means a characteristic that is objectively measured and
evaluated as an indicator of normal biological processes, pathogenic processes,
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BILLAS INTRODUCED AND PASSED BY SENATE S.154
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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 gene mutations,
characteristics of genes, and protein expression.
(2) “Biomarker testing” means the analysis of a patient’s tissue, blood,
or other biospecimen for the presence of a biomarker. Biomarker testing
includes single-analyte tests, multiplexpanel tests, protein expression analysis,
and whole exome, whole genome, and whole transcriptome sequencing.
(3) “Consensus statements” means 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 the
statements are based on the best available evidence for the purpose of
optimizing the outcomes of clinical care.
(4) “Nation