Bill > HB8

This bill mandates that health insurance plans and the state's Medicaid program must cover biomarker testing, which is the analysis of biological samples like blood or tissue to identify specific characteristics (biomarkers) that indicate normal biological processes, disease, or how a person might respond to a medication. This coverage is intended for diagnosing, treating, managing, and monitoring diseases or conditions, and will apply to tests ordered by a qualified healthcare provider when supported by medical evidence, including FDA-approved indications, drug information, national coverage decisions, or recognized clinical guidelines. The bill also requires that if multiple biomarker tests provide similar information, at least one must be covered to avoid disrupting patient care and the need for repeated biopsies, and it establishes an appeal process for coverage decisions. Furthermore, both health plans and Medicaid must report annually on various aspects of biomarker testing coverage, including the number of tests performed, prior authorization approvals and denials, reimbursement rates, and cost savings, with the stated intent of improving health outcomes and achieving long-term healthcare cost savings without encouraging price increases for these tests.

Health and Social Services

https://www.legislature.ohio.gov/legislation/136/hb8