89R9454 MEW-F     By: Howard H.B. No. 5178       A BILL TO BE ENTITLED   AN ACT   relating to health benefit plan coverage for certain biomarker   testing.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 1372.003(a), Insurance Code, is amended   to read as follows:          (a)  Subject to Subsection (b), a health benefit plan must   provide coverage for biomarker testing for the purpose of   diagnosis, treatment, appropriate management, or ongoing   monitoring of an enrollee's disease or condition, including an   enrollee's condition of having received an organ transplant, to   guide treatment when the test is supported by the following kinds of   medical and scientific evidence:                (1)  a labeled indication for a test approved or   cleared by the United States Food and Drug Administration;                (2)  an indicated test for a drug approved by the United   States Food and Drug Administration;                (3)  a national coverage determination made by the   Centers for Medicare and Medicaid Services or a local coverage   determination made by a Medicare administrative contractor;                (4)  nationally recognized clinical practice   guidelines; or                (5)  consensus statements.          SECTION 2.  If before implementing any provision of this Act   a state agency determines that a waiver or authorization from a   federal agency is necessary for implementation of that provision,   the agency affected by the provision shall request the waiver or   authorization and may delay implementing that provision until the   waiver or authorization is granted.          SECTION 3.  The change in law made by this Act applies only   to a health benefit plan that is delivered, issued for delivery, or   renewed on or after January 1, 2026.  A health benefit plan   delivered, issued for delivery, or renewed before January 1, 2026,   is governed by the law as it existed immediately before the   effective date of this Act, and that law is continued in effect for   that purpose.          SECTION 4.  This Act takes effect September 1, 2025.