HB 4753 — Relating to providing health insurance coverage concerning biomarker testing
Last action — Removed from calendar by Rules Committee
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✓Introduced
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✓In Committee
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3Passed House of Delegates
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4Passed Senate
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5To Executive
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6Enacted
This bill has passed the House of Delegates. Introduced January 15, 2024. It now moves to the second chamber.
Next likely step: consideration and a floor vote in the Senate.
Odds of enactment
Moderate chanceBased on the sponsor, cosponsors, and committee posture, this bill has a moderate chance of becoming law.
Upgrade to see the exact probability and what's driving it.
A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.
Prognosis
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Passed House of Delegates
Current position in the legislative process.
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11 sponsors
1 primary, 10 co-sponsors signed on.
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Bipartisan support
Sponsored across 2 parties (7 R · 3 D) — cross-party backing.
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Mixed recorded votes
2 passed, 1 failed in recorded votes so far.
Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.
Bill Text
What changed in the latest version
1 added · 449 removedPlain-language change summary
The amendment to HB 4753 changes the agency responsible for reporting the costs related to health insurance coverage for biomarker testing. Initially, the Public Employees Insurance Agency was tasked with this responsibility, but it has now been switched to the Bureau of Medical Services. Additionally, the amendment establishes a requirement for this agency to report back to the Joint Committee of Government and Finance one year after the changes are implemented. This matters because it ensures oversight and accountability regarding the financial impacts of the new health insurance provisions.
WESTHB4753 VIRGINIAHFA LEGISLATURESummers REGULAR2-25 SESSION#1JW ENGROSSED3295 Delegate CommitteeSummers Substitutemoved forto Houseamend Billthe 4753bill Byon Delegatespage Westfall,3, Barnhart,line Riley,54, Young,by Hornbuckle,inserting W.a new subsection (c) to read as follows:
Hall,"(c) Garcia,One Jeffries,year Hott,following Cannon,implementation, andthe AkersPublic [OriginatingEmployees inInsurance Agency shall report to the Joint Committee onof Government and Finance the Judiciary;cost of this change.";And,On page 5, line 49, by striking the words, "The Public Employees Insurance Agency" and inserting in lieu thereof, "The Bureau of Medical Services";AndOn page 6, line 54, by inserting a new subsection (c) to read as follows:
Reported"(c) onOne Februaryyear 21,following 2024]implementation, Engthe CSBureau forof HBMedical 4753Services Ashall BILLreport to amend the codeJoint Committee of WestGovernment Virginia,and 1931,Finance bythe addingcost theretoof athis newchange."; AdoptedRejected section designated, §5- 16-7h;
to amend said code by adding thereto a new section designated §9-5-34;
to amend said code by adding thereto a new section designated §33-15-4x;
to amend said code by adding thereto a new section designated §33-16-3aa;
to amend said code by adding thereto a new section designated §33-24-7y;
to amend said code by adding thereto a new section designated §33-25-8v;
and to amend said code by adding thereto a new section designated §33-25A-8y, all relating to providing health insurance coverage concerning biomarker testing.
Be it enacted by the Legislature of West Virginia:
CHAPTER 5.
GENERAL POWERS AND AUTHORITY OF THE GOVERNOR, SECRETARY OF STATE AND ATTORNEY GENERAL;
BOARD OF PUBLIC WORKS;
MISCELLANEOUS AGENCIES, COMMISSIONS, OFFICES, PROGRAMS, ETC.
ARTICLE 16.
WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7h.
Biomarker testing.
(a) As used in this section:
(1) "Biomarker":
means a characteristic that is objectively measured and evaluated as an indicator of normal biologic 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;
and includes but is not limited to 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;
and includes but is not limited to single-analyte 1 Eng CS for HB 4753 tests, multiplex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing;
(3) "Consensus statements" means statements that are:
(A) Developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure with a conflict of interest policy;
(B) Aimed at specific clinical circumstances;
and (C) Based on the best available evidence for the purpose of optimizing the outcomes of clinical care;
(4) "FDA" means the United States Food and Drug Administration;
and (5) "Nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines that:
(A) Are developed by an independent organization or medical professional society utilizing a transparent methodology and reporting structure with a conflict of interest policy and include recommendations intended to optimize care;
(B) Establish standards of care informed by:
(i) A systematic review of evidence;
and (ii) An assessment of the benefits and risks of alternative care options.
(6) "Precision diagnosis" means the use of biomarker testing after a covered individual has received a medical diagnosis of a disease or condition for which biomarker testing is appropriate.
(7) "Prior authorization" means obtaining advanced approval from a health insurer about the coverage of a service or medication.
(b)(1) The Public Employees Insurance Agency shall provide coverage for biomarker testing for the purposes of precision diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person's disease or condition when supported by medical and scientific evidence, including, but not limited to:
(A) Labeled indications for a test approved or cleared by the FDA;
2 Eng CS for HB 4753 (B) Indicated tests for an FDA-approved drug;
Show all 266 changed lines (226 more)
(C) Warnings and precautions on FDA-approved drug labels;
(D) Centers for Medicare and Medicaid Services national coverage determinations and Medicare administrative contractor local coverage determinations;
or (E) Nationally recognized clinical practice guidelines such as, but not limited to, those of the National Comprehensive Cancer Network or the American Society of Clinical Oncology, and consensus statements:
Provided, That any treatment provided in accordance with such practice guidelines is limited to the use of drugs and tests approved or cleared by the FDA.
(2) Nothing in this section shall require coverage of biomarker testing for the purpose of screening an individual prior to receiving a diagnosis of a disease or condition for which biomarker testing is appropriate.
(3) The coverage shall be provided in a manner that shall limit disruptions in care including the need for multiple biopsies or biospecimen samples.
(4) The Public Employees Insurance Agency may require that biomarker testing be subject to prior authorization in accordance with §33-16-3dd.
(5) The covered person and prescribing practitioner shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy provided pursuant to the provisions of this section.
The process shall be made readily accessible on the website of the insurer.
(c) One year following implementation, the Public Employees Insurance Agency shall report to the Joint Committee on Government and Finance the cost of this change.
CHAPTER 9.
HUMAN SERVICES.
ARTICLE 5.
MISCELLANEOUS PROVISIONS.
§9-5-34.
Biomarker testing.
(a) As used in this section:
3 Eng CS for HB 4753 (1) "Biomarker":
means a characteristic that is objectively measured and evaluated as an indicator of normal biologic 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;
and includes but is not limited to 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;
and includes but is not limited to single-analyte tests, multiplex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing;
(3) "Consensus statements" means statements that are:
(A) Developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure with a conflict of interest policy;
(B) Aimed at specific clinical circumstances;
and (C) Based on the best available evidence for the purpose of optimizing the outcomes of clinical care;
(4) "FDA" means the United States Food and Drug Administration;
and (5) "Nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines that:
(A) Are developed by an independent organization or medical professional society utilizing a transparent methodology and reporting structure with a conflict of interest policy and include recommendations intended to optimize care;
(B) Establish standards of care informed by:
(i) A systematic review of evidence;
and (ii) An assessment of the benefits and risks of alternative care options.
(6) "Precision diagnosis" means the use of biomarker testing after a covered individual has received a medical diagnosis of a disease or condition for which biomarker testing is appropriate.
4 Eng CS for HB 4753 (7) "Prior authorization" means obtaining advanced approval from a health insurer about the coverage of a service or medication.
(b)(1) The Bureau for Medical Services shall provide coverage for biomarker testing for the purposes of precision diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person's disease or condition when supported by medical and scientific evidence, including, but not limited to:
(A) Labeled indications for a test approved or cleared by the FDA;
(B) Indicated tests for an FDA-approved drug;
(C) Warnings and precautions on FDA-approved drug labels;
(D) Centers for Medicare and Medicaid Services national coverage determinations and Medicare administrative contractor local coverage determinations;
or (E) Nationally recognized clinical practice guidelines such as, but not limited to, those of the National Comprehensive Cancer Network or the American Society of Clinical Oncology, and consensus statements:
Provided, That any treatment provided in accordance with such practice guidelines is limited to the use of drugs and tests approved or cleared by the FDA.
(2) Nothing in this section shall require coverage of biomarker testing for the purpose of screening an individual prior to receiving a diagnosis of a disease or condition for which biomarker testing is appropriate.
(3) The coverage shall be provided in a manner that shall limit disruptions in care including the need for multiple biopsies or biospecimen samples.
(4) The Bureau of Medical Services may require that biomarker testing be subject to prior authorization in accordance with §33-16-3dd.
(5) The covered person and prescribing practitioner shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy provided pursuant to the provisions of this section.
The process shall be made readily accessible on the website of the insurer.
5 Eng CS for HB 4753 (c) One year following implementation, the Bureau of Medical Services shall report to the Joint Committee on Government and Finance the cost of this change.
CHAPTER 33.
INSURANCE.
ARTICLE 15.
ACCIDENT AND SICKNESS INSURANCE.
§33-15-4x.
Biomarker testing.
(a) As used in this section:
(1) "Biomarker":
means a characteristic that is objectively measured and evaluated as an indicator of normal biologic 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;
and includes but is not limited to 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;
and includes but is not limited to single-analyte tests, multiplex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing;
(3) "Consensus statements" means statements that are:
(A) Developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure with a conflict of interest policy;
(B) Aimed at specific clinical circumstances;
and (C) Based on the best available evidence for the purpose of optimizing the outcomes of clinical care;
(4) "FDA" means the United States Food and Drug Administration;
and (5) "Nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines that:
6 Eng CS for HB 4753 (A) Are developed by an independent organization or medical professional society utilizing a transparent methodology and reporting structure with a conflict of interest policy and include recommendations intended to optimize care;
(B) Establish standards of care informed by:
(i) A systematic review of evidence;
and (ii) An assessment of the benefits and risks of alternative care options.
(6) "Precision diagnosis" means the use of biomarker testing after a covered individual has received a medical diagnosis of a disease or condition for which biomarker testing is appropriate.
(7) "Prior authorization" means obtaining advanced approval from a health insurer about the coverage of a service or medication.
(b)(1) The health insurers shall provide coverage for biomarker testing for the purposes of precision diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person's disease or condition when supported by medical and scientific evidence, including, but not limited to:
(A) Labeled indications for a test approved or cleared by the FDA;
(B) Indicated tests for an FDA-approved drug;
(C) Warnings and precautions on FDA-approved drug labels;
(D) Centers for Medicare and Medicaid Services national coverage determinations and Medicare administrative contractor local coverage determinations;
or (E) Nationally recognized clinical practice guidelines such as, but not limited to, those of the National Comprehensive Cancer Network or the American Society of Clinical Oncology, and consensus statements:
Provided, That any treatment provided in accordance with such practice guidelines is limited to the use of drugs and tests approved or cleared by the FDA.
(2) Nothing in this section shall require coverage of biomarker testing for the purpose of screening an individual prior to receiving a diagnosis of a disease or condition for which biomarker testing is appropriate.
7 Eng CS for HB 4753 (3) The coverage shall be provided in a manner that shall limit disruptions in care including the need for multiple biopsies or biospecimen samples.
(4) The health insurers may require that biomarker testing be subject to prior authorization in accordance with §33-16-3dd.
(5) The covered person and prescribing practitioner shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy provided pursuant to the provisions of this section.
The process shall be made readily accessible on the website of the insurer.
ARTICLE 16.
GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-3aa.
Biomarker testing.
(a) As used in this section:
(1) "Biomarker":
means a characteristic that is objectively measured and evaluated as an indicator of normal biologic 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;
and includes but is not limited to 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;
and includes but is not limited to single-analyte tests, multiplex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing;
(3) "Consensus statements" means statements that are:
(A) Developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure with a conflict of interest policy;
(B) Aimed at specific clinical circumstances;
and (C) Based on the best available evidence for the purpose of optimizing the outcomes of clinical care;
8 Eng CS for HB 4753 (4) "FDA" means the United States Food and Drug Administration;
and (5) "Nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines that:
(A) Are developed by an independent organization or medical professional society utilizing a transparent methodology and reporting structure with a conflict of interest policy and include recommendations intended to optimize care;
(B) Establish standards of care informed by:
(i) A systematic review of evidence;
and (ii) An assessment of the benefits and risks of alternative care options.
(6) "Precision diagnosis" means the use of biomarker testing after a covered individual has received a medical diagnosis of a disease or condition for which biomarker testing is appropriate.
(7) "Prior authorization" means obtaining advanced approval from a health insurer about the coverage of a service or medication.
(b)(1) The health insurers shall provide coverage for biomarker testing for the purposes of precision diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person's disease or condition when supported by medical and scientific evidence, including, but not limited to:
(A) Labeled indications for a test approved or cleared by the FDA;
(B) Indicated tests for an FDA-approved drug;
(C) Warnings and precautions on FDA-approved drug labels;
(D) Centers for Medicare and Medicaid Services national coverage determinations and Medicare administrative contractor local coverage determinations;
or (E) Nationally recognized clinical practice guidelines such as, but not limited to, those of the National Comprehensive Cancer Network or the American Society of Clinical Oncology, and consensus statements:
Provided, That any treatment provided in accordance with such practice guidelines is limited to the use of drugs and tests approved or cleared by the FDA.
9 Eng CS for HB 4753 (2) Nothing in this section shall require coverage of biomarker testing for the purpose of screening an individual prior to receiving a diagnosis of a disease or condition for which biomarker testing is appropriate.
(3) The coverage shall be provided in a manner that shall limit disruptions in care including the need for multiple biopsies or biospecimen samples.
(4) The health insurers may require that biomarker testing be subject to prior authorization in accordance with §33-16-3dd.
(5) The covered person and prescribing practitioner shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy provided pursuant to the provisions of this section.
The process shall be made readily accessible on the website of the insurer.
ARTICLE 24.
HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS, AND HEALTH SERVICE CORPORATIONS.
§33-24-7y.
Biomarker testing.
(a) As used in this section:
(1) "Biomarker":
means a characteristic that is objectively measured and evaluated as an indicator of normal biologic 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;
and includes but is not limited to 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;
and includes but is not limited to single-analyte tests, multiplex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing;
10 Eng CS for HB 4753 (3) "Consensus statements" means statements that are:
(A) Developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure with a conflict of interest policy;
(B) Aimed at specific clinical circumstances;
and (C) Based on the best available evidence for the purpose of optimizing the outcomes of clinical care;
(4) "FDA" means the United States Food and Drug Administration;
and (5) "Nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines that:
(A) Are developed by an independent organization or medical professional society utilizing a transparent methodology and reporting structure with a conflict of interest policy and include recommendations intended to optimize care;
(B) Establish standards of care informed by:
(i) A systematic review of evidence;
and (ii) An assessment of the benefits and risks of alternative care options.
(6) "Precision diagnosis" means the use of biomarker testing after a covered individual has received a medical diagnosis of a disease or condition for which biomarker testing is appropriate.
(7) "Prior authorization" means obtaining advanced approval from a health insurer about the coverage of a service or medication.
(b)(1) The health insurers shall provide coverage for biomarker testing for the purposes of precision diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person's disease or condition when supported by medical and scientific evidence, including, but not limited to:
(A) Labeled indications for a test approved or cleared by the FDA;
(B) Indicated tests for an FDA-approved drug;
(C) Warnings and precautions on FDA-approved drug labels;
11 Eng CS for HB 4753 (D) Centers for Medicare and Medicaid Services national coverage determinations and Medicare administrative contractor local coverage determinations;
or (E) Nationally recognized clinical practice guidelines such as, but not limited to, those of the National Comprehensive Cancer Network or the American Society of Clinical Oncology, and consensus statements:
Provided, That any treatment provided in accordance with such practice guidelines is limited to the use of drugs and tests approved or cleared by the FDA.
(2) Nothing in this section shall require coverage of biomarker testing for the purpose of screening an individual prior to receiving a diagnosis of a disease or condition for which biomarker testing is appropriate.
(3) The coverage shall be provided in a manner that shall limit disruptions in care including the need for multiple biopsies or biospecimen samples.
(4) The health insurers may require that biomarker testing be subject to prior authorization in accordance with §33-16-3dd.
(5) The covered person and prescribing practitioner shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy provided pursuant to the provisions of this section.
The process shall be made readily accessible on the website of the insurer.
ARTICLE 25.
HEALTH CARE CORPORATIONS.
§33-25-8v.
Biomarker testing.
(a) As used in this section:
(1) "Biomarker":
means a characteristic that is objectively measured and evaluated as an indicator of normal biologic 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;
and includes but is not limited to gene mutations, characteristics of genes and protein expression;
12 Eng CS for HB 4753 (2) "Biomarker testing":
means the analysis of a patient's tissue, blood, or other biospecimen for the presence of a biomarker;
and includes but is not limited to single-analyte tests, multiplex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing;
(3) "Consensus statements" means statements that are:
(A) Developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure with a conflict of interest policy;
(B) Aimed at specific clinical circumstances;
and (C) Based on the best available evidence for the purpose of optimizing the outcomes of clinical care;
(4) "FDA" means the United States Food and Drug Administration;
and (5) "Nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines that:
(A) Are developed by an independent organization or medical professional society utilizing a transparent methodology and reporting structure with a conflict of interest policy and include recommendations intended to optimize care;
(B) Establish standards of care informed by:
(i) A systematic review of evidence;
and (ii) An assessment of the benefits and risks of alternative care options.
(6) "Precision diagnosis" means the use of biomarker testing after a covered individual has received a medical diagnosis of a disease or condition for which biomarker testing is appropriate.
(7) "Prior authorization" means obtaining advanced approval from a health insurer about the coverage of a service or medication.
(b)(1) The health insurers shall provide coverage for biomarker testing for the purposes of precision diagnosis, treatment, appropriate management, or ongoing monitoring of a covered 13 Eng CS for HB 4753 person's disease or condition when supported by medical and scientific evidence, including, but not limited to:
(A) Labeled indications for a test approved or cleared by the FDA;
(B) Indicated tests for an FDA-approved drug;
(C) Warnings and precautions on FDA-approved drug labels;
(D) Centers for Medicare and Medicaid Services national coverage determinations and Medicare administrative contractor local coverage determinations;
or (E) Nationally recognized clinical practice guidelines such as, but not limited to, those of the National Comprehensive Cancer Network or the American Society of Clinical Oncology, and consensus statements:
Provided, That any treatment provided in accordance with such practice guidelines is limited to the use of drugs and tests approved or cleared by the FDA.
(2) Nothing in this section shall require coverage of biomarker testing for the purpose of screening an individual prior to receiving a diagnosis of a disease or condition for which biomarker testing is appropriate.
(3) The coverage shall be provided in a manner that shall limit disruptions in care including the need for multiple biopsies or biospecimen samples.
(4) The health insurers may require that biomarker testing be subject to prior authorization in accordance with §33-16-3dd.
(5) The covered person and prescribing practitioner shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy provided pursuant to the provisions of this section.
The process shall be made readily accessible on the website of the insurer.
ARTICLE 25A.
HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-8y.
Biomarker testing.
(a) As used in this section:
14 Eng CS for HB 4753 (1) "Biomarker":
means a characteristic that is objectively measured and evaluated as an indicator of normal biologic 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;
and includes but is not limited to 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;
and includes but is not limited to single-analyte tests, multiplex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing;
(3) "Consensus statements" means statements that are:
(A) Developed by an independent, multidisciplinary panel of experts utilizing a transparent methodology and reporting structure with a conflict of interest policy;
(B) Aimed at specific clinical circumstances;
and (C) Based on the best available evidence for the purpose of optimizing the outcomes of clinical care;
(4) "FDA" means the United States Food and Drug Administration;
and (5) "Nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines that:
(A) Are developed by an independent organization or medical professional society utilizing a transparent methodology and reporting structure with a conflict of interest policy and include recommendations intended to optimize care;
(B) Establish standards of care informed by:
(i) A systematic review of evidence;
and (ii) An assessment of the benefits and risks of alternative care options.
(6) "Precision diagnosis" means the use of biomarker testing after a covered individual has received a medical diagnosis of a disease or condition for which biomarker testing is appropriate.
15 Eng CS for HB 4753 (7) "Prior authorization" means obtaining advanced approval from a health insurer about the coverage of a service or medication.
(b)(1) The health insurers shall provide coverage for biomarker testing for the purposes of precision diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person's disease or condition when supported by medical and scientific evidence, including, but not limited to:
(A) Labeled indications for a test approved or cleared by the FDA;
(B) Indicated tests for an FDA-approved drug;
(C) Warnings and precautions on FDA-approved drug labels;
(D) Centers for Medicare and Medicaid Services national coverage determinations and Medicare administrative contractor local coverage determinations;
or (E) Nationally recognized clinical practice guidelines such as, but not limited to, those of the National Comprehensive Cancer Network or the American Society of Clinical Oncology, and consensus statements:
Provided, That any treatment provided in accordance with such practice guidelines is limited to the use of drugs and tests approved or cleared by the FDA.
(2) Nothing in this section shall require coverage of biomarker testing for the purpose of screening an individual prior to receiving a diagnosis of a disease or condition for which biomarker testing is appropriate.
(3) The coverage shall be provided in a manner that shall limit disruptions in care including the need for multiple biopsies or biospecimen samples.
(4) The health insurers may require that biomarker testing be subject to prior authorization in accordance with §33-16-3dd.
(5) The covered person and prescribing practitioner shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy provided pursuant to the provisions of this section.
The process shall be made readily accessible on the website of the insurer.
16
Show all 266 changed rows (226 more)
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- hb4753 hfa summers 2-25 _1 adopted.htm View text Current html
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- Committee Substitute View text pdf
- Introduced Introduced Version pdf
Action History
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Removed from calendar by Rules Committee
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Laid over on 3rd reading 3/8/2024 with right to amend
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Deferred until foot of 3rd reading
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On 3rd reading with right to amend
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Read 2nd time
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On 2nd reading
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Read 1st time
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On 1st reading
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Reported do pass, with amendments and title amendment
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To Health and Human Resources
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To Health and Human Resources
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Introduced in Senate
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Communicated to Senate
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Effective July 1, 2024 (Roll No. 313)
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Passed House (Roll No. 312)
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Read 3rd time
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On 3rd reading, Special Calendar
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Amendment rejected (Roll No. 303)
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Amendment reported by the Clerk
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Amendment adopted (Voice vote)
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Amendment reported by the Clerk
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Read 2nd time
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On 2nd reading, Special Calendar
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Read 1st time
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On 1st reading, Special Calendar
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By substitute, do pass
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To House Judiciary
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With amendment, do pass, but first to Judiciary
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To House Banking and Insurance
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Introduced in House
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To Banking and Insurance then Judiciary
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Filed for introduction
Sponsors
- James Robert "JB" Akers II · Cosponsor
- Jarred Cannon · Cosponsor
- John Paul Hott · Cosponsor
- Joey Garcia · Cosponsor
- Walter Hall · Cosponsor
- Sean Hornbuckle · Cosponsor
- Trenton Barnhart · Cosponsor
- Clay Riley · Cosponsor
- Kayla Young · Cosponsor
- Westfall · Primary
- Dean Jeffries · Cosponsor
Sponsorship breakdown
Export CSV (upgrade) →1 sponsors · 10 co-sponsors · 141 not signed on · 50 voted No
Sponsors (1)
- Westfall
Co-sponsors (10)
- James Robert "JB" Akers II Republican
- Jarred Cannon Republican
- John Paul Hott Republican Voted No
- Joey Garcia Democrat
- Walter Hall Republican Voted No
- Sean Hornbuckle Democrat
- Trenton Barnhart Republican Voted No
- Clay Riley Republican Voted No
- Kayla Young Democrat
- Dean Jeffries Republican
Not signed on (141)
141 members have not signed on to this bill.
Show all 141 →"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.
Votes
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Republican | 61 | 2 | 0 | 3 |
| Unaffiliated | 22 | 2 | 0 | 2 |
| Democrat | 7 | 0 | 0 | 1 |
| Total | 90 | 4 | 0 | 6 |
| % of votes cast | 90% | 4% | 0% | 6% |
How each member voted (100)
| Member | Party | Vote |
|---|---|---|
| Forsht | — | Yea |
| Kump | — | Yea |
| Rowe | — | Yea |
| Linville | — | Yea |
| Smith | — | Yea |
| Griffith | — | Yea |
| Hamilton | — | Yea |
| Martin | — | Yea |
| Summers | — | Yea |
| Hardy | — | Yea |
| Tully | — | Yea |
| Nestor | — | Yea |
| Warner | — | Yea |
| Phillips | — | Yea |
| Westfall | — | Yea |
| Devault | — | Yea |
| Householder | — | Yea |
| Winzenreid | — | Yea |
| Jeffries | — | Yea |
| Espinosa | — | Yea |
| Fast | — | Yea |
| Kirby | — | Yea |
| Foster | — | Nay |
| Longanacre | — | Nay |
| Ross | — | Not Voting |
| Steele | — | Not Voting |
| Evan Hansen | Democrat | Yea |
| Hollis Lewis | Democrat | Yea |
| Joey Garcia | Democrat | Yea |
| John Williams | Democrat | Yea |
| Kayla Young | Democrat | Yea |
| Mike Pushkin | Democrat | Yea |
| Sean Hornbuckle | Democrat | Yea |
| Shawn Fluharty | Democrat | Not Voting |
| Adam Burkhammer | Republican | Yea |
| Adam Vance | Republican | Yea |
| Andy Shamblin | Republican | Yea |
| Betsy Kelly | Republican | Yea |
| Bill Ridenour | Republican | Yea |
| Bob Fehrenbacher | Republican | Yea |
| Bryan Ward | Republican | Yea |
| Charles Sheedy | Republican | Yea |
| Christopher W. Toney | Republican | Yea |
| Chuck Horst | Republican | Not Voting |
| Clay Riley | Republican | Yea |
| D. Rolland Jennings | Republican | Yea |
| Dana Ferrell | Republican | Yea |
| Darren Thorne | Republican | Yea |
| Dave Foggin | Republican | Not Voting |
| David Green | Republican | Yea |
| Elias Coop-Gonzalez | Republican | Nay |
| Eric Brooks | Republican | Yea |
| Erica Moore | Republican | Yea |
| Evan Worrell | Republican | Yea |
| Gary G. Howell | Republican | Yea |
| Geno Chiarelli | Republican | Yea |
| George Miller | Republican | Yea |
| George Street | Republican | Yea |
| Henry Dillon | Republican | Nay |
| James Robert "JB" Akers II | Republican | Yea |
| Jarred Cannon | Republican | Yea |
| Jeff Campbell | Republican | Yea |
| Jeffrey Stephens | Republican | Yea |
| Jim Butler | Republican | Yea |
| Jimmy Willis | Republican | Yea |
| Joe Ellington | Republican | Yea |
| Joe Statler | Republican | Yea |
| John Paul Hott | Republican | Yea |
| Jonathan Pinson | Republican | Yea |
| Jordan Bridges | Republican | Yea |
| Jordan Maynor | Republican | Yea |
| Josh Holstein | Republican | Yea |
| Kathie Hess Crouse | Republican | Yea |
| Keith Marple | Republican | Yea |
| Laura Kimble | Republican | Yea |
| Lori Dittman | Republican | Yea |
| Margitta Mazzocchi | Republican | Yea |
| Mark Dean | Republican | Not Voting |
| Mark Zatezalo | Republican | Yea |
| Marty Gearheart | Republican | Yea |
| Matthew Rohrbach | Republican | Yea |
| Michael Hite | Republican | Yea |
| Michael Hornby | Republican | Yea |
| Mickey Petitto | Republican | Yea |
| Pat McGeehan | Republican | Yea |
| Patrick Lucas | Republican | Yea |
| Phil Mallow | Republican | Yea |
| Rick Hillenbrand | Republican | Yea |
| Roger Hanshaw | Republican | Yea |
| Roy Cooper | Republican | Yea |
| Scot C. Heckert | Republican | Yea |
| Stanley Adkins | Republican | Yea |
| Trenton Barnhart | Republican | Yea |
| Vacant1 | Republican | Yea |
| Vacant1 | Republican | Yea |
| Vernon Criss | Republican | Yea |
| Walter Hall | Republican | Yea |
| Wayne Clark | Republican | Yea |
| Wayne Clark | Republican | Yea |
| William Anderson | Republican | Yea |
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Republican | 62 | 1 | 0 | 3 |
| Unaffiliated | 25 | 0 | 0 | 1 |
| Democrat | 7 | 0 | 0 | 1 |
| Total | 94 | 1 | 0 | 5 |
| % of votes cast | 94% | 1% | 0% | 5% |
How each member voted (100)
| Member | Party | Vote |
|---|---|---|
| Forsht | — | Yea |
| Kump | — | Yea |
| Ross | — | Yea |
| Foster | — | Yea |
| Rowe | — | Yea |
| Linville | — | Yea |
| Longanacre | — | Yea |
| Smith | — | Yea |
| Griffith | — | Yea |
| Hamilton | — | Yea |
| Martin | — | Yea |
| Summers | — | Yea |
| Hardy | — | Yea |
| Tully | — | Yea |
| Nestor | — | Yea |
| Warner | — | Yea |
| Phillips | — | Yea |
| Westfall | — | Yea |
| Devault | — | Yea |
| Householder | — | Yea |
| Winzenreid | — | Yea |
| Jeffries | — | Yea |
| Espinosa | — | Yea |
| Fast | — | Yea |
| Kirby | — | Yea |
| Steele | — | Not Voting |
| Evan Hansen | Democrat | Yea |
| Hollis Lewis | Democrat | Yea |
| Joey Garcia | Democrat | Yea |
| John Williams | Democrat | Yea |
| Kayla Young | Democrat | Yea |
| Mike Pushkin | Democrat | Yea |
| Sean Hornbuckle | Democrat | Yea |
| Shawn Fluharty | Democrat | Not Voting |
| Adam Burkhammer | Republican | Yea |
| Adam Vance | Republican | Yea |
| Andy Shamblin | Republican | Yea |
| Betsy Kelly | Republican | Yea |
| Bill Ridenour | Republican | Yea |
| Bob Fehrenbacher | Republican | Yea |
| Bryan Ward | Republican | Yea |
| Charles Sheedy | Republican | Yea |
| Christopher W. Toney | Republican | Yea |
| Chuck Horst | Republican | Not Voting |
| Clay Riley | Republican | Yea |
| D. Rolland Jennings | Republican | Yea |
| Dana Ferrell | Republican | Yea |
| Darren Thorne | Republican | Yea |
| Dave Foggin | Republican | Not Voting |
| David Green | Republican | Yea |
| Elias Coop-Gonzalez | Republican | Yea |
| Eric Brooks | Republican | Yea |
| Erica Moore | Republican | Yea |
| Evan Worrell | Republican | Yea |
| Gary G. Howell | Republican | Yea |
| Geno Chiarelli | Republican | Yea |
| George Miller | Republican | Yea |
| George Street | Republican | Yea |
| Henry Dillon | Republican | Nay |
| James Robert "JB" Akers II | Republican | Yea |
| Jarred Cannon | Republican | Yea |
| Jeff Campbell | Republican | Yea |
| Jeffrey Stephens | Republican | Yea |
| Jim Butler | Republican | Yea |
| Jimmy Willis | Republican | Yea |
| Joe Ellington | Republican | Yea |
| Joe Statler | Republican | Yea |
| John Paul Hott | Republican | Yea |
| Jonathan Pinson | Republican | Yea |
| Jordan Bridges | Republican | Yea |
| Jordan Maynor | Republican | Yea |
| Josh Holstein | Republican | Yea |
| Kathie Hess Crouse | Republican | Yea |
| Keith Marple | Republican | Yea |
| Laura Kimble | Republican | Yea |
| Lori Dittman | Republican | Yea |
| Margitta Mazzocchi | Republican | Yea |
| Mark Dean | Republican | Not Voting |
| Mark Zatezalo | Republican | Yea |
| Marty Gearheart | Republican | Yea |
| Matthew Rohrbach | Republican | Yea |
| Michael Hite | Republican | Yea |
| Michael Hornby | Republican | Yea |
| Mickey Petitto | Republican | Yea |
| Pat McGeehan | Republican | Yea |
| Patrick Lucas | Republican | Yea |
| Phil Mallow | Republican | Yea |
| Rick Hillenbrand | Republican | Yea |
| Roger Hanshaw | Republican | Yea |
| Roy Cooper | Republican | Yea |
| Scot C. Heckert | Republican | Yea |
| Stanley Adkins | Republican | Yea |
| Trenton Barnhart | Republican | Yea |
| Vacant1 | Republican | Yea |
| Vacant1 | Republican | Yea |
| Vernon Criss | Republican | Yea |
| Walter Hall | Republican | Yea |
| Wayne Clark | Republican | Yea |
| Wayne Clark | Republican | Yea |
| William Anderson | Republican | Yea |
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Republican | 9 | 55 | 0 | 2 |
| Unaffiliated | 6 | 16 | 0 | 4 |
| Democrat | 7 | 0 | 0 | 1 |
| Total | 22 | 71 | 0 | 7 |
| % of votes cast | 22% | 71% | 0% | 7% |
How each member voted (100)
| Member | Party | Vote |
|---|---|---|
| Hamilton | — | Yea |
| Winzenreid | — | Yea |
| Kirby | — | Yea |
| Rowe | — | Yea |
| Griffith | — | Yea |
| Nestor | — | Yea |
| Jeffries | — | Nay |
| Ross | — | Nay |
| Espinosa | — | Nay |
| Fast | — | Nay |
| Linville | — | Nay |
| Smith | — | Nay |
| Longanacre | — | Nay |
| Forsht | — | Nay |
| Foster | — | Nay |
| Summers | — | Nay |
| Martin | — | Nay |
| Tully | — | Nay |
| Warner | — | Nay |
| Westfall | — | Nay |
| Devault | — | Nay |
| Householder | — | Nay |
| Steele | — | Not Voting |
| Hardy | — | Not Voting |
| Kump | — | Not Voting |
| Phillips | — | Not Voting |
| Evan Hansen | Democrat | Yea |
| Hollis Lewis | Democrat | Not Voting |
| Joey Garcia | Democrat | Yea |
| John Williams | Democrat | Yea |
| Kayla Young | Democrat | Yea |
| Mike Pushkin | Democrat | Yea |
| Sean Hornbuckle | Democrat | Yea |
| Shawn Fluharty | Democrat | Yea |
| Adam Burkhammer | Republican | Nay |
| Adam Vance | Republican | Yea |
| Andy Shamblin | Republican | Nay |
| Betsy Kelly | Republican | Not Voting |
| Bill Ridenour | Republican | Yea |
| Bob Fehrenbacher | Republican | Nay |
| Bryan Ward | Republican | Nay |
| Charles Sheedy | Republican | Nay |
| Christopher W. Toney | Republican | Nay |
| Chuck Horst | Republican | Nay |
| Clay Riley | Republican | Nay |
| D. Rolland Jennings | Republican | Nay |
| Dana Ferrell | Republican | Nay |
| Darren Thorne | Republican | Nay |
| Dave Foggin | Republican | Yea |
| David Green | Republican | Nay |
| Elias Coop-Gonzalez | Republican | Nay |
| Eric Brooks | Republican | Nay |
| Erica Moore | Republican | Nay |
| Evan Worrell | Republican | Nay |
| Gary G. Howell | Republican | Nay |
| Geno Chiarelli | Republican | Nay |
| George Miller | Republican | Nay |
| George Street | Republican | Nay |
| Henry Dillon | Republican | Nay |
| James Robert "JB" Akers II | Republican | Yea |
| Jarred Cannon | Republican | Yea |
| Jeff Campbell | Republican | Nay |
| Jeffrey Stephens | Republican | Yea |
| Jim Butler | Republican | Nay |
| Jimmy Willis | Republican | Nay |
| Joe Ellington | Republican | Nay |
| Joe Statler | Republican | Nay |
| John Paul Hott | Republican | Nay |
| Jonathan Pinson | Republican | Nay |
| Jordan Bridges | Republican | Not Voting |
| Jordan Maynor | Republican | Nay |
| Josh Holstein | Republican | Yea |
| Kathie Hess Crouse | Republican | Nay |
| Keith Marple | Republican | Nay |
| Laura Kimble | Republican | Nay |
| Lori Dittman | Republican | Nay |
| Margitta Mazzocchi | Republican | Nay |
| Mark Dean | Republican | Nay |
| Mark Zatezalo | Republican | Nay |
| Marty Gearheart | Republican | Nay |
| Matthew Rohrbach | Republican | Nay |
| Michael Hite | Republican | Nay |
| Michael Hornby | Republican | Nay |
| Mickey Petitto | Republican | Yea |
| Pat McGeehan | Republican | Nay |
| Patrick Lucas | Republican | Nay |
| Phil Mallow | Republican | Nay |
| Rick Hillenbrand | Republican | Nay |
| Roger Hanshaw | Republican | Nay |
| Roy Cooper | Republican | Nay |
| Scot C. Heckert | Republican | Nay |
| Stanley Adkins | Republican | Nay |
| Trenton Barnhart | Republican | Nay |
| Vacant1 | Republican | Yea |
| Vacant1 | Republican | Nay |
| Vernon Criss | Republican | Nay |
| Walter Hall | Republican | Nay |
| Wayne Clark | Republican | Nay |
| Wayne Clark | Republican | Nay |
| William Anderson | Republican | Nay |
Subjects
Frequently asked questions
- Who sponsors HB 4753?
- HB 4753 is sponsored by James Robert "JB" Akers II (Republican), Jarred Cannon (Republican), John Paul Hott (Republican), Joey Garcia (Democrat), Walter Hall (Republican), Sean Hornbuckle (Democrat), Trenton Barnhart (Republican), Clay Riley (Republican), Kayla Young (Democrat), Westfall, and Dean Jeffries (Republican).
- What is the current status of HB 4753?
- This bill has passed the House of Delegates. Introduced January 15, 2024. It now moves to the second chamber.
- Where can I track HB 4753?
- Track HB 4753 free on One Click Politics — get push/email alerts when it moves.
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