SB606 — relative to insurance coverage for biomarker testing.

SB 606-FN - AS INTRODUCEDAMENDED BY THE SENATE 02/19/2026 0689s SESSION 26-2063 05/08 SENATE BILL 606-FN AN ACT relative to insurance coverage for biomarker testing.

Health and Human Services ───────────────────────────────────────────────────────────────── AMENDED ANALYSIS This bill requires healththe insuranceNew Hampshire Medicaid program to provide coverage for biomarker testing.testing under certain circumstances.

The bill also requires the state Medicaid plan to include coverage for biomarker testing.

SB 606-FN - AS INTRODUCEDAMENDED BY THE SENATE 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.

"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 decisionsThedecisionThe 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.

420-J:420-J:28 Biomarker Testing;

28State BiomarkerMedicaid Testing;Plan Coverage Requirements.

HealthSB Benefit606-FN Plan- CoverageAS Requirements.AMENDED BY THE SENATE - Page 2 - I.

SBBiomarker 606-FNtesting -shall ASbe INTRODUCEDcovered -by Pagethe 2New -Hampshire I.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:

Each health carrier issuing, amending, delivering or renewing a health benefit plan on or after January 1, 2027 shall include coverage for biomarker testing as defined in RSA 420-J:20, II, pursuant to the criteria established in this section.

II.

Biomarker testing shall be covered 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:

III.II.

AIf healthutilization carrierreview, shallincluding ensurebut thatnot coveragelimited asto definedprior inauthorization, paragraphis IIrequired, isthe providedutilization inreview aentity, manneror thatany limitsthird disruptionsparty inacting careon includingbehalf of the needNew forHampshire multipleMedicaid biopsiesprogram shall approve or biospecimendeny samples.a prior authorization request and notify the beneficiary, and the ordering health care provider.

IV.

If utilization review, including but not limited to prior authorization, is required, the health carrier, utilization review entity, or any third party acting on behalf of an organization or entity subject to this subdivision shall approve or deny a prior authorization request and notify the enrollee, the enrollee’s health care provider, and any entity requesting authorization of the service within 14 days for non-urgent requests or within 72 hours for urgent requests.

V.

The patient and prescribing practitioner shall have access to a clear, readily accessible, and convenient process to request an exception to a coverage policy or an adverse utilization review determination of a health carrier.

The process shall be made readily accessible on the health carrier’s website.

The state Medicaid plan shall cover biomarker testingtesting, as defined in RSA 420-J:27, II, in accordance with the requirements of this section.section when the biomarker test is determined as medically necessary by the New Hampshire Medicaid program for the beneficiary.

Biomarker testing shall be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of anthe enrollee’sbeneficiary’s disease or condition when the department of health and human services determines that the test provides clinical utility, as defined in RSA 420- J:27, III and is demonstrated by the following medical and scientific evidence,evidence and determined as medically necessary by the New Hampshire Medicaid program, including but not limited to any of the following:

SB 606-FN - AS INTRODUCED - Page 3 - (c) Warnings and precautions on FDA-approved drug labels;

SB 606-FN - AS AMENDED BY THE SENATE - Page 3 - IV.

The state Medicaid plan shall ensure coveragecoverage, as definedoutlined in paragraph IIII, is provided in a manner that limits disruptions in care including the need for multiple biopsies or biospecimen samples.

VIII.

The provisions of this section shall only take effect provided that there is sufficient funding included in the operating budget for the biennium ending June 30, 2029.

This act shall take effect July 1, 2026.2027.

LBA 26-2063 10/13/2503/27/2026 SB 606-FN- FISCAL NOTE AS INTRODUCEDAMENDED BY THE SENATE (AMENDMENT #2026-0689s) AN ACT relative to insurance coverage for biomarker testing.

EstimatedThis State Impact FY 2026 FY 2027 FY 2028 FY 2029 Revenue $0 $0 Indeterminable Indeterminable Revenue Fund(s) General Fund Expenditures* $0 $0 Indeterminable Indeterminable Funding Source(s) General Fund, Highway Fund, and Various Agency Funds Appropriations* $0 $0 $0 $0 Funding Source(s) None *Expenditure = Cost of bill *Appropriationdoes =not Authorizedprovide fundingfunding, tonor coverdoes costit ofauthorize billnew METHODOLOGY:positions.

ThisEstimated billState requiresImpact healthFY insurers2026 toFY pay2027 forFY biomarker2028 testingFY for2029 diagnostic,Revenue treatment,$0 appropriate$0 management$0 or$0 ongoingRevenue monitoringFund(s) ofNone a$170,000 disease- or$170,000 condition.- $600,000 state $600,000 state Expenditures* $0 $0 funds;

The$330,000 Insurance- Departmentfunds; states this bill amendments RSA 420-J requiring health carriers to cover biomarker testing.

While$330,000 some- testing$1.3 maymillion already$1.3 bemillion includedfederal underfunds thefederal statefunds BenchmarkFunding PlanSource(s) whenGeneral deemedfunds, medicallyfederal necessary,funds, anyother additionalfunds testingAppropriations* mandated$0 by$0 this$0 law$0 wouldFunding constituteSource(s) aNone new*Expenditure benefit= requirement.Cost of bill *Appropriation = Authorized funding to cover cost of bill METHODOLOGY:

SectionThis 420-J:21,bill IVrequires introducesthe priorstate authorizationMedicaid timeprogram framesto (14cover daysbiomarker fortesting non-urgentwhen andmedically 72necessary. hours for urgent cases) that conflict with existing time frames in 420-J:6 (7 calendar days for nonurgent and 72 hours for urgent cases).

ThePer Departmentactuarial statesestimates thebased financialon impactpaid and denied claims, the Department of requiringHealth insurersand toHuman coverServices biomarkerestimates testingthe forbill diagnostic,will treatment,increase management,total orexpenditures monitoringby purposesbetween is$500,000 indeterminable.and $1.9 million per year.

CostsSince dependthe onfederal planshare design,of cost-sharingMedicaid structures,costs andranges annualfrom medical50 expenses.percent for the standard Medicaid program to 90 percent for the Granite Advantage Program, the state share of costs is anticipated to range from $170,000 to $600,000 per year, with the remainder being federally funded.

IncreasedAlthough utilizationthe maystate raiseshare initialof expenses,Granite butAdvantage earliercosts detectionis andcovered targetedby treatmentsvarious couldnon- offsetgeneral costsfund throughrevenue improvedsources, outcomes.the bulk of state Medicaid expenditures are paid for with state general funds.

TheTherefore, netfor the purposes of this fiscal note, it is indeterminable.reasonable to assume that the bill will result in annual general fund expenditures of approximately $170,000 to $600,000 per year.

IfIt theshould mandatedbe benefitsnoted exceedthat thosesection covered1 underof the Benchmarkbill Plan,places theyMedicaid wouldbiomarker becoverage classifiedwithin asRSA additional420- EssentialJ, Healthwhich Benefitsis requiringtypically thereserved state to cover associated costs for Qualifiednon-Medicaid Healthinsurance Planmandates. enrollees.

ThisSection would2 resultduplicates inmuch anof indeterminablethe expenselanguage toof thesection State's1, expendituresbut startinglocates init FYwithin 2026.RSA 167:4, which governs eligibility for certain types of public assistance.

TheIt Departmentis ofunclear Healthwhether and Human Services states this billduplication willwas notintentional. impact their department.