Summary — HB 6895
Title: AN ACT CONCERNING HEALTH BENEFIT REVIEW AND REQUIRING HEALTH INSURANCE COVERAGE FOR BIOMARKER TESTING
Bill No.: HB 6895
Introduced: February 6, 2025
Current status: Referred by House to Committee on Appropriations (4/29/2025)
Purpose
The bill’s stated purpose (from the title) is twofold:
- Require a health benefit review related to a proposed insurance coverage requirement, and
- Require health insurance coverage for biomarker testing.
Because the full text is not provided here, this summary describes the bill’s apparent intent and likely substantive effects based on the title and legislative history.
Key provisions (as indicated by the title and legislative history)
- Coverage mandate for biomarker testing: The bill would require health insurers to cover biomarker tests. “Biomarker testing” generally refers to laboratory or molecular tests used to detect biological markers (for diagnosis, prognosis, treatment selection or monitoring), including—but not limited to—genetic tests and companion diagnostics. The bill likely defines which types of biomarker tests are covered and under what clinical circumstances.
- Health benefit review requirement: The bill references a health benefit review process — a formal analysis (often prepared by the Office of Legislative Research and/or Office of Fiscal Analysis) that assesses clinical effectiveness, utilization, and fiscal impact of mandated health benefits. The bill may require such a review before implementation or as part of reporting requirements.
- Utilization review / prior authorization: The subject list includes “utilization review,” indicating the bill may address prior authorization, utilization-management procedures, or timelines for decisions related to biomarker testing (for example, limits on delays or requirements for expedited review).
- Reporting and oversight: The title and subject terms (public hearings, reports) suggest the bill could require insurer or state reporting on use, cost, or outcomes of covered biomarker tests, or create public hearing/oversight requirements tied to the benefit review.
Note: Specifics such as definitions, covered populations, cost‑sharing limits, exceptions, effective dates, or implementation mechanics are not available in the summary materials provided.
Who would be affected
- Patients who may benefit from biomarker testing (e.g., cancer patients, individuals needing precision medicine diagnostics).
- Health insurers and other payors (private group and individual plans, possibly state-administered plans depending on statutory language).
- Health care providers and clinical laboratories that order or perform biomarker tests.
- State agencies involved in health benefit review, procurement, and oversight.
Procedural timeline / legislative actions
- 02/06/2025: Referred to Joint Committee on Insurance and Real Estate; public hearing held 02/11/2025.
- 03/11/2025: Joint Favorable Substitute filed with LCO.
- 03/21/2025: Referred to Office of Legislative Research and Office of Fiscal Analysis for review.
- 03/27/2025: Reported out of LCO; favorably reported and tabled for House calendar (House Calendar No. 212, File No. 310).
- 04/29/2025: Referred by House to Committee on Appropriations.
Potential impacts and considerations
- Access: If enacted, the bill would likely increase access to biomarker testing for covered patients, potentially improving precision-treatment matching.
- Costs: Mandated coverage could increase short-term insurer costs and, depending on design, affect premiums; however, targeted biomarker testing can also reduce costs by avoiding ineffective therapies.
- Implementation details matter: Coverage scope (which tests/conditions), cost-sharing rules, prior authorization limits, and effective dates will determine fiscal and clinical impact.
- Further analysis: The Office of Legislative Research and Office of Fiscal Analysis reviews associated with the bill should provide clinical, utilization, and budgetary analysis once completed.
Where to find the bill text and analyses
For the precise statutory language, definitions, exemptions, and fiscal estimates, consult:
- LCO File No. 310 (filed 03/27/2025)
- Committee reports from Insurance and Real Estate and the Appropriations Committee
- OLR and OFA health benefit review documents filed after 03/21/2025
If you’d like, I can locate and summarize the bill’s full text and any OLR/OFA analyses once those documents are available.
