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Bill

HB 1079

TO MANDATE COVERAGE FOR GENETIC TESTING FOR AN INHERITED GENE MUTATION FOR CERTAIN INDIVIDUALS; AND TO MANDATE COVERAGE FOR EVIDENCE-BASED CANCER IMAGING FOR CERTAIN INDIVIDUALS.

2025 Regular Session Introduced by Fred Allen and 4 co-sponsors

House Bill 1079 mandates full coverage for genetic testing and cancer imaging for at-risk individuals, removing out-of-pocket costs to improve access and early detection.

Notification that HB1079 is now Act 860
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Bill Summary · HB 1079

Summary of House Bill 1079 (Act 860)

Purpose of the Bill

House Bill 1079 aims to mandate coverage for genetic testing related to inherited gene mutations and evidence-based cancer imaging for certain individuals. The bill specifies that these services will not be subject to any deductible, copayment, or coinsurance limits, thereby enhancing access to critical health services for at-risk populations.

Key Provisions

  • Coverage Mandate: The bill requires health benefit plans to cover:

    • Genetic Testing: For individuals with a personal or family history of cancer, provided the testing is clinically useful and recommended by a healthcare provider.
    • Evidence-Based Cancer Imaging: For individuals at increased risk of developing cancer, also contingent upon clinical utility and provider recommendation.

  • Financial Structure:

    • The coverage for both genetic testing and cancer imaging is mandated to be provided at 100% of the cost, meaning no out-of-pocket expenses for patients in the form of deductibles, copayments, or coinsurance.

  • Exemptions: The bill does not apply to:

    • Health benefit plans providing coverage to state and public school employees.
    • Self-funded governmental plans.

  • Implementation Date: The provisions of the bill will take effect on January 1, 2026.

Fiscal Impact

  • The estimated annual cost for implementing this coverage is projected to be between $2.0 million and $2.5 million, which represents approximately 0.4% of projected medical claims. This cost reflects the elimination of member cost-sharing that previously amounted to about $1.5 million in 2022.

Legislative Timeline

  • Introduced: January 8, 2025
  • Amendments: The bill underwent several amendments, with significant changes made on March 17, 2025, to clarify exemptions and coverage details.
  • Passed: The bill was passed by both the House and Senate and was signed into law, becoming Act 860 on April 17, 2025.

Impacted Parties

  • Individuals: Patients with a personal or family history of cancer will benefit from increased access to genetic testing and cancer imaging without financial barriers.
  • Healthcare Providers: Providers will be able to recommend necessary tests and imaging without concerns about patient cost-sharing.
  • Health Insurers: Insurance plans will need to adjust their coverage policies to comply with the new mandates.

Conclusion

House Bill 1079 represents a significant step toward improving access to essential healthcare services for individuals at risk of hereditary cancers. By eliminating financial barriers, the legislation aims to facilitate early detection and treatment, ultimately enhancing patient outcomes.

Compiled from official sources — confirm details with the bill’s official record.

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