HB 1335 would expand Florida Medicaid coverage for biomarker testing, a category of laboratory analysis used to identify characteristics in tissue, blood, or other biospecimens that can help guide diagnosis, treatment selection, and monitoring. The bill defines key terms such as biomarker, biomarker testing, and clinical utility, and it requires the Agency for Health Care Administration (AHCA) to create a clear authorization process for recipients and providers. It also directs AHCA to establish reimbursement schedules and billing codes for proprietary laboratory analyses codes to ensure biomarker testing can be paid for under Medicaid.
The bill specifically addresses colorectal cancer by allowing Medicaid to pay for medically necessary blood-based biomarker tests for colorectal cancer screening, and by requiring Medicaid managed care plans to cover those tests at the same scope and frequency as other medically necessary colorectal cancer screenings. The bill does not require coverage of biomarker testing for general screening purposes beyond that colorectal cancer provision. It also requires AHCA to include the rate impact of the new coverage in Medicaid managed care rates.
HB 1335 would amend sections 409.906 and 409.9745, Florida Statutes, to add biomarker testing as an optional Medicaid service and to impose parallel coverage requirements on Medicaid managed care plans. It would require AHCA to set reimbursement and billing infrastructure for biomarker testing by August 1, 2025, and to treat medically necessary blood-based colorectal cancer biomarker tests as covered services. The bill also mandates a 5-year independent cost-benefit analysis of colorectal cancer blood-based biomarker testing, with interim and final reports to state leaders, and includes a sunset repeal of the new provisions on July 1, 2031 unless reenacted.
The available context suggests generally favorable policy support for biomarker testing coverage, but the bill itself did not advance in the House Health & Human Services Committee. The fact that a companion measure passed in the Senate indicates the policy had support in at least one chamber, even though HB 1335 died in committee. No committee transcript or recorded votes are provided, so the detailed debate record is unavailable.
The main points of contention likely center on Medicaid cost, rate impacts, and whether the state should mandate coverage for newer diagnostic tests before long-term cost-effectiveness is fully established. The bill anticipates those concerns by requiring an actuarially sound comparative cost-benefit study and by limiting the coverage mandate to medically necessary blood-based colorectal cancer biomarker tests rather than broad screening coverage. Another possible issue is administrative burden, since AHCA must create billing codes, reimbursement schedules, and authorization processes for both fee-for-service Medicaid and managed care plans.