H1335 expands Florida Medicaid coverage for biomarker testing and related colorectal cancer screening services. The bill revises the statutory definition of “biomarker testing” to include analyses of tissue, blood, or other biospecimens for biomarkers, including single-analyte tests, multiplex panels, protein expression tests, and whole exome, genome, and transcriptome sequencing when billed under recognized laboratory codes and performed by certified in-network labs. It also requires the Agency for Health Care Administration (AHCA) to create a provider reimbursement schedule and billing codes for proprietary laboratory analyses by August 1, 2025, and to provide a clear authorization process for recipients and providers.
The bill further authorizes Medicaid payment for medically necessary blood-based biomarker tests for colorectal cancer screening and requires Medicaid managed care plans to cover biomarker testing and those colorectal cancer blood-based tests at the same scope and frequency as other medically necessary treatments or screenings. It expressly states that the coverage mandate does not extend to biomarker testing for general screening purposes, except for the specified colorectal cancer blood-based tests. The bill also directs AHCA to conduct an independent five-year cost-benefit analysis of covering blood-based colorectal cancer biomarker tests in Medicaid, with interim and final reports due in 2028 and 2030, and includes a sunset provision repealing the new coverage requirements on July 1, 2031 unless reenacted.
In state law terms, the bill amends sections 409.906 and 409.9745, Florida Statutes, which govern optional Medicaid services and Medicaid managed care plan requirements. It would require AHCA to set reimbursement and billing infrastructure for biomarker testing, expand Medicaid and managed care coverage obligations, and incorporate the rate impact into managed care program rates. The bill also affects Medicaid recipients, providers, laboratories, and managed care plans by establishing a new coverage pathway and administrative process for biomarker testing, especially for colorectal cancer-related diagnostics.
The general sentiment around the bill appears strongly favorable. It passed the House Health Care Facilities & Systems Subcommittee unanimously 16-0 and the House Budget Committee unanimously 25-0, suggesting broad bipartisan support and little visible opposition in committee action. The absence of recorded committee transcript debate in the provided materials also suggests the measure was not especially controversial at those stages.
The main point of potential contention is cost and coverage scope. The bill requires a cost-benefit analysis and rate-impact consideration, indicating legislative attention to fiscal effects on Medicaid and managed care plans. It also draws a line between biomarker testing for medically necessary use and broader screening coverage, which may reflect concern about limiting mandates while still expanding access to specific colorectal cancer tests. The sunset date in 2031 suggests lawmakers want to revisit the policy after collecting utilization and cost data.
The bill would amend Florida’s Medicaid statutes to add and define biomarker testing as a covered optional service, require AHCA to establish reimbursement and billing codes, and mandate Medicaid managed care coverage for biomarker testing and medically necessary blood-based colorectal cancer screening tests. It would also require a formal cost-benefit study and reporting process, and the new coverage provisions would expire in 2031 unless reenacted.
Available voting history shows unanimous support in both the House Health Care Facilities & Systems Subcommittee and the House Budget Committee, indicating a broadly positive reception. No committee transcript opposition is provided, and the bill’s framing around cancer detection and Medicaid access suggests it was viewed as a targeted health coverage expansion rather than a controversial mandate.
The likely areas of contention are fiscal impact, administrative implementation, and the scope of required coverage. AHCA must create reimbursement schedules, managed care rates must account for the new mandate, and the bill limits screening coverage except for specified colorectal cancer blood-based tests. The required actuarial study and sunset provision suggest lawmakers anticipated questions about cost-effectiveness and long-term budget effects, even though no formal opposition appears in the provided vote record.