TennCare

Plain English Breakdown

The bill summary does not provide specific details about the effectiveness or limitations of biomarker testing, only requirements and definitions.

TennCare Biomarker Testing for Preeclampsia Coverage

This bill requires TennCare health benefit plans renewed or issued on or after July 1, 2025, to cover and pay for biomarker testing for preeclampsia.

What This Bill Does

• Requires TennCare health insurance plans renewed or issued on or after July 1, 2025, to provide coverage for biomarker tests used to detect preeclampsia in pregnant women.
• Defines a 'biomarker test' as an FDA-approved analysis of tissue, blood, or other biospecimens for specific markers.
• Specifies that the testing must be ordered by and conducted according to guidelines set by the attending physician providing prenatal care.
• Authorizes TennCare to create rules and apply for federal funding through CMS to support this coverage.

Who It Names or Affects

• Pregnant women enrolled in TennCare health benefit plans renewed or issued on or after July 1, 2025.
• Health insurance carriers that provide TennCare plans.
• Physicians and healthcare providers who conduct the biomarker tests.

Terms To Know

Biomarker

A characteristic objectively measured as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention.

TennCare health benefit plan

Health insurance coverage provided by TennCare for eligible individuals under the medical assistance program.

Limits and Unknowns

• The bill does not specify what happens to plans issued before July 1, 2025.
• It is unclear how much additional funding will be needed beyond the initial federal and state allocations.

Official Summary Text

For
TennCare health benefit plan
s
renewed or issued on or after July 1, 2025,
this bill requires the
health insurance carrier
to
provide coverage and reimbursement for biomarker testing for preeclampsia
if the conditions of this bill, as describe
d below, are met. As used in this bill, a
''
b
iomarker test" means the analysis of a patient's tissue, blood, or other biospecimen for the presence of a biomarker using a method of analysis approved by the federal food and drug administration (FDA), includ
ing

single-analyte tests, multiplex panel tests, whole genome sequencing, protein expression, whole exome, and whole transcriptome
.

Under this bill, a pregnant woman may be screened for preeclampsia using biomarker testing when ordered by the pregnant wo
man's attending physician. Additionally, the test must be conducted by the physician or other healthcare provider who is providing prenatal care for the pregnant woman according to nationally recognized clinical practice guidelines and consensus statemen
t
s.

This bill authorizes the division of TennCare to promulgate rules to effectuate this bill and to
submit to the federal centers for medicare and medicaid services (CMS) new waiver applications and amendments to existing waivers necessary to ensure fed
eral financial participation for medicaid coverage pursuant to this
bill.

Current Bill Text

HOUSE BILL 70
By Helton-Haynes

SENATE BILL 205
By Massey

SB0205
000102
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 56;
Title 63; Title 68 and Title 71, relative to coverage
of biomarker testing for preeclampsia.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
adding the following as a new section:
(a) As used in this section:
(1) ''Biomarker'' means a characteristic that is objectively measured and
evaluated as an indicator of normal biological processes, pathogenic processes,
or pharmacologic responses to a specific therapeutic intervention, including, but
not limited to, gene mutations, protein expression, known gene-drug interactions
for medications, and characteristics of genes;
(2) ''Biomarker test" or "biomarker testing'' means the analysis of a
patient's tissue, blood, or other biospecimen for the presence of a biomarker
using a method of analysis approved by the federal food and drug administration
(FDA), including, but not limited to, single-analyte tests, multiplex panel tests,
whole genome sequencing, protein expression, whole exome, and whole
transcriptome;
(3) "Health benefit plan" means a plan of health insurance coverage
under the medical assistance program;
(4) "Health insurance carrier":
(A) Means an entity subject to title 56, or subject to the jurisdiction
of the commissioner of commerce and insurance, that contracts with

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healthcare providers in connection with a plan of health insurance, health
benefits, or health services; and
(B) Includes a vendor or an entity that provides a health benefit
plan of coverage under TennCare or a successor program provided for
pursuant to this chapter; and
(5) "TennCare health benefit plan" means a health benefit plan issued by
a health insurance carrier pursuant to an agreement with the division of
TennCare to provide health insurance coverage for an enrollee in the medical
assistance program.
(b) Notwithstanding another law to the contrary, a TennCare health benefit plan
renewed or issued on or after July 1, 2025, by a health insurance carrier shall provide
coverage and reimbursement for biomarker testing for preeclampsia as provided in this
section.
(c) A pregnant woman may be screened for preeclampsia using biomarker
testing when ordered by the pregnant woman's attending physician.
(d) Each preeclampsia biomarker test must be conducted by the physician or
other healthcare provider who is providing prenatal care for such pregnant woman
according to nationally recognized clinical practice guidelines and consensus
statements.
(e) The division of TennCare may promulgate rules and take necessary
administrative action to effectuate this section. The rules must be promulgated in
accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter
5. The division of TennCare may submit to the federal centers for medicare and
medicaid services (CMS) new waiver applications and amendments to existing waivers

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necessary to ensure federal financial participation for medicaid coverage pursuant to this
section.
SECTION 2. For purposes of rulemaking and other administrative actions, this act takes
effect upon becoming a law, the public welfare requiring it. For all other purposes, this act takes
effect July 1, 2025, the public welfare requiring it.