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Read. Follow. Verify.North Carolina Requires Health Plans and Medicaid to Cover Biomarker Testing and Sets Strict Review Timelines
Last action · May 7, 2025: Ref To Com On Rules and Operations of the Senate (Senate action)Sponsors: Diane Wheatley and 15 others
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What This Bill Would Do
Health benefit plans and Medicaid in North Carolina are required to cover testing for diagnosis, treatment, and ongoing monitoring when supported by medical and scientific evidence. The legislation also prohibits insurers from raising premiums or denying coverage based on biomarker or genetic information, and establishes strict 24-hour response timelines for urgent s.
Insured residents and Medicaid beneficiaries gain guaranteed coverage for analysis of tissue, blood, or biospecimens to guide medical care, while insurance companies and the state health plan must comply with new coverage mandates and faster authorization deadlines backed by a $1,000,000 recurring annual .
- Biomarker testing analyzes tissue, blood, or other biospecimens to identify gene mutations, protein expressions, or other molecular characteristics that guide targeted medical treatments, particularly in oncology and neurology. context
- Utilization reviews are standard administrative procedures used by health insurance companies to evaluate the medical necessity, appropriateness, and efficiency of healthcare services before, during, or after they are delivered. context
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
insured residents
Insured individuals gain guaranteed health benefit plan coverage for medically supported biomarker testing and protection against premium increases based on genetic or biomarker data.
Medicaid beneficiaries
Medicaid recipients receive coverage for biomarker testing under clinical coverage policies alongside fixed 24-hour and 72-hour prior authorization response timelines.
health insurance companies
Insurers must update coverage policies, member handbooks, and websites to include biomarker testing and adhere to expedited utilization review deadlines.
Key Facts
- Health benefit plans must provide coverage for biomarker testing for diagnosis, treatment, care management, or ongoing monitoring when supported by medical and scientific evidence.
- Insurers are prohibited from raising premiums, refusing to issue plans, or charging higher rates based on biomarker or genetic information.
- Insurers or their utilization review organizations must render determinations and notify providers within 24 hours for urgent healthcare services if electronic health records are accessible.
- For non-urgent healthcare services, insurers must render utilization review determinations and notify providers and covered persons within three business days after obtaining necessary information.
Show all 9 facts
- The State Health Plan for Teachers and State Employees is required to include coverage for biomarker testing starting at the next plan year.
- The sum of $1,000,000 is appropriated from the General Fund to the Department of State Treasurer in recurring funds for each year of the 2025-2027 fiscal biennium to implement State Health Plan coverage.
- The Department of Health and Human Services, Division of Health Benefits, must ensure coverage for biomarker testing under Medicaid laboratory services clinical coverage policies 1S-1 through 1S-13.
- Medicaid urgent prior authorization requests must be approved or denied within 24 hours after receiving all necessary information, while non-urgent requests must be processed within 72 hours.
- The provisions governing insurance contracts and utilization reviews become effective October 1, 2025, and apply to contracts issued, renewed, or amended on or after that date.
Frequently Asked Questions
What types of biomarker tests are covered under this bill?
Can my insurance company raise my rates if I undergo biomarker testing?
How quickly must an insurer respond to an urgent prior authorization or utilization review request?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
Currently passed chamber. The next step in the legislative lifecycle is Law.
Procedural history
16 actions- May 7, 2025SenateRef To Com On Rules and Operations of the Senate
- May 7, 2025SenatePassed 1st Reading
- May 7, 2025SenateSpecial Message Received From House
- May 7, 2025HouseSpecial Message Sent To Senate
- May 7, 2025HousePassed 3rd Reading
- May 7, 2025HousePassed 2nd Reading
Show 10 earlier actions
- May 6, 2025HousePlaced On Cal For 05/07/2025
- May 6, 2025HouseCal Pursuant Rule 36(b)
- May 6, 2025HouseReptd Fav
- Apr 30, 2025HouseRe-ref Com On Rules, Calendar, and Operations of the House
- Apr 30, 2025HouseWithdrawn From Com
- Apr 29, 2025HouseRe-ref Com On Appropriations
- Apr 29, 2025HouseReptd Fav Com Substitute
- Mar 31, 2025HouseRef to the Com on Health, if favorable, Appropriations, if favorable, Rules, Calendar, and Operations of the House
- Mar 31, 2025HousePassed 1st Reading
- Mar 27, 2025HouseIntroducedFiled
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Show 11 more sponsors
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
State Health Plan Funding Appropriation
The bill explicitly appropriates $1,000,000 in recurring funds for each year of the 2025-2027 fiscal biennium to the Department of State Treasurer to implement coverage for the State Health Plan.
Connected Entities
Sources
www.ncleg.gov
Analysis Score
0–100- Significance85How much this matters to a regular citizen
- Controversy40Intensity of disagreement among stakeholders
- Entertainment5Compellingness for a non-policy-wonk reader
- Buzz45Current news / social attention level
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