An Act to Require Health Insurance Coverage for Biomarker Tetinf
Maine Legislature, Session 132, LD 0107
Committee Amendment CA_A_H237 (House)

COMMITTEEAMENDMENT" L1. "to H.P. 72,L.D.107, "AnActtoRequireHealth 
Insurance Coverage for Biomarker T~g" 
Amend the bill in section 1 in §3174-PPP in subsection 1 by striking out all of 
paragraph C (page 1, lines 16 to 22 in L.D.) and inserting the following: 
'C. "Clinical utility" means, in the context of biomarker testing, that the use of 
biomarker testing is expected to provide meaningful information to guide decisions for 
the treatment of a disease or condition to improve net health outcomes, quality of life 
or survival of a patient, even if the results of biomarker testing are not immediately 
actionable in the course of a patient's treatment.' 
Amend the bill in section 1 in §3174-PPP in subsection 2 in the 3rd line (page 1, line 
in L.D.) by striking out the following: "is supported" and inserting the following: 
'provides clinical utility as demonstrated' 
Amend the bill in section 1 in §3174-PPP in subsection 2 in paragraph Din the last 2 
lines (page 2, lines 2 and 3 in L.D.) by striking out the following: "Medicare administrative 
contractor local coverage determination" and inserting the following: 'a Medicare 
administrative contractor local coverage determination that is explicitly applicable in this 
State' 
Amend the bill in section 1 in §3174-PPP in subsection 2 in paragraph E in the first 
line (page 2, line 4 in L.D.) by striking out the following: "or consensus statement" 
Amend the bill in section 1 in §3174-PPP by inserting after subsection 2 the following: 
'3. Prior authorization. Before providing coverage for biomarker testing as required 
by subsection 2, the department may require prior authorization. If prior authorization is 
required prior to biomarker testing, the department or any 3rd party acting on behalf of the 
department must approve or deny a prior authorization request and notify the MaineCare 
member and the MaineCare member's health care provider and any entity requesting 
authorization of the service within 72 hours for requests that are not urgent or within 24 
hours for urgent requests. 
Page I - l32LR0062(02) 
COMMITTEE AMENDMENT 
COMMITIEEAMENDMENT4-"toH.P. 72,L.D.107 
4. No biomarker testing for asymptomatic screening. This section may not be 
construed to require coverage for biomarker testing for the purposes of asymptomatic 
screening.' 
Amend the bill in section 3 in §2745-H in subsection 1 by striking out all of paragraph 
C (page 2, lines 25 to 31 in L.D.) and inserting the following: 
'C. 
"Clinical utility" means, in the context of biomarker testing, that the use of 
biomarker testing is expected to provide meaningful information to guide decisions for 
the treatment of a disease or condition to improve net health outcomes, quality of life 
or survival of a patient, even if the results of biomarker testing are not immediately 
actionable in the course of a patient's treatment.' 
Amend the bill in section 3 in §2745-H in subsection 2 in the 4th line (page 3, line 4 in 
L.D.) by striking out the following: 
11is supported" and inserting the following: 'provides 
clinical utility as demonstrated' 
Amend the bill in section 3 in §2745-H in subsection 2 in paragraph D in the last line 
(page 3, line 12 in L.D.) by inserting after the following: "determination" the following: 
'that is explicitly applicable in this State' 
Amend the bill in section 3 in §2745-H in subsection 2 in paragraph E in the first line 
(page 3, line 13 in L.D.) by striking out the following: "or consensus statement" 
Amend the bill in section 3 in §2745-H in subsection 3 in the last 3 lines (page 3, lines 
to 24 in L.D .) by striking out the following: "and notify the person covered by the policy, 
the person's health care provider and any entity requesting authorization of the service 
within 72 hours for nonurgent requests or within 24 hours for urgent requests" and inserting 
the following: 'in accordance with the requirements in section 4304' 
Amend the bill in section 3 in §2745-H by inserting after subsection 3 the following: 
'4. No biomarker testing for asymptomatic screening. This section may not be 
construed to require coverage for biomarker testing for the purposes of asymptomatic 
screening.' 
Amend the bill in section 4 in §2837-I in subsection 1 by striking out all of paragraph 
C (page 3, lines 39 to 42 and page 4, lines 1 to 3 in L.D.) and inserting the following: 
'C. 
"Clinical utility" means, in the context of biomarker testing, that the use of 
biomarker testing is expected to provide meaningful information to guide decisions for 
the treatment of a disease or condition to improve net health outcomes, quality of life 
or survival of a patient, even if the results of biomarker testing are not immediately 
actionable in the course of a patient's treatment.' 
Amend the bill in section 4 in §2837-I in subsection 2 in the 4th line (page 4, line 15 
in L.D.) by striking out the following: "is supported" and inserting the following: 'provides 
clinical utility as demonstrated' 
Amend the bill in section 4 in §283 7-I in subsection 2 in paragraph D in the last 2 lines 
(page 4, lines 23 and 24 in L.D.) by striking out the following: "Medicare administrative 
contractor local coverage determination" and inserting the following: 'a Medicare 
administrative contractor local coverage determination that is explicitly applicable in this 
State' 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT «-rt• to H.P. 72, L.D. 107 
Amend the bill in section 4 in §2837-I in subsection 2 in paragraph E in the first line 
(page 4, line 25 in L.D.) by striking out the following: "or consensus statement" 
Amend the bill in section 4 in §2837-I in subsection 3 in the last 4 lines (page 4, lines 
to 37 in L.D.) by striking out the following: "and notify the insured person or subscriber 
covered by that policy, the insured person's or subscriber's health care provider and any 
entity requesting authorization of the service within 72 hours for nonurgent requests or 
within 24 hours for urgent requests" and inserting the following: 'in accordance with the 
requirements in section 4304' 
Amend the bill in section 4 in §2837-I by inserting after subsection 3 the following: 
'4. No biomarker testing for asymptomatic screening. This section may not be 
construed to require coverage for biomarker testing for the purposes of asymptomatic 
screening.' 
Amend the bill in section 5 in §4237-B in subsection 1 by striking out all of paragraph 
C (page 5, lines 11 to 17 in L.D.) and inserting the following: 
'C. "Clinical utility" means. in the context of biomarker testing, that the use of a 
biomarker test is expected to provide meaningful information to guide decisions for the 
treatment of a disease or condition to improve net health outcomes. quality of life or 
survival of a patient, even if the results of a biornarker test are not immediately 
actionable in the course of a patient's treatment.' 
Amend the bill in section 5 in §4237-B in subsection 2 in the 4th line (page 5, line 29 
in.L.D.) by striking out the following: "is supported" and inserting the following: 'provides 
clinical utility as demonstrated' 
Amend the bill in section 5 in §4237-B in subsection 2 in paragraph Din the last 2 lines 
(page 5, lines 37 and 38 in L.D.) by striking out the following: "Medicare administrative 
contractor local coverage detem1itiation
and inserting the following: 'a Medicare 
administrative contractor local coverage determination that is explicitly applicable in this 
State' 
Amend the bill in section 5 in §4237-B in subsection 2 in paragraph E in the first line 
(page 5, line 39 in L.D.) by striking out the following: "or consensus statement" 
Amend the bill in section 5 in §4237-B in subsection 3 in the last 4 lines (page 6, lines 
to 12 in L.D.) by striking out the following: "and notify the insured person or subscriber 
covered by that policy, the insured person's or subscriber's health care provider and any 
entity requesting authorization of the service within 72 hours for nonurgent requests or 
within 24 hours for urgent requests" and inserting the following: 'in accordance with the 
5 
requirements in section '4304' 
Amend the bill in section 5 in §4237-B by inserting after subsection 3 the following: 
'4. No biomarker testing for asymptomatic screening. This section may not be 
construed to require coverage for biornarker testing for the purposes of asymptomatic 
screening.' 
Amend the bill iµ section 6 in the last line (page 6, line 16 in L.D.) by striking out the 
following: 
112026
and inserting the following: '2027' 
Amend the bill by inserting after section 6 the following: 
COMMITTEE A·MENDMENT 
·9 
COMMITTEEAMENDMENT"A"toH.P. 72,L.D. 107 
'Sec. 7. Exempt from mandate review. Notwithstanding the Maine Revised 
Statutes, Title 24-A, section 2752, this Act is enacted without review and evaluation by the 
Department of Professional and Financial Regulation, Bureau of Insurance. 
Sec. 8, Appropriations and allocations. The following appropriations and 
allocatio:t;ts are made. 
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF 
State Benefit Mandate Defrayal Z373 
Initiative: Provides ongoing funding for the cost of the benefit mandate providing coverage, 
including coverage in the MaineCare program, for biomarker testing, beginning January 1, 
2027. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
ADMINISTRATIVE AND FINANCIAL 
SERVICES, DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
DEPARTMENT TOTAL-ALL FUNDS 
2025-26 
$0 
$0 
2025-26 
$0 
$0 
2026-27 
$170,000 
$170,000 
2026-27 
$170,000 
$170,000 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Medical Care-Payments to Providers 0147 
Initiative: Provides funding for MaineCare coverage of biomarker testing. 
GENERAL FUND 
2025-26 
All Other 
$0 
GENERAL FUND TOTAL 
$0 
FEDERAL EXPENDITURES FUND 
2025-26 
All Other 
$0 
FEDERAL EXPENDITURES FUND TOTAL 
$0 
FEDERAL BLOCK GRANT FUND 
2025-26 
All Other 
$0 
FEDERAL BLOCK GRANT FUND TOTAL 
$0 
Office of MaineCare Services 0129 
COMMITTEE AMENDMENT 
2026-27 
$935,162 
$935,162 
2026-27 
$2,098,754 
$2,098,754 
2026-27 
$12,773 
$12,773 
COMMITTEEAMENDMENT'A'toH.P. 72,L.D.107 
Initiative: Establishes one Health Services Consultant position funded 50% General Fund 
and 50% Federal Expenditures Fund in the Office of MaineCare Services to conduct prior 
authorization work and provides funding for related All Other costs. 
GENERAL FUND 
2025-26 
2026-27 
POSITIONS - LEGISLATIVE COUNT 
0.000 
1.000 
Personal Services 
$0 
$54,559 
All Other 
$0 
$3,628 
GENERAL FUND TOTAL 
$0 
$58,187 
FEDERAL EXPENDITURES FUND 
2025-26 
2026-27 
POSITIONS - LEGISLATIVE COUNT 
0.000 
1.000 
Personal Services 
$0 
$54,559 
All Other 
$0 
$4,978 
FEDERAL EXPENDITURES FUND TOTAL 
$0 
$59,537 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF 
DEPARTMENT TOTALS 
2025-26 
2026-27 
GENERAL FUND 
$0 
$993,349 
FEDERAL EXPENDITURES FUND 
$0 
$2,158,291 
FEDERAL BLOCK GRANT FUND 
$0 
$12,773 
DEPARTMENT TOTAL-ALL FUNDS 
$0 
$3,164,413 
SECTION TOTALS 
2025-26 
2026-27 
GENERAL FUND 
$0 
$1,163,349 
FEDERAL EXPENDITURES FUND 
$0 
$2,158,291 
FEDERAL BLOCK GRANT FUND 
$0 
$12,773 
SECTION TOTAL -ALL FUNDS 
$0 
$3,334,413 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
As drafted, the bill requires insurance coverage, including coverage in the MaineCare 
program, for biomarker testing. This amendment proposes to make the following changes 
to the bill. The amendment: 
COMMITTEE AMENDMENT 
COMMITTEEAMENDMENT"ktoH.P. 72,L.D.107 
1. Eliminates "consensus statement" as a source of evidence by removing the definition 
and all uses of the term in the bill; 
2. Adds a definition of "clinical utility" in the context of biomarker testing that means 
that the use of biomarker testing will provide meaningful information that affects treatment 
decisions and guides improvement of net health outcomes, including an improved quality 
of life or longer survival. The most appropriate test may include some information that is 
not immediately actionable; 
3. Expressly states that no coverage is required for biomarker testing for the purposes 
of asymptomatic screening; 
4. Adds that coverage for a Medicare administrative contractor local coverage 
determination is only required when applicable to Maine; 
5. Clarifies testing is done to guide treatment decisions; 
6. Expressly permits the MaineCare program to require prior authorization for 
biomarker testing; 
7. Clarifies that prior authorization determinations by health insurance carriers must be 
done in accordance with the requirements of current law in the Maine Revised Statutes, 
Title 24-A, section 4304; 
8. Extends the application date from January 1, 2026 to January 1, 2027; 
9. Adds language exempting the pr9posal from review an,d evaluation by the 
Department of Professional and Financial Regulation, Bureau of Insurance; and 
10. Adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 04/29/25 LRL 
132nd MAlNE LEGISLATURE 
LD 107 
LR 62(02) 
An Act to Require Health Insurance Coverage for Biomarker Tetinf 
H) 
Fiscal Note for Bill as Amended by Committee Amendment 'Ji L R-Z 3 / 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Projections 
Projections 
FY 2025-26 
FY 2026-27 
FY 2027-28 
FY 2028-29 
Net Cost (Savings) 
General Fund 
$0 
$1,163,349 
$2,287,608 
$2,289,253 
Highway Fund 
$0 
$0 
$6,113 
$6,113 
Appropriations/ Allocations 
General Fund 
$0 
$1,163,349 
$2,287,608 
$2,289,253 
. Highway Fund 
$0 
,$0 
$6,113 
$6,113 
Federal Expenditures Fund 
$0 
$2,158,291 
$4,258,602 
$4,260,285 
Federal Block Grant Fund 
$0 
$12,773 
$25,546 
$25,546 
Revenue 
Federal Expenditures Fund 
$0 
$2,158,291 
$4,258,602 
$4,260,286 
Federal Block Grant Fund 
$0 
$12,773 
$25,546 
$25,546 
Fiscal Detail and Notes 
The bill include~ General Fund appropriations to the Department of Health and Human Services of $993,349 in fiscal 
year 2026-27 to provide coverage for biomarker testing in the MaineCare program beginning January 1, 2027 and to 
establish one Health Services Consultant position in the Office of MaineCare Services to conduct prior authorization 
work. Federal Expenditures Fund and Federal Block Grant Fund allocations are also included for the FMAP match. 
The bill also includes General Fund appropriations to the Department of Administrative and Financial 
Services of $170,000 for the estimated cost to reimburse insurance carriers for 6 months of the State's defrayal cost of 
this new mandate. The mandate will go into effect on all health insurance plans on the marketplace beginning January 
1, 2027 and is estimated to cost $340,000 annually thereafter. 
The State Employee Health Plan's first impacted plan year will be fiscal year 2027-28 and is estimated to cost $38,209 
annually thereafter. The costs are split across the General Fund ($17,576), Highway Fund ($6,113) and all other funds 
($14,519). 
LR0062(02) - Fiscal Note - Page 1 of 1