S 154 Vermont Senate · 2025-2026 Regular Session

An act relating to health insurance coverage for biomarker testing

Senate Bill S 154 requires health insurance plans and Vermont's Medicaid program to provide coverage for biomarker testing. This testing analyzes a patient's samples to identify biological characteristics relevant to a disease or condition. Coverage is mandated for the diagnosis, treatment, management, and ongoing monitoring of a patient's disease. Such coverage is required when the test is supported by medical and scientific evidence, including FDA approvals, Medicare/Medicaid determinations, or nationally recognized clinical practice guidelines. The bill also specifies that coverage should be provided in a way that minimizes disruptions to patient care.

Issues: ✓ Healthcare

Bill status passed 3 of 5 stages cleared

Introduction

May 2025

Committee Review

Mar 2026

Senate Passage

Mar 2026

House Passage

Governor

Introduced May 9, 2025 Last action Mar 26, 2026

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What changed between versions

As Passed By the Senate (UnofficialOpens in a new window) → As Passed By the Senate (OfficialOpens in a new window) · 6 edits · Mar 24, 2026

MODERATE

The bill was substantially expanded from a cost-analysis and reporting study into a mandatory coverage law. The unofficial version only required the Department of Financial Regulation and Agency of Human Services to analyze costs and report to the legislature by January 15, 2027. The official version adds binding mandates requiring private health insurance plans and Vermont Medicaid to cover biomarker testing supported by medical and scientific evidence, with staggered effective dates beginning January 1, 2026.

Scope change

The bill's scope changed from a non-binding study requiring agencies to analyze costs and report to the legislature by January 15, 2027, into a binding mandate requiring both private health insurers and Vermont Medicaid to actually cover biomarker testing, with coverage obligations beginning as early as January 1, 2026.

SCOPE

Added a mandate (8 V.S.A. 4088n) requiring all health insurance plans to cover biomarker testing for diagnosis, treatment, management, and monitoring when supported by FDA indications, FDA-approved drug tests, drug label warnings, CMS coverage determinations, or nationally recognized clinical practice guidelines and consensus statements.

Added a mandate (33 V.S.A. 1901n) requiring the Agency of Human Services to provide Medicaid coverage for biomarker testing under the same evidence criteria as the private insurance mandate.

DEFINITION

Added a new definition of 'health insurance plan' meaning any health insurance policy or health benefit plan offered by a health insurer, excluding policies providing coverage for a specified disease or other limited benefit coverage.

REQUIREMENT

Added a requirement that the Agency of Human Services request CMS approval to amend Vermont's Medicaid state plan if necessary to provide the mandated biomarker testing coverage.

Added a requirement that coverage be provided in a manner that limits disruptions in care, including the need for multiple biopsies or biospecimen samples, applying to both the health insurance and Medicaid mandates.

TIMELINE

Replaced the simple 'effective on passage' date with staggered effective dates: the health insurance mandate takes effect January 1, 2026 and applies to plans issued on or after that date (no later than January 1, 2027); the Medicaid mandate takes effect on the later of January 1, 2026 or CMS approval of a state plan amendment.

As IntroducedOpens in a new window → As Passed By the Senate (UnofficialOpens in a new window) · 7 edits · Mar 24, 2026

MODERATE

The Senate fundamentally changed this bill from a mandate requiring health insurance and Medicaid to cover biomarker testing into a cost-analysis and reporting requirement. Instead of forcing insurers and Medicaid to provide coverage, the act now requires the Department of Financial Regulation and the Agency of Human Services to study the costs and report their findings to legislative committees by January 15, 2027. This shifts the bill from an immediate policy change to a preliminary step that would inform future legislation.

SCOPE

The core requirement changed from mandating coverage to requiring cost analysis. The original bill stated 'A health insurance plan shall provide coverage' and 'The Agency of Human Services shall provide Medicaid coverage.' The Senate version replaces this with a requirement that the Department of Financial Regulation and Agency of Human Services 'analyze the costs associated with requiring' such coverage.

Removed the Medicaid state plan amendment section (original Sec. 3) that directed the Agency of Human Services to request CMS approval to amend Vermont's Medicaid state plan.

TIMELINE

New reporting deadline of January 15, 2027 for the Department of Financial Regulation to report estimated health insurance premium increases (including state financial obligations for defrayal under 45 C.F.R. 155.170 and State Employees' Health Benefit Plan increases) to the House Committee on Health Care and Senate Committees on Health and Welfare and Finance.

New reporting deadline of January 15, 2027 for the Agency of Human Services to report to the Senate Committee on Health and Welfare on what CMS approvals would be needed for Medicaid to cover biomarker testing and the associated costs to the Medicaid program.

Effective dates simplified from a staggered schedule (January 1, 2026 for health insurance; later of January 1, 2026 or CMS approval for Medicaid; passage for the amendment section) to a single effective date of passage for the entire act.

REQUIREMENT

Removed the requirement that coverage be provided in a manner that limits disruptions in care, including the need for multiple biopsies or biospecimen samples.

DEFINITION

Removed the definition of 'Health insurance plan' that had been included in the original bill's definitions subsection.

Floor votes

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No floor votes recorded yet.

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Mar 26, 2026

Introduced

Read first time and referred to the Committee on Health Care

lower

Mar 20, 2026

Upper · Passed

Recommendation of amendment by Committee on Health and Welfare agreed to

upper

Mar 20, 2026

Upper · Passed

Reported favorably by Senator Lyons for Committee on Appropriations

upper

Mar 20, 2026

Upper · Passed

Read 2nd time, reported favorably with recommendation of amendment by Senator Cummings for Committee on Health and Welfare

upper

Mar 20, 2026

Upper · Passed

Favorable report by Committee on Appropriations

upper

Mar 20, 2026

Upper · Passed

Favorable report with recommendation of amendment by Committee on Health and Welfare

upper

Mar 19, 2026

Upper · Passed

Favorable report by Committee on Appropriations

upper

Mar 19, 2026

Upper · Passed

Favorable report with recommendation of amendment by Committee on Health and Welfare

upper

Mar 17, 2026

Committee

Referred to Committee on Appropriations per Senate Rule 31

upper

Mar 17, 2026

Upper · Passed

Favorable report with recommendation of amendment by Committee on Health and Welfare

upper

Jan 23, 2026

Upper · Passed

Committee on Finance relieved; bill committed to Committee on Health and Welfare on motion of Senator Cummings

upper

May 9, 2025

Introduced

Read 1st time & referred to Committee on Finance

upper

4 primary · 0 co-sponsors