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ARIZONA HOUSE OF REPRESENTATIVESFifty-sixth Legislature First Regular Session |
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HB 2470: AHCCCS; rapid genome sequencing
Sponsor: Representative Montenegro, LD 29
Committee on Health & Human Services
Overview
Directs the Arizona Health Care Cost Containment System (AHCCCS) to provide coverage of rapid whole genome sequencing as a separate payable service for members that meet certain criteria, subject to approval by the Center for Medicare and Medicaid Services (CMS).
History
Established in 1981, AHCCCS is Arizona's Medicaid program that oversees contracted health plans for the delivery of health care to individuals and families who qualify for Medicaid and other medical assistance programs. Through contracted health plans across the state, AHCCCS delivers health care to qualifying individuals including low-income adults, their children or people with certain disabilities.
Statute outlines the covered health and medical services offered to AHCCCS members, including: 1) inpatient hospital services; 2) outpatient health services; 3) laboratory and X-ray services; 4) prescription medications; 5) medical supplies, durable medical equipment, insulin pumps and prosthetic devices; 6) treatment of medical conditions of the eye; 7) early and periodic health screening and diagnostic services; 8) family planning services; 9) podiatry services; 10) nonexperimental transplants; 11) emergency dental care; 12) ambulance and nonambulance transportation; 13) hospice care; 14) orthotics; 15) medically necessary chiropractic services; and 16) diabetes outpatient self-management training services (A.R.S. § 36-2907).
Provisions
1.
Requires AHCCCS, subject to CMS
approval, to provide coverage of rapid whole genome sequencing as a separate
payable service for members that meet the following criteria:
a) is under one year's old;
b) has a complex or acute illness of unknown etiology that is not confirmed to be caused by an environmental exposure, toxic ingestion, infection with normal response to therapy or trauma; and
c) is receiving inpatient hospital services in an intensive care unit or a high acuity pediatric care unit. (Sec. 1)
2. Specifies that coverage for rapid whole genome sequencing may be subject to applicable evidence-based medical necessity criteria that is based on the following:
a) the patient has symptoms that suggest a broad differential diagnosis that would require an evaluation by multiple genetic tests if rapid whole genome sequencing is not performed;
b) the patient's treating health care provider determines that timely identification of a molecular diagnosis is necessary to guide clinical decision-making and that testing results may guide the treatment or management of the patient's condition; or
c) the patient has a complex or acute illness of unknown etiology, including at least one of the specified conditions. (Sec. 1)
3. Requires genetic data generated as a result of performing rapid whole genome sequencing that is covered to include:
a) a primary use of assisting the ordering health care professional and treating care team to diagnose and treat the patient; and
b) protected health information that is subject to the requirements applicable to protected health information as set forth by certain federal laws and their attendant regulations. (Sec. 1)
4. Directs the AHCCCS Director to submit any new waiver application, amendment to an existing waiver or Medicaid state plan amendment necessary for CMS approval for coverage of rapid whole genome sequencing. (Sec. 1)
5. Allows the AHCCCS Director to adopt any rules or take any other administrative action necessary to implement these requirements. (Sec. 1)
6. Defines rapid whole genome sequencing. (Sec. 1)
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HB 2470
Initials AG/BSR Page 0 Health & Human Services
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