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Pennsylvania State Senate
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Senate of Pennsylvania
Session of 2023 - 2024 Regular Session


Posted: June 29, 2023 03:59 PM
From: Senator Lynda Schlegel Culver
To: All Senate members
Subject: Medicaid (MA) Coverage of Rapid Whole Genome Sequencing (rWGS) Testing
In the near future, I plan to introduce legislation that would provide MA coverage for rapid whole genome sequencing (rWGS) for critically ill infants up to one year of age who are admitted to an inpatient intensive care unit with a complex illness of unknown etiology.
The Department of Human Services would reimburse hospitals separately for rWGS for both fee-for-service and HealthChoices beneficiaries.
Reimbursement for rWGS would be limited to infants that meet specific criteria and provider requirements. The number of infants that would qualify for rWGS would be minimal since the criteria for testing in the legislation would include only those
infants that:
• Are critically ill and up to one year of age
• Are admitted to an inpatient intensive care unit with a complex illness of unknown etiology
• Meet a list of medically necessary criteria to be tested as set forth in the legislation
Early diagnosis for NICU infants with genetic disorders is sound medicine in that it:
• Shortens the diagnostic odyssey that can be agonizing for families
• Allows for early treatment which results in better outcomes
• Results in fewer hospital days for inpatients which presents a financial benefit for MA, patients and families
Three clinical studies have shown clinical and cost effectiveness of rWGS for critically ill infants. The studies conducted in California, Michigan and Florida consistently demonstrated aggregate and per person cost savings as compared to the standard of care. Rapid WGS yields twice as many diagnoses than usual care in the ICU. There is significant value for both patients and Medicaid if the program provides coverage and reimbursement of rWGS in high acuity clinical settings.

Introduced as SB965