MN HF3632

Medical assistance must cover rapid whole genome sequencing (rWGS) testing for critically ill infants one year of age or younger admitted to an inpatient intensive care unit with complex illness of unknown etiology.

Testing is covered only when the infant's symptoms suggest a rare genetic condition not diagnosable by standard workup, a broad differential diagnosis requiring multiple genetic tests, and timely molecular diagnosis is necessary to guide clinical decision-making.

At least one of ten specified clinical criteria must apply to the infant, including multiple congenital anomalies, abnormal laboratory tests, severe hypoglycemia, refractory seizures, abnormal cardiac findings, or relevant family genetic history.

Testing must be ordered by the infant's treating physician and preceded by evaluation by a medical geneticist or physician subspecialist with expertise in the relevant genetic disorder.

Commissioner shall establish a separate payment methodology to reimburse hospitals for rWGS testing costs; managed care and county-based plans are not responsible for additional payment; hospitals must request prior authorization and submit claims directly to the commissioner.

Effective July 1, 2022, or upon federal approval, whichever occurs last.