MN SF2445

Health plans covering Minnesota residents must provide coverage for rapid whole genome sequencing (rWGS) testing for enrollees age 21 and younger with complex or acute illness of unknown etiology receiving inpatient hospital services in intensive care, neonatal, or high acuity pediatric care units.

rWGS is defined as investigation of the entire human genome to identify disease-causing genetic changes, returning preliminary results within 5 days and final results within 14 days, including patient-only or duo/trio sequencing with biological parents.

Coverage eligibility requires symptoms suggesting broad differential diagnosis, timely molecular diagnosis necessary for clinical decision-making, and presence of specified conditions including congenital anomalies, abnormal lab tests, refractory seizures, cardiac abnormalities, or family genetic history.

Coverage is subject to standard plan cost-sharing requirements including deductibles, co-payments, and coinsurance; reimbursement under capitated or bundled payment arrangements must be paid separately unless carrier and provider negotiate increased rates.

Genetic data generated from rWGS must be used for diagnosis and treatment purposes and is protected under HIPAA and the Minnesota Health Records Act, effective January 1, 2024.