House Bill No. 1199, introduced by Representative Jordan, mandates that health coverage plans in Louisiana provide insurance coverage for genetic testing and medically necessary treatments related to SCN2A-associated medical conditions. Effective January 1, 2027, any health coverage plan issued or renewed in the state must cover genetic testing when ordered by a treating physician or advanced practice provider and deemed medically necessary. The bill outlines specific treatments that must be covered, including anti-seizure medications, rehabilitative services, durable medical equipment, and nutritional management services, among others.

The bill also establishes that determinations of medical necessity will be made by the enrollee's treating physician or advanced practice provider, with written notifications required for any denials of coverage. It allows for prior authorization procedures, provided they are applied fairly, and permits cost-sharing requirements that do not exceed those for other medical benefits. Importantly, the bill prohibits denial of coverage based on disability, developmental status, or pre-existing conditions, and clarifies that the mandated benefits will be considered essential health benefits. However, the provisions do not apply to limited benefit health insurance policies or contracts.