This bill mandates the Executive Office of Health and Human Services, in collaboration with the Office of MassHealth, to provide rapid whole genome sequencing for Medicaid beneficiaries under specific clinical criteria. Rapid whole genome sequencing is defined as a comprehensive analysis of the human genome that delivers preliminary results within 5 days and final results within 14 days. Coverage is available for beneficiaries aged 21 or younger who are hospitalized in intensive care or high acuity pediatric units and have complex or acute illnesses of unknown origin. The bill outlines various medical conditions that qualify for this service and emphasizes the importance of timely genetic diagnosis to inform treatment decisions.

Additionally, the bill requires the Division of Medical Assistance to establish a separate reimbursement rate for rapid whole genome sequencing, ensuring it is not included in bundled payments or inpatient diagnosis-related groups. This reimbursement will reflect the costs associated with laboratory processing and result interpretation. The division is tasked with notifying hospitals of this new reimbursement structure within 12 months of the regulatory changes. The act will take effect immediately upon passage.