SPONSOR: Veit
MEDICAL TESTING UNDER MO HEALTHNET (Sections 191.300, 191.312, and 208.152) Under this bill, the Department of Health and Senior Services must offer a public comment period each year to collect comments and information pertaining to best practices in genetically-based newborn screening for pediatric rare diseases. The Department will also annually seek out information and research updates from prenatal and early childhood genetic screening research organizations. The Department will compile this information in an annual report to the Governor and General Assembly and must include any recommendations for any updates for newborn screening. Additionally, the Department of Social Services will include coverage of genetic testing for pediatric rare diseases as a covered MO HealthNet service. Rapid whole genome sequencing testing will be covered in certain inpatient settings, while biomarker testing will be covered in certain outpatient settings. The Department must seek any necessary State plan amendments or waivers from the Centers for Medicare and Medicaid Services to implement this provision. MEDICAL TESTING UNDER HEALTH BENEFIT PLANS (Section 376.1270) This bill requires health benefit plans to provide coverage for biomarker testing, as defined in the bill, as well as for rapid whole genome sequencing (rWGS), as defined in the bill. The bill specifies when the testing will be covered, includes examples of medical necessity, enacts provisions relating to prior authorization and utilization review for the services, prohibits coverage denials based on the tests being experimental or investigational, specifies that genetic counseling before and after the tests is covered, requires health carriers to maintain on their web sites up-to-date policies on covered genomic and biomarker tests, and requires testing under the bill to be performed by a laboratory certified in accordance with Federal law.
This bill is similar to SB 828 (2025).
Statutes affected: