HB2470 proposes an amendment to the Arizona Health Care Cost Containment System (AHCCCS) to include coverage for rapid whole genome sequencing as a separately payable service for eligible members under specific conditions. The bill outlines that this coverage is subject to approval by the Centers for Medicare and Medicaid Services (CMS) and would apply to members who are under one year old, have a complex or acute illness of unknown origin not caused by environmental exposure, toxic ingestion, infection with normal response to therapy, or trauma, and are receiving inpatient hospital services in an intensive care unit or high acuity pediatric care unit.

The bill also details that the coverage may be subject to evidence-based medical necessity criteria, including the need for a broad differential diagnosis, timely identification of a molecular diagnosis to guide clinical decision-making, or the presence of a complex or acute illness of unknown etiology with specific conditions listed. Additionally, the bill requires that genetic data generated from the sequencing be used primarily to assist in diagnosing and treating the patient and be protected as health information under HIPAA and HITECH regulations. The AHCCCS Director is tasked with submitting necessary waivers or amendments for CMS approval and may adopt rules or take administrative actions to implement this coverage. Rapid whole genome sequencing is defined within the bill, including the timeframe for results and the inclusion of sequencing for the patient and their biological parents.

Statutes affected:
Introduced Version: 36-2907.16
House Engrossed Version: 36-2907.16