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Bill Summary · HB 242

Summary of House Bill 242: Medicaid Coverage for Rapid Whole Genome Sequencing

Bill Number: HB 242
Introduced On: February 11, 2025
Status: Read for the first time and referred to the House Committee on Ways and Means General Fund
Sponsor: Representative Phillip Rigsby
Fiscal Note Analyst: Tiffany Weaver
Estimated Annual Cost: $4.5 million (including $3.3 million in federal funds and $1.2 million in state funds)

Purpose and Intent

House Bill 242 aims to expand Medicaid coverage in Alabama by requiring the Alabama Medicaid Agency to provide coverage for rapid whole genome sequencing (WGS) for specific individuals. The intent of the bill is to facilitate the diagnosis of complex or acute illnesses in young patients when traditional diagnostic methods fail to identify the underlying genetic causes.

Key Provisions

  • Definition of Rapid Whole Genome Sequencing:
    Rapid whole genome sequencing is defined as an analysis of the entire human genome, yielding preliminary results within five days and final results within 14 days. This includes patient-only sequencing as well as duo and trio sequencing involving the patient and their biological parents.

  • Eligibility Criteria:
    Coverage for rapid whole genome sequencing is available for Medicaid recipients who:

    1. Are 21 years of age or younger.
    2. Have a complex or acute illness of unknown origin, not attributable to environmental factors, toxic ingestion, infections, or trauma.
    3. Are hospitalized in an intensive care unit (ICU), including neonatal ICUs or high acuity pediatric units.

  • Approval Requirements:
    The coverage is subject to prior approval or a waiver from the Centers for Medicare and Medicaid Services (CMS).

Impact

  • Affected Population:
    The bill primarily affects hospitalized infants, children, and young adults under 21 years old who are experiencing acute or complex medical conditions that require genetic investigation.

  • Financial Implications:
    The implementation of this bill is expected to increase the financial obligations of the Alabama Medicaid Agency by an estimated minimum of $4.5 million annually. This includes $3.3 million in federal funding and $1.2 million in state funding.

Procedural Aspects

  • Effective Date:
    If passed, the provisions of this bill will take effect on October 1, 2025.

  • Legislative Timeline:

    • February 11, 2025: The bill was read for the first time and referred to the House Committee on Ways and Means General Fund.
    • Further actions are pending in the committee.

Conclusion

House Bill 242 represents a significant step towards enhancing diagnostic capabilities for young patients with complex medical conditions by mandating Medicaid coverage for rapid whole genome sequencing. This legislation could lead to timely and accurate diagnoses, ultimately improving patient outcomes and healthcare efficiency.

Compiled from official sources — confirm details with the bill’s official record.

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