A genome is a human’s or other organism’s complete set of genetic information. The genome of a human contains between 20,000 and 25,000 genes. Each gene carries information that determines a different trait, which is a feature or characteristic that may be inherited from the parents and passed down to the offspring. The molecules that make up the genome and its genes are called deoxyribonucleic acid (DNA). The genetic information in DNA is stored as a code made up of four building blocks, or bases. A gene variant is a heritable change to the DNA sequence that makes up a gene. Most gene variants have no impact on a person’s health or development, but some gene variants result in genetic diseases.
Using a method or technology called DNA sequencing, it is possible to determine whether a person has one or more variants in a single gene, multiple genes, or in the whole genome. When testing for single gene variants and analysis of one or more gene sequences does not provide a diagnosis of disease, whole genome sequencing may be used to locate rare gene variants that may be the genetic cause of the condition.
The Health Care Authority does not have an official policy on Medicaid reimbursement for payment codes related to whole genome sequencing, but will consider requests for payment according to the standards used by other payers or professional organizations.
Collaborative for the Advancement of Telemedicine.
In July 2016, the Collaborative for the Advancement of Telemedicine (Collaborative) was established to enhance the understanding and use of health services provided through telemedicine and other similar models in Washington. The Collaborative is hosted by the University of Washington and considers issues related to reimbursement, access, best practices, and technical assistance.
Beginning January 1, 2024, medical assistance programs administered by the Health Care Authority must require provider payment for rapid whole genome sequencing for enrollees who are 21 years old and younger. The Authority must adopt medical necessity criteria for the coverage upon consideration of standards developed by the American College of Medical Genetics and Genomics and hospitals in Washington that predominantly serve children. The term "rapid whole genome sequencing" is defined as the unbiased sequencing of all deoxyribonucleic acid bases in the genome of a patient for the purpose of determining whether one or more potentially disease-causing genetic variants are present in the genome of the patient or biological parent.
The Collaborative for the Advancement of Telemedicine (Collaborative) at the University of Washington must consider strategies to promote and expand the use of telemedicine to provide genetic counseling services, especially in rural areas. The Collaborative must report to the Governor and the relevant committees of the Legislature by December 1, 2023. The report must include a description of obstacles to providing genetic counseling services through telemedicine and recommendations for promoting and expanding the use of telemedicine to provide genetic counseling services, especially in rural areas.