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An Act
ENROLLED HOUSE
BILL NO. 1576 By: Lawson, Cantrell, and
Williams of the House
and
Hicks of the Senate
An Act relating to Medicaid; defining terms;
requiring the Oklahoma Health Care Authority to
provide coverage through Medicaid for certain
services; providing certain criteria; providing for
certain medical necessity criteria; authorizing
discretion to the Chief Operating Officer of the
Oklahoma Health Care Authority; providing for Health
Information Portability and Accountability Act
requirements; providing for scientific research;
providing for consent to provide data for research;
providing for opting-out; providing for minors;
providing for the promulgation of rules and
regulations; providing for waiver application;
providing for codification; providing for an
effective date; and declaring an emergency.
SUBJECT: Medicaid
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 4005 of Title 56, unless there
is created a duplication in numbering, reads as follows:
A. For purposes of this section, "rapid whole genome
sequencing" is defined as an investigation of the entire human
genome, including coding and non-coding regions and mitochondrial
deoxyribonucleic acid, to identify disease-causing genetic changes
that returns the preliminary positive results within seven (7) days
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and final results within fifteen (15) to twenty-one (21) days from
the date of receipt of the sample by the lab performing the test,
and includes patient-only whole genome sequencing (WGS) and duo and
trio whole genome sequencing of the patient and biological parent or
parents.
B. Subject to any required approval of the Centers for Medicare
and Medicaid Services, the Oklahoma Health Care Authority shall
include coverage of rapid whole genome sequencing as a separately
payable service for Medicaid beneficiaries when all of the following
criteria are met:
1. Beneficiary is under twenty-one (21) years of age;
2. Beneficiary has a complex or acute illness of unknown
etiology, that is not confirmed to be caused by an environmental
exposure, toxic ingestion, infection with normal response to
therapy, or trauma; and
3. Beneficiary is receiving hospital services in an intensive
care unit or other high acuity care unit within a hospital.
C. The coverage provided pursuant to this section may be
subject to applicable evidence-based medical necessity criteria that
shall be based on all of the following:
1. The patient has symptoms that suggest a broad differential
diagnosis that would require an evaluation by multiple genetic tests
if rapid whole genome sequencing is not performed;
2. The patient's treating health care provider has determined
that timely identification of a molecular diagnosis is necessary to
guide clinical decision-making and testing results may guide the
treatment or management of the patient's condition; and
3. The patient has a complex or acute illness of unknown
etiology, including at least one of the following conditions:
a. congenital anomalies involving at least two organ
systems or complex and multiple congenital anomalies
in one organ system,
b. specific organ malformations highly suggestive of a
genetic etiology,
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c. abnormal laboratory tests or abnormal chemistry
profiles suggesting the presence of a genetic disease,
complex metabolic disorder, or inborn error of
metabolism,
d. refractory or severe hypoglycemia or hyperglycemia,
e. abnormal response to therapy related to an underlying
medical condition affecting vital organs or bodily
systems,
f. severe muscle weakness, rigidity, or spasticity,
g. refractory seizures,
h. a high-risk stratification on evaluation for a brief
resolved unexplained event with any of the following:
(1) a recurrent event without respiratory infection,
(2) a recurrent event witnessed seizure-like event,
or
(3) a recurrent cardiopulmonary resuscitation,
i. abnormal cardiac diagnostic testing results suggestive
of possible channelopathies, arrhythmias,
cardiomyopathies, myocarditis, or structural heart
disease,
j. abnormal diagnostic imaging studies suggestive of an
underlying genetic condition,
k. abnormal physiologic function studies suggestive of an
underlying genetic etiology, or
l. family genetic history related to the patient's
condition.
D. Nothing in this section prohibits the Chief Operating
Officer of the Oklahoma Health Care Authority from adding additional
conditions to those contained in paragraph 3 of subsection C of this
section based upon new medical evidence or from providing coverage
for rapid whole genome sequencing or other next generation
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sequencing (NGS) and genetic testing for Medicaid beneficiaries that
is in addition to the coverage required under this section.
E. Genetic data generated as a result of performing rapid whole
genome sequencing, covered pursuant to this section, shall have a
primary use of assisting the ordering health care professional and
treating care team to diagnose and treat the patient, and as
protected health information, it shall be subject to the
requirements applicable to protected health information as set forth
in the Health Information Portability and Accountability Act
(HIPAA), the Health Information Technology for Economic and Clinical
Health Act, and their attendant regulations, including, but not
limited to, the HIPAA privacy rule as promulgated at 45 CFR, Part
160 and Subparts A and E of 45 CFR, Part 164.
F. Genetic data generated from rapid whole genome sequencing,
covered pursuant to this section, can be used in scientific research
if consent for such use of the data has been expressly given by the
patient, or the patient's legal guardian in the case of a minor.
The patient, the patient's legal guardian in the case of a minor, or
the patient's health care provider with the patient's consent, may
request access to the results of the testing covered by this section
for use in other clinical settings. A health care provider may only
charge a small fee to the patient based on the direct costs of
producing the results in a format usable in other clinical settings.
A patient, or patient's legal guardian in the case of a minor, shall
have the right to rescind the original consent to the use of the
data in scientific research at any time, and upon receipt of a
written revocation of the consent, the health care provider or other
entity using the data shall cease use and expunge the data from any
data repository where it is held.
G. The Chief Operating Officer of the Oklahoma Health Care
Authority shall take any actions necessary to implement the
provisions of this section, which may include, if deemed necessary,
the following:
1. Promulgation of rules and regulations to provide for
Medicaid coverage pursuant to this section;
2. Submission to the Centers for Medicare and Medicaid Services
of any new waiver application, amendment to an existing waiver, or
Medicaid state plan amendment necessary to ensure federal financial
participation for Medicaid coverage pursuant to this section; or
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3. Any other administrative action determined by the Chief
Operating Officer as necessary to implement the requirements of this
section.
SECTION 2. This act shall become effective July 1, 2025.
SECTION 3. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
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Passed the House of Representatives the 22nd day of May, 2025.
Presiding Officer of the House
of Representatives
Passed the Senate the 22nd day of May, 2025.
Presiding Officer of the Senate
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
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