TennCare

Plain English Breakdown

The bill text does not provide specific details about the extent of coverage or exact requirements for what is covered.

TennCare Coverage for Kleefstra Syndrome

This bill authorizes TennCare to provide coverage and benefits for diagnosing and treating Kleefstra syndrome in a manner similar to how they cover autism spectrum disorder, Trisomy 21, or Down syndrome when medically necessary.

What This Bill Does

• Defines 'Kleefstra syndrome' as a rare genetic condition that affects multiple body systems and includes specific symptoms like developmental delay, intellectual disability, distinctive facial features, speech and hearing disorders, seizures, gastrointestinal disorders, respiratory infections, autism, obesity, and organ defects.
• Authorizes TennCare to provide coverage for diagnosing and treating Kleefstra syndrome in the same manner it covers other similar genetic disorders such as autism spectrum disorder, Trisomy 21, or Down syndrome when medically necessary.
• Allows TennCare to cover early intervention programs, therapies, medications, education, treatments, clothing, devices, and equipment needed by individuals with Kleefstra syndrome when determined to be medically necessary.
• Gives the director of TennCare permission to apply for federal waivers if necessary to implement this coverage.

Who It Names or Affects

• People enrolled in TennCare who have or are suspected of having Kleefstra syndrome.
• The bureau of TennCare, which will be responsible for providing and managing the new coverage.

Terms To Know

Kleefstra syndrome

A rare genetic disorder that affects multiple body systems and includes symptoms like developmental delay, intellectual disability, distinctive facial features, speech and hearing disorders, seizures, gastrointestinal disorders, respiratory infections, autism, obesity, and organ defects.

TennCare

The state of Tennessee's Medicaid program that provides health care coverage to eligible individuals.

Limits and Unknowns

• Coverage for Kleefstra syndrome is only authorized when it is medically necessary.
• Specific details about the extent and nature of the coverage are not fully defined in this bill.

Official Summary Text

Kleefstra syndrome is a rare genetic condition that affects development and involves many
body systems. People with Kleefstra syndrome usually have distinct facial features, developmental delay, intellectual disability, low muscle tone (hypotonia), and communication difficulties. Kleefstra syndrome is caused by a mutation in a gene called E
H
MT1 or the deletion of a specific region of chromosome 9 that includes EHMT1. Other names for Kleefstra syndrome include 9q-syndrome, 9q34.3 deletion syndrome, and chromosome 9q deletion syndrome.

Kleefstra syndrome causes a range of symptoms that can d
iffer from person to person, which may include microcephaly; seizures; hearing loss; wide, short skull (brachycephaly); limited or absent speech; autism spectrum disorders; heart defects; sleep disorders; kidney defects; gastrointestinal problems such as
g
astroesophageal reflux (GERD); protruding jaw; single eyebrow; widely spaced eyes; rolled out lips; large tongue; nostrils that open out; and high birth weight and childhood obesity. In some cases, symptoms may include severe respiratory infections. Chi
l
dren with Kleefstra syndrome may have trouble communicating or interacting socially. Some adolescents may lose interest (apathy), lose developmental skills (regression), or become unresponsive (catatonic).

This bill requires the bureau of TennCare to pr
ovide coverage and benefits on behalf of an enrollee for the diagnosis, including genetic testing, and treatment of Kleefstra syndrome in the same manner and to the same extent that the bureau provides coverage for autism spectrum disorder, Trisomy 21, or

Down syndrome, and other similar or related genetic disorders. Such coverage and benefits must include early intervention and promoting improvements to the enrollee's quality of life and development throughout the life of the enrollee through appropriate

modalities of therapy, appropriate medications, and other interventive programs, education, treatments, clothing, devices, and equipment. The director of TennCare may apply for a federal waiver as the director deems necessary to effectuate this bill.

ON
MARCH 10, 2025, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 502, AS AMENDED.

AMENDMENT #1 makes the following changes:



Revises the requirement that the bureau
provide coverage and benefits on behalf of an enrollee for the diagnosis, including genetic testing, and treatment of Kleefstra syndrome in the same manner and to the same extent that the bureau provides coverage for autism spectrum disorder, Trisomy 21 or Down syndrome, and other similar or related genetic disorders
to, instead, be permissive instead of required and only permissive when determined to be medically necessary.



Revises the requirement that c
overage and benefits
as described above must
include, without limitation, early intervention and promoting improvements to the enrollee's quality of life and development throughout the life of the enrollee through
a
ppropriate modalities of therapy
, a
ppropriate medications
,
and
o
ther interventive programs, education, treatments, clothing, devices, and equipment
to, instead, be permissive instead of required.

Current Bill Text

SENATE BILL 522
By Roberts

HOUSE BILL 502
By Littleton

HB0502
001919
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 56
and Title 71, relative to TennCare.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
adding the following as a new section:
(a) As used in this section:
(1) "Bureau" means the bureau of TennCare;
(2) "Enrollee" means an individual enrolled in TennCare;
(3) "Kleefstra syndrome" means a rare genetic disorder resulting from a
mutation in the euchromatic histone methyltransferase 1 (EHMT1) gene or a
deletion of a region of chromosome 9 that includes the EHMT1 gene that affects
multiple organs and functions of the body, including the face, brain, heart, and
kidneys, and that is characterized by features including, but not limited to:
(A) Developmental delay;
(B) Intellectual disability;
(C) Distinctive facial features;
(D) Speech and hearing disorders;
(E) Seizures;
(F) Gastrointestinal disorders;
(G) Respiratory infections;
(H) Autism;
(I) Obesity; and

- 2 - 001919

(J) Organ defects.
(b) The bureau shall provide coverage and benefits on behalf of an enrollee for
the diagnosis, including genetic testing, and treatment of Kleefstra syndrome in the
same manner and to the same extent that the bureau provides coverage for autism
spectrum disorder, Trisomy 21 or Down syndrome, and other similar or related genetic
disorders.
(c) Coverage and benefits under subsection (b) must include, without limitation,
early intervention and promoting improvements to the enrollee's quality of life and
development throughout the life of the enrollee through:
(1) Appropriate modalities of therapy;
(2) Appropriate medications; and
(3) Other interventive programs, education, treatments, clothing, devices,
and equipment.
(d) The director of TennCare may apply for a federal waiver as the director
deems necessary to effectuate this section.
SECTION 2. This act takes effect July 1, 2025, the public welfare requiring it.