The original instrument and the following digest, which constitutes no part of the
legislative instrument, were prepared by Beth O'Quin.
DIGEST
SB 154 Original 2022 Regular Session Talbot
Proposed law requires any health coverage plan renewed, delivered, or issued for delivery, in this
state to include coverage for using rapid whole genome sequencing (rWGS) that helps a physician
timely diagnosis in and guide treatment for a critically ill infant who is one year or younger and is
receiving care in the intensive care unit or in the pediatric care unit and the infant has a complex
illness of unknown etiology.
Proposed law provides that coverage may be subject to annual deductibles, coinsurance, copayment
provisions consistent with that established under the health coverage plan and that this coverage may
be subject to applicable evidence-based medical necessity criteria based on all of the following:
(1)The infant is suspected of having a rare genetic condition not diagnosable by a standard
clinical work-up.
(2)The infant has symptoms that suggest a broad differential diagnosis that requires an
evaluation by multiple genetic tests if rWGS testing is not performed.
(3)Timely identification of a molecular diagnosis is necessary in order to guide clinical decision
making and rWGS testing results would guide the treatment or management of the infant's
condition.
(4)The infant has at least one of the following conditions:
(a)Multiple congenital anomalies.
(b)Specific malformations highly suggestive of a genetic etiology.
(c)Abnormal laboratory test suggests the presence of a genetic disease or complex
metabolic phenotype like but not limited to an abnormal newborn screen,
hyperarammonemia, or lactic acidosis not due to poor perfusion.
(d)Refractory or severe hypoglycemia.
(e)Abnormal response to therapy relates to an underlying medical condition that affects
vital organs or bodily systems.
(f)Severe hypotonia.
(g)Refractory seizures. (h)A high-risk stratification on evaluation for a brief resolved unexplained event with
any of the following:
(i)A recurrent event without respiratory infection.
(ii)A recurrent event witnessed seizure-like event.
(iii)A recurrent cardiopulmonary resuscitation.
(i)Abnormal chemistry levels like but not limited to electrolytes, bicarbonate, lactic
acid, venous blood gas, and glucose that suggest inborn error of metabolism.
(j)Abnormal cardiac diagnostic test results suggests possible channelopathies,
arrhythmias, cardiomyopathies, myocarditis, or structural heart disease.
(k)Family genetic history that relates to the infant's condition.
Proposed law provides rapid whole genome sequencing does not cover admission to the hospital if
one of the following conditions apply:
(1)Infection or sepsis with normal response to therapy.
(2)Confirmed prenatal or postnatal genetic diagnosis is consistent with the infant's condition.
(3)Hypoxic-ischemic encephalopathy with a clear precipitating event.
(4)Isolated prematurity.
(5)Isolated transient tachypnea of the newborn.
(6)Isolated unconjugated hyperbilrubinemia.
(7)Nonviable neonates.
(8)Trauma.
(9)Meconium aspiration.
Proposed law defines health coverage plan as any hospital, health, or medical expense insurance
policy, hospital or medical service contract, employee welfare benefit plan, contract, or other
agreement with a health maintenance organization or a preferred provider organization, health and
accident insurance policy, or any other insurance contract of this type in the state, including group
insurance plans, self-insurance plans, and the office of group benefits programs. Excludes a plan
providing coverage for excepted benefits in present law, limited benefit health insurance plans, and
short-term policies that have a term of less than 12 months. Proposed law defines a biomarker, biomarker testing, and rapid whole genome sequencing.
Proposed law applies to health coverage plans renewed, delivered, or issued for delivery in their state
on or after January 1, 2023.
Effective January 1, 2023.
(Adds R.S. 22:1028.4)