APA WF #25-06 and OK SPA #25-0015 Rapid Whole Genome Sequencing

The proposed policy changes and State Plan amendment establish coverage and reimbursement for rapid whole genome sequencing. House Bill 1576 (2025) directed OHCA to cover rapid whole genome sequencing in certain situations. Testing will be covered for members who are under 21 years of age, have an unknown complex or acute illness, and are receiving intensive care unit hospital services. This coverage will include testing for genetic changes that may help identify the member’s condition. A prior authorization will be required. Rapid whole genome sequencing will be excluded from the Per Discharge Prospective Rate for hospitals and will be reimbursed separately based on the Ambulatory Payment Classification fee schedule. Reimbursement for testing provided in an ITU facility will be included in the Inpatient Hospital Per Diem Rate.

Please view the administrative rules draft here: APA WF # 25-06

Please view the State Plan amendment draft here: OK SPA #25-0015

Comments may be submitted to the comment box below or to federal.authorities@okhca.org. Interested parties who submit a comment via email may request to remain anonymous by stating that request in their email.

Circulation Date: October 10, 2025

Comment Due Date: October 25, 2025

Medical Advisory Committee Date: November 6, 2025

Tentative OHCA Board Date: November 10, 2025