APA WF # 25-06 Rapid Whole Genome Sequencing

The proposed policy changes are being promulgated as Permanent Rules.

The proposed policy changes establish coverage and reimbursement for rapid whole genome sequencing (rWGS) in accordance with House Bill 1576 (2025). Coverage applies to members under age 21 who have an unknown complex or acute illness and are receiving intensive care unit hospital services. The testing may help identify genetic changes and determine the member’s condition. When medically necessary, coverage on behalf of the child will include comparator testing of one or both parents. Prior authorization will be required. Rapid whole genome sequencing will be excluded from the Per Discharge Prospective Rate for hospitals and reimbursed separately under the Ambulatory Payment Classification fee schedule. Reimbursement for testing provided in an I/T/U facility will be included in the Inpatient Hospital Per Diem Rate.

Please view the draft regulatory here and submit feedback via the comment box.

Pursuant to 75 O.S. §303(D), a rule impact statement will be posted here beginning December 30, 2025. Individuals may also request a copy using the comment box, and the statement will be provided on December 30, 2025.

Proposed Policy Timeline

Circulation Date: 12/15/2025

Medical Advisory Committee: 1/8/2026

Comment Due Date: 1/15/2026

Public Hearing: 1/15/2026

Board Meeting: 1/21/2026

After you submit your comment, you should be re-directed to a confirmation page. If you are not, please submit your comment through e-mail to federal.authorities@okhca.org.

Please note that all comments must be reviewed and approved prior to posting. Approved comments will be posted Monday through Friday between the hours of 7:30 a.m. – 4 p.m. Any comments received after 4 p.m. will be posted on the following business day.