23 Miss. Code. R. 219-1.9 - Genetic Testing
A. The Division of
Medicaid defines genetic testing as a type of analysis that identifies changes
in chromosomes, genes, or proteins that confirms or rules out a suspected
genetic condition.
B. The Division
of Medicaid covers genetic testing when medically necessary to establish a
diagnosis of an inheritable disease only when all of the following are met:
1. The beneficiary displays clinical
features, or is at direct risk of inheriting the mutation in question
(pre-symptomatic),
2. The result of
the test will directly guide the treatment being delivered to the beneficiary,
and
3. After history, physical
exam, pedigree analysis, genetic counseling, and completion of conventional
diagnostic studies, a definitive diagnosis remains uncertain.
C. The Division of Medicaid does
not cover genetic testing:
1. Of family
members of a beneficiary,
2. If
considered to be experimental, investigational or unproven,
3. To determine the likelihood of passing on
a trait,
4. For the purpose of
determining ancestry, or
5. Other
purposes not specifically defined that are not diagnostic in nature.
D. Prior authorization is required
by the Utilization Management/Quality Improvement Organization (UM/QIO) for
medical necessity and appropriateness.
Notes
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No prior version found.