Provider Bulletin 2018-64 October 2018
November 14, 2018Effective November 1, 2018 and forward, the Department of Social Services (DSS) is implementing (1) new coverage guidelines for genetic testing.
New coverage guidelines will be used, in conjunction with DSS’ definition of medical necessity (see section 17b-259b of the Connecticut General Statutes), to render determinations on prior authorization (PA) requests for coverage of genetic testing services (including panel testing) not currently addressed in McKesson’s InterQual® Molecular Diagnostics Criteria.
The current policy, Genetic Cancer Susceptibility Panels using Next Generation Sequencing, will be retired on November 1, 2018. Requests for genetic cancer susceptibility panels will be reviewed using the new Genetic Testing policy along with the DSS definition of medical necessity. The Whole Exome and Whole Genome Sequencing policy will remain in effect.
Accessing the HUSKY Health Policies :
Policy outlined above is available on the HUSKY Health Web site at: www.ct.gov/husky. To access the policy, click on For Providers followed by Policies, Procedures and Guidelines under the Medical Management menu item.