Members of the Committee,
My name is Ashley Arthur, and I am the Vice President of Market Access and Government Affairs at GeneDx, a national leader in genomic testing for rare diseases. Thank you for the opportunity to comment on this important legislation. This bill represents an important step forward for Virginia families, and I want to stress the value of incorporating lessons learned from other states to ensure that this program delivers the access and outcomes it promises.
GeneDx has been involved in rWGS implementation across the country, and we’ve seen that very well-intentioned programs face operational barriers that limit their effectiveness. To avoid these same challenges, I urge the Committee to address the following key areas:
Carve Out rWGS Payment From the Inpatient DRG Model:
The DRG payment model bundles payments for all services during an inpatient stay. While it promotes efficiency, it does not account for specialized diagnostics like rWGS. Due to financial uncertainty, hospitals often delay or avoid ordering rWGS without test-specific reimbursement. Explicitly recognizing rWGS as a separately reimbursed service will empower hospitals to order this test based on clinical need rather than financial considerations.
Reimbursement Flexibility for Hospitals and Labs:
The bill should clarify that rWGS reimbursement can be directed either to the hospital or the performing laboratory, depending on who provides the service. This flexibility ensures operational efficiency and accommodates the partnerships hospitals rely on to access specialized labs like GeneDx.
Access Without Prior Authorization:
Requiring prior authorization for rWGS in critical care settings creates delays that undermine the purpose of this test. Virginia should ensure that rWGS is exempt from prior authorization, with post-service review used as needed for oversight.
Clear Guidance for Managed Medicaid Plans:
Inconsistent implementation by Managed Care Organizations (MCOs) has been a major barrier in other states, with claims denied due to network issues, coverage misinterpretations, or administrative delays. Either bypassing the MCOs or providing very clear implementation guidance to MCOs will be essential to avoid these issues.
The benefits of rWGS are well-documented. In studies like Project Baby Manatee at Nicklaus Children’s Hospital, rWGS delivered a diagnosis in 40% of cases, changed medical management in 33% of cases, and saved $75,000 per child tested. When utilization is optimized, these benefits translate to improved child outcomes and significant cost savings for Medicaid.
Virginia has the opportunity to lead the nation by designing a comprehensive and effective rWGS program that serves as a model for other states. By carving out reimbursement, simplifying access, and providing operational clarity, this legislation can ensure that every eligible child receives the timely, life-saving diagnosis they deserve.
Finally, I want to emphasize GeneDx’s commitment to supporting this process. We look forward to providing the Committee and Virginia Medicaid with any assistance, knowledge, or insights they may need as this legislation becomes law.
Thank you for your time and consideration.
Sincerely,
Ashley Arthur
VP, Market Access, GeneDx
Members of the Committee, My name is Ashley Arthur, and I am the Vice President of Market Access and Government Affairs at GeneDx, a national leader in genomic testing for rare diseases. Thank you for the opportunity to comment on this important legislation. This bill represents an important step forward for Virginia families, and I want to stress the value of incorporating lessons learned from other states to ensure that this program delivers the access and outcomes it promises. GeneDx has been involved in rWGS implementation across the country, and we’ve seen that very well-intentioned programs face operational barriers that limit their effectiveness. To avoid these same challenges, I urge the Committee to address the following key areas: Carve Out rWGS Payment From the Inpatient DRG Model: The DRG payment model bundles payments for all services during an inpatient stay. While it promotes efficiency, it does not account for specialized diagnostics like rWGS. Due to financial uncertainty, hospitals often delay or avoid ordering rWGS without test-specific reimbursement. Explicitly recognizing rWGS as a separately reimbursed service will empower hospitals to order this test based on clinical need rather than financial considerations. Reimbursement Flexibility for Hospitals and Labs: The bill should clarify that rWGS reimbursement can be directed either to the hospital or the performing laboratory, depending on who provides the service. This flexibility ensures operational efficiency and accommodates the partnerships hospitals rely on to access specialized labs like GeneDx. Access Without Prior Authorization: Requiring prior authorization for rWGS in critical care settings creates delays that undermine the purpose of this test. Virginia should ensure that rWGS is exempt from prior authorization, with post-service review used as needed for oversight. Clear Guidance for Managed Medicaid Plans: Inconsistent implementation by Managed Care Organizations (MCOs) has been a major barrier in other states, with claims denied due to network issues, coverage misinterpretations, or administrative delays. Either bypassing the MCOs or providing very clear implementation guidance to MCOs will be essential to avoid these issues. The benefits of rWGS are well-documented. In studies like Project Baby Manatee at Nicklaus Children’s Hospital, rWGS delivered a diagnosis in 40% of cases, changed medical management in 33% of cases, and saved $75,000 per child tested. When utilization is optimized, these benefits translate to improved child outcomes and significant cost savings for Medicaid. Virginia has the opportunity to lead the nation by designing a comprehensive and effective rWGS program that serves as a model for other states. By carving out reimbursement, simplifying access, and providing operational clarity, this legislation can ensure that every eligible child receives the timely, life-saving diagnosis they deserve. Finally, I want to emphasize GeneDx’s commitment to supporting this process. We look forward to providing the Committee and Virginia Medicaid with any assistance, knowledge, or insights they may need as this legislation becomes law. Thank you for your time and consideration. Sincerely, Ashley Arthur VP, Market Access, GeneDx