Provider Announcements

Notice for HUSKY genetic testing medical policies

Effective April 1st 2017, all HUSKY Health genetic testing medical policies will be retired. McKesson’s InterQual^® Molecular Diagnostics Criteria will instead be used in conjunction with the Department of Social Services (DSS) definition of Medical Necessity. The criteria provide evidence-based clinical decision support for molecular and genetic tests. While there will be no change to the prior authorization submission process itself, more detailed information will be required to facilitate person-centered, medical necessity determinations that will support high quality, cost-effective outcomes. Clinical validity, utility, and efficacy will all be considered in determining if the test being requested is medically appropriate.

The following are examples of documentation that will be required from the ordering provider as part of the medical necessity review process:

• Pertinent ethnic background (e.g. individuals of Ashkenazi Jewish descent)
• Clinical symptoms and findings
• Specific personal and family medical history related to the requested test
• Presence or absence of disease risk factors

• Results of risk assessment algorithms or prediction models
• Existence or absence of known familial mutation(s)
• Importance of outcomes to the individual and their family
• Usefulness to the provider to guide or change medical management