Children's Special Health Services

Montana Genetic Testing Financial Assistance Information 

Funding 

Genetic Testing Financial Assistance funds can be used when:

• The applicant’s insurance company will not pay for the test, or the applicant is uninsured or underinsured.
• The applicant has no other resource to cover the requested service.

Funds are limited and may not meet the needs of all individuals that qualify. The fund operates on a state fiscal year. New funds will be available every July 1^st. If the application is approved, the test must be done before June 30^th, or a new application will be required.

Medical Requirements

Shodair Children’s Hospital reviews applications for genetic testing financial assistance. The review is based on the following information, which must be specific to the applicant, documented on the application, or submitted with the application:

• Pre- and post-test genetic counseling must be provided;
• The requested test must be performed by a CLIA-certified laboratory;
• Genetic testing is recommended in place of to confirm or to rule out a clinical diagnosis;
• The requested test is not considered experimental or investigational;
• The requested laboratory test is to provide clinical benefit (the course of treatment may change) to the patient;
• Current signs or symptoms or a family history suggest a genetic condition;
• Current medical records (applicant must have been seen within the last six months) and physician notes verify the confirmed or suspected medical condition for which testing is being planned.

Application

The Genetic Financial Assistance Application can be found by clicking here.

In addition to the application, the provider requesting the laboratory testing must supply the following information:

• Current medical records and physician notes that detail the confirmed or suspected medical condition.
• If the individual has insurance coverage, you will need to pre-authorize the requested service and supply a copy of the determination.
• Include a copy of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services program denial letter if the individual is a child through age 20 and is covered under Medicaid or Healthy Montana Kids Plus. See the section below on special instructions for youth with Montana Medicaid Coverage.

When a request is approved, the provider will be notified. Please note:

• Genetic financial assistance cannot be awarded prior to the signature date on the application.
• Incomplete applications will not be approved.
• Patients may submit multiple applications.
• The application must be completed and signed on the day of or prior to the blood draw.

*Special Instructions for Youth with Montana Medicaid Coverage*

If the applicant is a child through age 20 and is covered by Medicaid or Healthy Montana Kids Plus, use the same process followed when submitting claims and requesting prior authorizations as outlined in the General Information for Providers Manual located at http://medicaidprovider.mt.gov.

If the requested procedure code is denied and/or not listed on the current fee schedule (located at the link above), you must request a review for medical necessity through Early Periodic Screening Diagnosis and Treatment (EPSDT).

Contact the EPSDT Program Officer at (406) 444-0950 and ask for a Request for Additional Services (EPSDT) Information Sheet form. Complete and return the form to the EPSDT Program Officer. When the review is complete, the Program Officer will send a written approval or denial letter. If approved, the letter will contain instructions explaining where to send the claim or the Prior Authorization (PA) number (if necessary). If the test is denied, please continue with the Genetic Testing Financial Assistance application process.

Questions?

General Inquiries: Please contact the Children’s Special Health Services’ Nurse Consultant at 406-444-3657 or email at chelsea.pugh@mt.gov.

Application Specific Inquiries: If you have questions about a specific application, review timeline, or application requirements, please contact Jaclyn Haven with Shodair Children’s Hospital at 406-444-7520 or by email at  jhaven@shodair.org.