Medicare coverage of genetic counseling services

(a)

In general

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—(1)in subsection (s)(2)—(A)by striking and at the end of subparagraph (II);(B)by adding and at the end of subparagraph (JJ); and(C)by adding at the end the following new subparagraph:

(KK)covered genetic counseling services (as defined in subsection (nnn)(1));

; and

(2)by adding at the end the following new subsection:

(nnn)

Covered Genetic Counseling Services

(1)The term covered genetic counseling services means genetic counseling services furnished on or after January 1, 2027, by a genetic counselor (as defined in paragraph (2)) and such services and supplies furnished as an incident to the provision of such services which the genetic counselor is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) as would otherwise be covered if furnished by a physician (or as incident to a physician’s service).(2)The term genetic counselor means an individual who—(A)is licensed as a genetic counselor by the State in which the individual furnishes genetic counseling services; or(B)in the case of an individual practicing in a State that does not license genetic counselors, is certified by the American Board of Genetic Counseling and meets such other criteria as the Secretary establishes.

(b)

Balance billing

Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clause:

(ix)A genetic counselor (as defined in section 1861(nnn)(2)).

(c)

Payment

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—(1)by striking and (HH) and inserting (HH); and(2)by inserting before the semicolon at the end the following: , and (II) with respect to covered genetic counseling services (as defined in section 1861(nnn)(1)), the amount paid shall be equal to 80 percent of the lesser of (i) the actual charge for the services or (ii) 85 percent of the fee schedule amount provided under section 1848 that would have applied had the genetic counseling services been furnished by a physician.(d)

Conforming amendment

Section 1862(a)(14) of the Social Security Act (42 U.S.C. 1395(y)(a)(14)) is amended by inserting covered genetic counseling services, after qualified psychologist services,.(e)

Rule of construction

The amendments made by this section shall not be construed as preventing physicians and health care providers other than genetic counselors from billing for genetic counseling services under the Medicare program which are otherwise covered under such program.(f)

Implementation

Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by this section by interim final rule with comment period.