On March 23, 2021, Representative Brian Higgins introduced H.R. 2144, a bill to amend title XVIII of the Social Security Act to provide for expanded coverage of services furnished by genetic counselors under part B of the Medicare program. The bill, developed by working closely with the National Society of Genetic Counselors (NSGC), would authorize the United States Centers for Medicare and Medicaid Services (CMS) to recognize certified genetic counselors (CGCs) as healthcare providers.
The expansion of coverage would improve Medicare beneficiaries’ accessibility to genetic counselors, healthcare professionals who provide specialized services in medical genetics and counseling. Currently, CGCs do not have provider status under Medicare even though genetic counseling is a covered benefit and therefore, CGCs cannot be reimbursed for providing services to Medicare beneficiaries, which impedes patients’ access to these uniquely trained healthcare professionals who completed specialized master degree programs in genetic counseling.
CGCs bring expertise to the healthcare team by guiding and supporting patients seeking more information about how inherited diseases and conditions might affect them or their families. Research demonstrates that CGCs improve the quality of patients’ healthcare and reduce the costs of genetic services – all priorities as personalized medicine and genetics become more prevalent.
“As the leading voice for the genetic counseling profession, the National Society of Genetic Counselors (NSGC) is pleased Representative Higgins has taken this step to allow Medicare patients to access genetic counselors,” said Sara Riordan, MS, CGC, NSGC president. “CMS status has been a priority for our organization because the services genetic counselors provide can have a huge impact on the health of individuals and their families, especially as both the benefits of personalized medicine and complexities of genetic testing expand.”
“Adding genetic counselors as qualified Medicare providers is an important link in achieving optimal health system performance,” said Riordan. “We already know genetic counselors improve the quality of care and reduce costs, and when this bill passes, we’ll also be accessible to a larger population. We encourage people to contact their members of Congress to ask for support of H.R. 2144.”
According to NSGC, if Congress were to pass this legislation, healthcare costs could be lowered because it would help to ensure the appropriate use of genetic testing. When done improperly, inaccurate risk assessments can lead to inappropriate medical treatment and in worst case scenarios, death. Additionally, by not providing it as a benefit to Medicare beneficiaries, it results in a lack of access to a large contingent of the patient population. Lack of access can result in harm such as incorrect interpretations of genetic test results and failure to identify individuals who have increased genetic risk.
This bill was also previously introduced in 2019, though it did not make it out of Committee.