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Genetic Counseling Medicare Payment Bill Introduced in Congress

NEW YORK (GenomeWeb) – A bill granting the US Centers for Medicare & Medicaid Services the authority to recognize certified genetic counselors as healthcare providers and reimburse them for their services was introduced in the US Congress last week.

Currently, CMS doesn't recognize genetic counselors as healthcare providers, and H.R. 3235, the "Access to Genetic Counselor Services Act of 2019," would require that genetic counselors be reimbursed for counseling Medicare beneficiaries in the same way these services are covered when provided by a physician.

"Certified genetic counselors are not currently recognized by CMS even though genetic counseling is a covered benefit under Medicare," and this limits Medicare beneficiaries' access to trained healthcare professionals who have a master's degree in genetic counseling, the National Society of Genetic Counselors said in a statement.

The bill was sponsored by Representatives Dave Loebsack (D-IA) and Mike Kelly (R-PA), and the NSGC worked with the legislators on the bill. This issue has been a priority for the genetic counselors' group for well over a decade, and last year the NSGC was successful in getting a bill introduced for the first time in the 115th Congress, co-sponsored by Loebsack and Representative Erik Paulsen (R-Minn.). 

"CMS recognition 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 are expanding," Amy Sturm, NSGC president, said in a statement.

The society has tried to make the case that expanding access to genetic counselors makes good economic sense for CMS and commissioned healthcare consulting firm Dobson, DaVanzo & Associates to conduct an analysis. The study, which relied on interviews, published data, and a claims analysis, projected $4 billion in potential Medicare savings over a decade if certified genetic counselors were to help patients and physicians order the right genetic tests. Moreover, when genetic counselors provide such services, they are reimbursed at 85 percent of the fee that physicians get for the same services, which could lead to potential Medicare savings of $50.7 million over a decade. 

With an estimated 14 new genetic tests entering the market daily, CMS has been concerned about its growing spending in this sector and about inappropriate utilization. "Adding genetic counselors as qualified Medicare providers is an important link in achieving optimal health system performance," Sturm said.

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