Access to Genetic Counselor Services Act of 2026
Summary
The "Access to Genetic Counselor Services Act of 2026" aims to amend Title XVIII of the Social Security Act to expand Medicare coverage for services provided by genetic counselors. This bill ensures that Medicare Part B covers genetic counseling services furnished by qualified genetic counselors, starting January 1, 2027. It also addresses balance billing and payment structures for these services.
Expected Effects
The primary effect of this bill is to increase access to genetic counseling services for Medicare beneficiaries. By including genetic counselors as recognized providers under Medicare, the bill enables more individuals to receive these services. This will likely lead to earlier detection and management of genetic predispositions to diseases.
Potential Benefits
- Increased access to genetic counseling services for Medicare beneficiaries.
- Potential for earlier detection and management of genetic predispositions to diseases.
- Recognition of genetic counselors as healthcare providers under Medicare.
- Improved healthcare outcomes through proactive genetic risk assessment.
- May reduce long-term healthcare costs by preventing or mitigating genetic-related conditions.
Potential Disadvantages
- Potential increase in Medicare spending due to expanded coverage.
- Possible administrative challenges in implementing the new coverage provisions.
- Risk of overutilization of genetic counseling services if not properly managed.
- The bill stipulates that 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, which may create access issues in some areas.
- The bill relies on state licensing or American Board of Genetic Counseling certification, which may create disparities in service availability depending on location.
Constitutional Alignment
This bill appears to align with the "general Welfare" clause of the US Constitution, as it aims to improve public health by expanding access to genetic counseling services. Specifically, the bill amends Title XVIII of the Social Security Act, which falls under the purview of Congress's power to provide for the general welfare through taxation and spending. The expansion of Medicare coverage does not infringe upon any specific constitutional rights or limitations.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).