H.R. 6280: Access to Genetic Counselor Services Act of 2025

This bill, titled the Access to Genetic Counselor Services Act of 2025, aims to amend the Social Security Act to expand the coverage of genetic counseling services under Medicare, specifically part B. The primary components of the bill include:

Expanded Coverage of Genetic Counseling

The bill seeks to provide Medicare coverage for genetic counseling services beginning January 1, 2027. This means that individuals eligible for Medicare will have access to genetic counseling services without significant out-of-pocket costs. The bill defines covered genetic counseling services as those provided by a licensed genetic counselor, or if the state does not license genetic counselors, services provided by a certified counselor who meets certain criteria established by the Secretary of Health and Human Services.

Definition and Standards for Genetic Counselors

The bill specifies that a genetic counselor must be:

• Licensed in the state where the services are provided, or
• Certified by the American Board of Genetic Counseling in states that do not offer licensure.

This ensures that the services provided are by qualified professionals who adhere to state regulations or national standards.

Payment Structure

Medicare is set to reimburse 80% of the cost for covered genetic counseling services. The payment is characterized as the lesser of either the actual charge for the services or 85% of the fee schedule amount that would be applied if the services were provided by a physician. This provision aims to make genetic counseling more financially accessible to Medicare recipients.

Balance Billing Protection

The bill also introduces measures to prevent genetic counselors from balance billing, which means they cannot charge patients the difference between what Medicare pays and what they might want to charge. This provides additional financial protection for beneficiaries receiving genetic counseling services.

Implementation Authority

The bill grants the Secretary of Health and Human Services the authority to implement these changes via an interim final rule, allowing the provisions to be enacted quickly while still opening the floor for comments and revisions from stakeholders.

Provisions for Existing Services

Furthermore, the bill clarifies that the amendments do not prevent physicians and other healthcare providers from billing for genetic counseling services that are already covered under Medicare. This maintains the flexibility for traditional healthcare providers to continue offering genetic counseling as part of their services.

Relevant Companies

• EXAS (Exact Sciences Corporation) - A company that specializes in genomic screening and diagnostic tests, may see increased demand for genetic counseling services as more patients gain access under Medicare.
• ILMN (Illumina, Inc.) - A leader in genomics and DNA sequencing technology, likely to benefit from a rise in genetic testing and counseling as more Medicare beneficiaries can access these services.