S. 3607: Access to Genetic Counselor Services Act of 2026

This bill, known as the Access to Genetic Counselor Services Act of 2026, aims to amend the Social Security Act to expand Medicare coverage for genetic counseling services. Here are the main points of the bill:

Overview of Genetic Counseling Services

Genetic counseling involves providing individuals and families with information and support regarding genetic conditions, including how genetic factors can affect health. This bill seeks to ensure that Medicare beneficiaries have better access to these services.

Changes to Medicare Coverage

The bill introduces several key amendments regarding the coverage of genetic counseling services under Medicare, effective starting January 1, 2027:

• Included Services: Genetic counseling services will be officially defined as covered services under Medicare.
• Provider Qualifications: Genetic counselors must either hold a license in the state where they practice or be certified by the American Board of Genetic Counseling if the state does not license genetic counselors.
• Payment Structure: Medicare will reimburse genetic counseling services at 80% of the lesser of the actual charge or 85% of the standard physician fee schedule. This ensures that genetic counselors are compensated similarly to other healthcare providers.

Impact on Billing Practices

The bill addresses how genetic counselors can bill for their services under Medicare:

• Balance Billing: The bill specifies that genetic counselors will be recognized for billing under existing balance billing provisions, allowing them to charge Medicare beneficiaries directly if necessary.
• Other Providers: The changes will not prevent other healthcare providers, including physicians, from continuing to bill for genetic counseling services that are covered by Medicare.

Implementation and Administrative Authority

The Secretary of Health and Human Services is given the authority to implement these changes through interim final rules, allowing for quicker enactment of the new coverage provisions.

Conclusion on Coverage Inclusion

Overall, the bill aims to enhance Medicare's coverage of genetic counseling services, making it easier for beneficiaries to receive important genetic information and support.

Relevant Companies

• ILMN (Illumina, Inc.) - Illumina is known for its genetic sequencing technology. Increased coverage of genetic counseling services could lead to higher demand for genetic testing products.
• EXAS (Exact Sciences Corporation) - This company provides cancer screening and diagnostic products. Expanding genetic counseling could drive greater usage of their tests and services.