Reducing Hereditary Cancer Act
- Bill Number
- H.R. 4752
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-06-19T08:05:55Z
AI-Generated Summary
Purpose of the Legislation
The Reducing Hereditary Cancer Act (H.R. 4752) aims to expand Medicare coverage for genetic testing, preventive surgeries, and enhanced cancer screenings for individuals at high risk of hereditary cancers due to inherited gene mutations or family history. It seeks to enable early detection and risk reduction for preventable cancers by making these services accessible under Medicare without additional cost-sharing for eligible beneficiaries.
Key Provisions
- Genetic Testing Coverage (Section 2): Medicare Part B will cover germline mutation testing (genetic tests for inherited mutations linked to higher cancer risk) for individuals with a personal or family history of a hereditary cancer gene mutation, or a history suspicious for hereditary cancer. Testing must follow evidence-based guidelines from nationally recognized oncology groups (e.g., National Comprehensive Cancer Network or American Society of Clinical Oncology). Coverage is limited to once per individual, and applies to tests performed on or after the date of enactment.
- Preventive Surgeries (Section 3): Medicare will cover risk-reducing surgeries (e.g., procedures to lower cancer risk) for individuals with confirmed hereditary mutations, if recommended by the same evidence-based guidelines. These surgeries are deemed "reasonable and necessary" for treatment, with coverage starting on or after enactment.
- Enhanced Screenings (Section 4): For those with confirmed hereditary mutations, Medicare will cover more frequent evidence-based cancer screenings (at least annually, or as guidelines recommend) beyond standard limits. This includes mammography, breast MRI, colonoscopy, PSA testing (for prostate cancer), and other appropriate screenings for high-risk individuals. A conforming change updates mammography coverage rules. Applies to services on or after enactment.
Significant Changes to Existing Law
- Amends Section 1861 of the Social Security Act to add germline mutation testing as a covered service under Medicare Part B, including a new definition tied to oncology guidelines (with Medicare contractors resolving conflicts by selecting the least restrictive option).
- Modifies Section 1862 to exclude these new services from Medicare's general exclusions for non-medically necessary items, and limits repeat genetic testing.
- Adds new subsections (p) and (q) to Section 1862 for surgery and screening coverage, overriding existing frequency limits (e.g., annual mammograms become more frequent if needed).
- These changes integrate with current Medicare preventive services but specifically target hereditary risks, without requiring prior authorization beyond guideline compliance.
Potential Impacts
- On Citizens: Medicare beneficiaries (typically age 65+) with hereditary cancer risks or family histories will gain no-cost access to testing, surgeries, and screenings, potentially leading to earlier interventions, reduced cancer incidence, and lower out-of-pocket costs for preventive care.
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) will need to update coverage policies, contractor guidelines, and claims processing to implement these evidence-based services, which could increase short-term administrative and reimbursement costs but may lower long-term expenses from advanced cancer treatments.
- On International Relations: No direct impacts, as the bill focuses on domestic Medicare policy.
Main Stakeholders Affected
- Medicare Beneficiaries: Primarily older adults with personal, family, or ancestral histories of hereditary cancers (e.g., BRCA1/2 mutations linked to breast/ovarian cancer).
- Healthcare Providers: Oncologists, genetic counselors, and surgeons who perform testing, screenings, and procedures, benefiting from clearer reimbursement guidelines.
- Oncology Professional Organizations: Groups like the National Comprehensive Cancer Network, which influence coverage through their guidelines.
- Government and Insurers: CMS and Medicare Administrative Contractors, responsible for enforcement and determining guideline compliance.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicare's preventive care framework under Title XVIII by explicitly covering hereditary risk services, potentially reducing future litigation over coverage denials for high-risk patients. Relies on "evidence-based" standards to ensure medical necessity, avoiding arbitrary decisions.
- Constitutional: No apparent challenges; aligns with Congress's authority to regulate interstate commerce and social welfare programs like Medicare.
- Political: Bipartisan introduction (by Democrats and Republicans) suggests broad support for cancer prevention. Could set a precedent for expanding Medicare to personalized medicine, influencing future health policy debates on genetic testing access and cost control.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Wasserman Schultz, Debbie [D-FL-25]
Cosponsors (31)
Rep. Miller-Meeks, Mariannette [R-IA-1], Rep. Schrier, Kim [D-WA-8], Rep. Buchanan, Vern [R-FL-16], Rep. Cohen, Steve [D-TN-9], Rep. Dingell, Debbie [D-MI-6], Rep. Gottheimer, Josh [D-NJ-5], Rep. Simon, Lateefah [D-CA-12], Rep. Carson, André [D-IN-7], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Bonamici, Suzanne [D-OR-1], Rep. Cisneros, Gilbert Ray [D-CA-31], Rep. Nunn, Zachary [R-IA-3], Rep. McBride, Sarah [D-DE-At Large], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Kennedy, Timothy M. [D-NY-26], Rep. Tonko, Paul [D-NY-20], Rep. Goldman, Daniel S. [D-NY-10], Rep. Bacon, Don [R-NE-2], Rep. Matsui, Doris O. [D-CA-7], Rep. Dean, Madeleine [D-PA-4], Rep. Hayes, Jahana [D-CT-5], Rep. Kiggans, Jennifer A. [R-VA-2], Rep. Owens, Burgess [R-UT-4], Rep. Scholten, Hillary J. [D-MI-3], Rep. Jackson, Jonathan L. [D-IL-1], Rep. Figures, Shomari [D-AL-2], Rep. Grijalva, Adelita S. [D-AZ-7], Rep. Langworthy, Nicholas A. [R-NY-23], Rep. Wilson, Frederica S. [D-FL-24], Rep. Barragán, Nanette Diaz [D-CA-44], Rep. Pocan, Mark [D-WI-2]
Recent Actions
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Introduced in House
- 2025-07-23: Introduced in House
Bill Versions
- Reducing Hereditary Cancer Act — issued 2025-07-23 — PDF (6 pages)