Access to Genetic Counselor Services Act of 2025
- Bill Number
- H.R. 6280
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-21: 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
- 2026-06-11T08:07:20Z
AI-Generated Summary
Purpose
The Access to Genetic Counselor Services Act of 2025 aims to expand Medicare Part B coverage to include genetic counseling services provided directly by qualified genetic counselors, making these services more accessible to Medicare beneficiaries without requiring them to be incidental to a physician's care.
Key Provisions
- Coverage Definition: Adds "covered genetic counseling services" to the list of Medicare Part B benefits under Section 1861(s) of the Social Security Act. These services must be furnished on or after January 1, 2027, by a licensed or certified genetic counselor and include related supplies or incident-to services (services provided under the counselor's supervision, similar to those covered when provided by a physician).
- Genetic Counselor Qualifications: Defines a genetic counselor as either:
- Licensed by the state where services are provided, or
- Certified by the American Board of Genetic Counseling in states without licensing, plus any additional criteria set by the Secretary of Health and Human Services (HHS).
- Balance Billing Protections: Prohibits genetic counselors from balance billing Medicare beneficiaries (charging them more than the Medicare-approved amount), aligning them with other non-physician providers.
- Payment Structure: Medicare pays 80% of the lesser of the actual charge or 85% of the physician fee schedule amount under Section 1848, reducing the rate slightly compared to full physician reimbursement to account for the counselor's scope.
- Exclusions and Flexibility: Exempts these services from certain Medicare restrictions on non-physician services. A rule of construction ensures physicians and other providers can still bill for genetic counseling if otherwise covered.
- Implementation: Allows HHS to enact changes via an interim final rule with a comment period, bypassing standard rulemaking delays.
Significant Changes to Existing Law
- Previously, genetic counseling under Medicare was often covered only as an incidental service to a physician's visit (e.g., under diagnostic testing rules), limiting direct access and reimbursement for counselors.
- This bill introduces standalone coverage for genetic counseling, expands the definition of eligible providers to include genetic counselors, and establishes a specific payment mechanism, marking a shift toward recognizing genetic counseling as a distinct, reimbursable profession.
- It also adds genetic counselors to balance billing limits and removes barriers under Section 1862(a)(14), which previously restricted certain non-physician services.
Potential Impacts
- On Citizens: Medicare beneficiaries, particularly older adults or those with hereditary conditions, gain easier access to genetic counseling for risk assessment, family planning, and preventive care, potentially improving health outcomes and reducing long-term costs from untreated genetic risks.
- On Government Agencies: HHS will need to update Medicare regulations, fee schedules, and oversight for genetic counselors, which may increase administrative workload and Medicare expenditures (exact costs unspecified but tied to utilization).
- On International Relations: No direct impacts, as the bill focuses on domestic U.S. healthcare policy.
- Broader effects could include encouraging state-level licensing of genetic counselors to standardize qualifications nationwide.
Main Stakeholders Affected
- Medicare Beneficiaries: Primary users who benefit from expanded, direct access to services.
- Genetic Counselors: Gain professional recognition, reimbursement eligibility, and ability to serve Medicare patients independently.
- Physicians and Healthcare Providers: Can continue providing these services but face potential competition; incident-to billing remains an option.
- HHS and Centers for Medicare & Medicaid Services (CMS): Responsible for implementation, payment adjustments, and monitoring compliance.
- Congressional Committees: Referred to Energy and Commerce and Ways and Means for oversight on healthcare and fiscal policy.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicare's role in preventive services by broadening provider types, aligning with existing expansions for non-physician roles (e.g., nurse practitioners). The interim final rule provision accelerates rollout but invites public input to ensure fairness.
- Constitutional: No apparent challenges; it operates within Congress's authority under the Spending Clause to regulate federal programs like Medicare.
- Political: Supports bipartisan healthcare access goals (introduced by representatives from both parties), potentially reducing disparities in genetic services amid rising demand for personalized medicine. Fiscal conservatives may scrutinize added costs to the Medicare trust fund, while advocates highlight long-term savings from early intervention.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (24)
Rep. Castor, Kathy [D-FL-14], Rep. Neguse, Joe [D-CO-2], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Davis, Donald G. [D-NC-1], Rep. Crow, Jason [D-CO-6], Rep. Raskin, Jamie [D-MD-8], Rep. Gottheimer, Josh [D-NJ-5], Rep. Bilirakis, Gus M. [R-FL-12], Rep. DelBene, Suzan K. [D-WA-1], Rep. Lawler, Michael [R-NY-17], Rep. Swalwell, Eric [D-CA-14], Rep. Dean, Madeleine [D-PA-4], Rep. Tonko, Paul [D-NY-20], Rescom. Hernández, Pablo Jose [D-PR-At Large], Rep. Peters, Scott H. [D-CA-50], Rep. Craig, Angie [D-MN-2], Rep. Pingree, Chellie [D-ME-1], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Cohen, Steve [D-TN-9], Rep. LaHood, Darin [R-IL-16], Rep. Scanlon, Mary Gay [D-PA-5], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Lynch, Stephen F. [D-MA-8], Rep. Houlahan, Chrissy [D-PA-6]
Recent Actions
- 2025-11-21: 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.
- 2025-11-21: 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.
- 2025-11-21: Introduced in House
- 2025-11-21: Introduced in House
Bill Versions
- Access to Genetic Counselor Services Act of 2025 — issued 2025-11-21 — PDF (4 pages)