II 

118TH CONGRESS 

1ST SESSION S. 765 

To amend title XVIII of the Social Security Act to provide hereditary cancer 

genetic testing for individuals with a history of a hereditary cancer 

gene mutation in a blood relative or a personal or ancestral history 

suspicious for hereditary cancer, and to provide coverage of certain 

cancer screenings or preventive surgeries that would reduce the risk 

for individuals with a germline (inherited) mutation associated with a 

high risk of developing a preventable cancer. 

IN THE SENATE OF THE UNITED STATES 

MARCH 9, 2023 

Ms. MURKOWSKI (for herself and Mr. CARDIN) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

hereditary cancer genetic testing for individuals with a 

history of a hereditary cancer gene mutation in a blood 

relative or a personal or ancestral history suspicious for 

hereditary cancer, and to provide coverage of certain 

cancer screenings or preventive surgeries that would reduce the risk for individuals with a germline (inherited) 

mutation associated with a high risk of developing a 

preventable cancer. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


kjohnson on DSK79L0C42PROD with BILLS
2 

•S 765 IS

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Reducing Hereditary 

3 Cancer Act of 2023’’. 

4 SEC. 2. HEREDITARY CANCER GENETIC TESTING OF INDI5 VIDUALS WITH A FAMILY HISTORY OF A HE6 REDITARY CANCER GENE MUTATION OR PER7 SONAL OR FAMILY HISTORY SUSPICIOUS FOR 

8 HEREDITARY CANCER. 

9 (a) COVERAGE.—Section 1861 of the Social Security 

10 Act (42 U.S.C. 1395x) is amended— 

11 (1) in subsection (s)(2)— 

12 (A) in subparagraph (II), by striking 

13 ‘‘and’’ at the end; 

14 (B) in subparagraph (JJ), by inserting 

15 ‘‘and’’ at the end; and 

16 (C) by adding at the end the following new 

17 subparagraph: 

18 ‘‘(KK) in the case of an individual with a per19 sonal or family history of a hereditary cancer gene 

20 mutation or a personal or family history suspicious 

21 for hereditary cancer, germline mutation testing;’’; 

22 and 

23 (2) by adding at the end the following new sub24 section: 

25 ‘‘(nnn) GERMLINE MUTATION TESTING.—The term 

26 ‘germline mutation testing’ means genetic testing for 


kjohnson on DSK79L0C42PROD with BILLS
3 

•S 765 IS

1 germline mutations that is in accordance with evidence2 based, clinical practice guidelines specifically addressing 

3 genetic testing, screening, and management of individuals 

4 with inherited mutations associated with increased cancer 

5 risk that— 

6 ‘‘(1) have been developed by a nationally recog7 nized oncology professional organization, including 

8 the National Comprehensive Cancer Network, the 

9 American Society of Clinical Oncology, the Society 

10 of Gynecologic Oncology, or any other oncology pro11 fessional organization specified by a medicare ad12 ministrative contractor with a contract under section 

13 1874A; and 

14 ‘‘(2) in the case of conflicting guidelines devel15 oped by more than one nationally recognized oncol16 ogy professional organization, are the least restric17 tive of such guidelines, as determined by such a 

18 medicare administrative contractor.’’. 

19 (b) FREQUENCY.—Section 1862(a)(1) of the Social 

20 Security Act (42 U.S.C. 1395y(a)(1)) is amended— 

21 (1) by striking ‘‘and’’ at the end of subpara22 graph (O); 

23 (2) by adding ‘‘and’’ at the end of subpara24 graph (P); and 


kjohnson on DSK79L0C42PROD with BILLS
4 

•S 765 IS

1 (3) by adding at the end the following new sub2 paragraph: 

3 ‘‘(Q) in the case of germline mutation testing 

4 as defined in section 1861(nnn), which is performed 

5 more than once with respect to an individual de6 scribed in such section;’’. 

7 (c) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply to testing furnished on or after 

9 the date of the enactment of this Act. 

10 SEC. 3. COVERAGE OF CERTAIN PREVENTIVE SURGERIES. 

11 (a) IN GENERAL.—Section 1862 of the Social Secu12 rity Act (42 U.S.C. 1395y) is amended by adding at the 

13 end the following new subsection: 

14 ‘‘(p) COVERAGE OF CERTAIN RISK-REDUCING SUR15 GERIES.—In the case of an individual described in section 

16 1861(s)(2)(JJ) for whom, based on evidence-based, clin17 ical practice guidelines described in section 1861(nnn), 

18 surgery would reduce the risk of developing cancer, such 

19 risk-reducing surgery shall be considered reasonable and 

20 necessary for treatment of illness under subsection 

21 (a)(1)(A).’’. 

22 (b) EFFECTIVE DATE.—The amendment made by 

23 subsection (a) shall apply to items and services furnished 

24 on or after the date of the enactment of this Act. 


kjohnson on DSK79L0C42PROD with BILLS
5 

•S 765 IS

1 SEC. 4. COVERAGE OF EVIDENCE-BASED SCREENINGS FOR 

2 INDIVIDUALS WITH A HEREDITARY CANCER 

3 GENE MUTATION. 

4 (a) IN GENERAL.—Section 1862 of the Social Secu5 rity Act (42 U.S.C. 1395y), as amended by section 3, is 

6 amended by adding at the end the following new sub7 section: 

8 ‘‘(q) COVERAGE OF EVIDENCE-BASED SCREENINGS

9 FOR INDIVIDUALS WITH A HEREDITARY CANCER GENE

10 MUTATION.—In the case of an individual who is deter11 mined pursuant to genetic testing to have a hereditary 

12 cancer (germline) gene mutation, the Secretary shall in13 crease any frequency limitations (or other limitations on 

14 coverage otherwise applicable under this title) for any evi15 dence-based screenings furnished to such individual, to be 

16 in compliance with evidence-based, clinical practice guide17 lines described in section 1861(nnn), or as determined ap18 propriate by the Secretary, but not less frequently than 

19 on an annual basis. For the purposes of this subsection, 

20 evidence-based screenings shall include screening mam21 mography, breast screening MRI, colonoscopy, PSA test22 ing, and any additional evidence-based screening modali23 ties appropriate for high-risk individuals as recommended 

24 by such guidelines.’’. 

25 (b) CONFORMING AMENDMENT FOR SCREENING

26 MAMMOGRAPHY.—Section 1834(c)(2)(A) of the Social SeVerDate Sep 11 2014 22:07 Mar 20, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S765.IS S765

kjohnson on DSK79L0C42PROD with BILLS
6 

•S 765 IS

1 curity Act (42 U.S.C. 1395m(c)(2)(A)) is amended, in the 

2 matter preceding clause (i), by striking ‘‘subparagraph 

3 (B)’’ and inserting ‘‘subparagraph (B) and section 

4 1862(q)’’. 

5 (c) EFFECTIVE DATE.—The amendments made by 

6 this section shall apply to items and services furnished on 

7 or after the date of the enactment of this Act. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS