Access to Genetic Counselor Services Act of 2021

To amend title XVIII of the Social Security Act to provide for expanded coverage of services furnished by genetic counselors under part B of the Medicare program, and for other purposes. 1. Short title This Act may be cited as the Access to Genetic Counselor Services Act of 2021 2. Medicare coverage of genetic counseling services (a) In general Section 1861 of the Social Security Act ( 42 U.S.C. 1395x (1) in subsection (s)(2)— (A) by striking and (B) by adding and (C) by adding at the end the following new subparagraph: (II) covered genetic counseling services (as defined in subsection (lll)(1)); ; and (2) by adding at the end the following new subsection: (lll) Covered genetic counseling services (1) The term covered genetic counseling services (2) The term genetic counselor (A) is licensed as a genetic counselor by the State in which the individual furnishes genetic counseling services; or (B) in the case of an individual practicing in a State that does not license genetic counselors, meets such other criteria as the Secretary establishes. The provisions of this paragraph shall not be construed as preventing other practitioners, including those providing telehealth services, from providing covered genetic counseling services within the scope of their practice. . (b) Physicians’ services Section 1848(j)(3) of the Social Security Act ( 42 U.S.C. 1395w–4(j)(3) (2)(II), (2)(FF) (including administration of the health risk assessment), (c) Payment (1) In general Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) (A) by striking and (DD) (B) by inserting before the semicolon at the end the following: , and (EE) with respect to covered genetic counseling services under section 1861(s)(2)(II), furnished by a genetic counselor, the amount of payment for such service shall be an amount equal to 85 percent of the lesser of the actual charge for the services or the amount determined under the fee schedule established under section 1848(b) for the same services if furnished by a physician (2) Modifier Section 1834 of the Social Security Act ( 42 U.S.C. 1395m (z) Use of modifier with respect to genetic counseling services (1) Establishment Not later than January 1, 2022, the Secretary shall establish a modifier to be utilized with evaluation and management CPT codes to indicate (in a form and manner specified by the Secretary), in the case of covered genetic counseling services under section 1861(s)(2)(II), if such services were furnished by a genetic counselor. (2) Required use Each request for payment, or bill submitted using evaluation and management CPT codes, for covered genetic counseling services (as defined in section 1861(lll)(1)) furnished by a genetic counselor (as defined in section 1861(lll)(2)) on or after January 1, 2022, shall include the modifier established under subparagraph (A) for each such service. . (d) Assignment of payment Section 1833(r) of the Social Security Act ( 42 U.S.C. 1395l(r) (3) Application to genetic counselors The provisions of paragraphs (1) and (2) shall apply with respect to covered genetic counseling services described in section 1861(s)(2)(II) and genetic counselors (as defined in section 1861(lll)(2)) in the same manner as such provisions apply with respect to services described in section 1861(s)(2)(K)(ii) and nurse practitioners. . (e) Conforming amendment Section 1862(a)(14) of the Social Security Act (42 U.S.C. 1395(y)(a)(14)) is amended by inserting covered genetic counseling services, qualified psychologist services, (f) Effective date (1) In general The amendments made by this section shall apply to services furnished on or after January 1, 2022. (2) Implementation The Secretary of Health and Human Services may implement the amendments made by this section by interim final rule with comment period.

Summary: Access to Genetic Counselor Services Act of 2021 This bill provides for coverage under Medicare of genetic counseling services that are furnished by genetic counselors. Covered services include those services, as well as incidental services and supplies, that would otherwise be covered under Medicare if provided by a physician.