Access to Genetic Counselor Services Act of 2021
Bill: H.R.2144 | Sponsor: Rep. Higgins, Brian (D-NY)
Policy area: Health

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.

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Access to Genetic Counselor Services 
Act of 2021''.

SEC. 2. MEDICARE COVERAGE OF GENETIC COUNSELING SERVICES.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) by striking ``and'' at the end of subparagraph 
                (GG);
                    (B) by adding ``and'' at the end of subparagraph 
                (HH); and
                    (C) by adding at the end the following new 
                subparagraph:
                                    ``(II) covered genetic counseling 
                                services (as defined in subsection 
                                (kkk)(1));''; and
            (2) by adding at the end the following new subsection:

                 ``Covered Genetic Counseling Services

    ``(kkk)(1) The term ``covered genetic counseling services'' means 
genetic counseling services furnished by a genetic counselor (as 
defined in paragraph (2)) (and such services and supplies furnished as 
an incident to the provision of such services) as would otherwise be 
covered under this title if furnished by a physician (or as incident to 
a physician's service).
    ``(2) The term `genetic counselor' means an individual who--
            ``(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)) is amended by inserting 
``(2)(II),'' after ``(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)) is amended--
                    (A) by striking ``and (CC)'' and inserting 
                ``(CC)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (DD) 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) is amended by adding at the end the following new 
        subsection:
    ``(x) 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(kkk)(1)) furnished by a genetic counselor (as defined in 
        section 1861(kkk)(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)) is amended by adding at the end the following 
new paragraph:
            ``(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(kkk)(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,'' after ``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.
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