Reducing Hereditary Cancer Act of 2021
Bill: H.R.4110 | Sponsor: Rep. Wasserman Schultz, Debbie (D-FL)
Policy area: Health

Summary:
Reducing Hereditary Cancer Act of 2021
This bill provides for Medicare coverage of germline mutation testing for individuals with a personal or family history of a hereditary cancer gene mutation or suspected history of hereditary cancer, as well as for associated coverage of risk-reducing surgeries and screenings.

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.

    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 ``Reducing Hereditary Cancer Act of 
2021''.

SEC. 2. HEREDITARY CANCER GENETIC TESTING OF INDIVIDUALS WITH A FAMILY 
              HISTORY OF A HEREDITARY CANCER GENE MUTATION OR PERSONAL 
              OR FAMILY HISTORY SUSPICIOUS FOR HEREDITARY CANCER.

    (a) Coverage.--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 striking the period and inserting ``; and'' 
                at the end of subparagraph (HH); and
                    (C) by inserting after subparagraph (HH) the 
                following new subparagraph:
                    ``(II) in the case of an individual with a personal 
                or family history of a hereditary cancer gene mutation 
                or a personal or family history suspicious for 
                hereditary cancer, germline mutation testing.''; and
            (2) by adding at the end the following new subsection:
    ``(lll) Germline Mutation Testing.--The term `germline mutation 
testing' means genetic testing for germline mutations that is in 
accordance with evidence-based, clinical practice guidelines 
specifically addressing genetic testing, screening, and management of 
individuals with inherited mutations associated with increased cancer 
risk that--
            ``(1) have been developed by a nationally recognized 
        oncology professional organization, including the National 
        Comprehensive Cancer Network, the American Society of Clinical 
        Oncology, the Society of Gynecologic Oncology, or any other 
        oncology professional organization specified by a medicare 
        administrative contractor with a contract under section 1874A; 
        and
            ``(2) in the case of conflicting guidelines developed by 
        more than one nationally recognized oncology professional 
        organization, the least restrictive of such guidelines, as 
        determined by such a medicare administrative contractor.''.
    (b) Frequency.--Section 1862(a)(1) of the Social Security Act (42 
U.S.C. 1395y(a)(1)) is amended--
            (1) by striking ``and'' at the end of subparagraph (O);
            (2) by adding ``and'' at the end of subparagraph (P); and
            (3) by adding at the end the following new subparagraph:
                    ``(Q) in the case of germline mutation testing as 
                defined in section 1861(lll), which is performed more 
                than once with respect to an individual described in 
                such section;''.
    (c) Effective Date.--The amendments made by this section shall 
apply to testing furnished on or after the date of the enactment of 
this Act.

SEC. 3. COVERAGE OF CERTAIN PREVENTIVE SURGERIES.

    (a) In General.--Section 1862 of the Social Security Act (42 U.S.C. 
1395y) is amended by adding at the end the following new subsection:
    ``(p) Coverage of Certain Risk-Reducing Surgeries.--In the case of 
an individual described in section 1861(s)(2)(II) for whom, based on 
evidence-based, clinical practice guidelines described in section 
1861(lll), surgery would reduce the risk of developing cancer, such 
risk-reducing surgery shall be considered reasonable and necessary for 
treatment of illness under subsection (a)(1)(A).''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items and services furnished on or after the date of the 
enactment of this Act.

SEC. 4. COVERAGE OF EVIDENCE-BASED SCREENINGS FOR INDIVIDUALS WITH A 
              HEREDITARY CANCER GENE MUTATION.

    (a) In General.--Section 1862 of the Social Security Act (42 U.S.C. 
1395y), as amended by section 3, is amended by adding at the end the 
following new subsection:
    ``(q) Coverage of Evidence-Based Screenings for Individuals With a 
Hereditary Cancer Gene Mutation.--In the case of an individual who is 
determined pursuant to genetic testing to have a hereditary cancer 
(germline) gene mutation, the Secretary shall increase any frequency 
limitations (or other limitations on coverage otherwise applicable 
under this title) for any evidence-based screenings furnished to such 
individual, to be in compliance with evidence-based, clinical practice 
guidelines described in section 1861(lll), or as determined appropriate 
by the Secretary, but not less frequently than on an annual basis. For 
the purposes of this subsection, evidence-based screenings shall 
include screening mammography, breast screening MRI, colonoscopy, PSA 
testing, and any additional evidence-based screening modalities 
appropriate for high-risk individuals as recommended by such 
guidelines.''.
    (b) Conforming Amendment for Screening Mammography.--Section 
1834(c)(2)(A) of the Social Security Act (42 U.S.C. 1395m(c)(2)(A)) is 
amended, in the matter preceding clause (i), by striking ``subparagraph 
(B)'' and inserting ``subparagraph (B) and section 1862(q)''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after the date of the 
enactment of this Act.
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