Access to Genetic Counselor Services Act of 2021

II 117TH CONGRESS 1ST SESSION S. 1450 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. IN THE SENATE OF THE UNITED STATES APRIL 29, 2021 Mr. BARRASSO (for himself and Mr. TESTER) 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 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 Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Access to Genetic 4 Counselor Services Act of 2021’’. 5 VerDate Sep 11 2014 01:21 May 25, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1450.IS S1450 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1450 IS SEC. 2. MEDICARE COVERAGE OF GENETIC COUNSELING 1 SERVICES. 2 (a) IN GENERAL.—Section 1861 of the Social Secu- 3 rity Act (42 U.S.C. 1395x) is amended— 4 (1) in subsection (s)(2)— 5 (A) by striking ‘‘and’’ at the end of sub- 6 paragraph (GG); 7 (B) by adding ‘‘and’’ at the end of sub- 8 paragraph (HH); and 9 (C) by adding at the end the following new 10 subparagraph: 11 ‘‘(II) covered genetic counseling services (as de- 12 fined in subsection (lll)(1));’’; and 13 (2) by adding at the end the following new sub- 14 section: 15 ‘‘Covered Genetic Counseling Services 16 ‘‘(lll)(1) The term ‘covered genetic counseling serv- 17 ices’ means genetic counseling services furnished by a ge- 18 netic counselor (as defined in paragraph (2)) (and such 19 services and supplies furnished as an incident to the provi- 20 sion of such services) as would otherwise be covered under 21 this title if furnished by a physician (or as incident to a 22 physician’s service). 23 ‘‘(2) The term ‘genetic counselor’ means an indi- 24 vidual who— 25 VerDate Sep 11 2014 01:21 May 25, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1450.IS S1450 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1450 IS ‘‘(A) is licensed as a genetic counselor by the 1 State in which the individual furnishes genetic coun- 2 seling services; or 3 ‘‘(B) in the case of an individual practicing in 4 a State that does not license genetic counselors, 5 meets such other criteria as the Secretary estab- 6 lishes. 7 The provisions of this paragraph shall not be construed 8 as preventing other practitioners, including those pro- 9 viding telehealth services, from providing covered genetic 10 counseling services within the scope of their practice.’’. 11 (b) PHYSICIANS’ SERVICES.—Section 1848(j)(3) of 12 the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 13 amended by inserting ‘‘(2)(II),’’ after ‘‘(2)(FF) (including 14 administration of the health risk assessment),’’. 15 (c) PAYMENT.— 16 (1) IN GENERAL.—Section 1833(a)(1) of the 17 Social Security Act (42 U.S.C. 1395l(a)(1)) is 18 amended— 19 (A) by striking ‘‘and’’ before ‘‘(DD)’’; and 20 (B) by inserting before the semicolon at 21 the end the following: ‘‘, and (EE) with respect 22 to covered genetic counseling services under sec- 23 tion 1861(s)(2)(II), furnished by a genetic 24 counselor, the amount of payment for such 25 VerDate Sep 11 2014 01:21 May 25, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1450.IS S1450 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1450 IS service shall be an amount equal to 85 percent 1 of the lesser of the actual charge for the serv- 2 ices or the amount determined under the fee 3 schedule established under section 1848(b) for 4 the same services if furnished by a physician’’. 5 (2) MODIFIER.—Section 1834 of the Social Se- 6 curity Act (42 U.S.C. 1395m) is amended by adding 7 at the end the following new subsection: 8 ‘‘(z) USE OF MODIFIER WITH RESPECT TO GENETIC 9 COUNSELING SERVICES.— 10 ‘‘(1) ESTABLISHMENT.—Not later than Janu- 11 ary 1, 2022, the Secretary shall establish a modifier 12 to be utilized with evaluation and management CPT 13 codes to indicate (in a form and manner specified by 14 the Secretary), in the case of covered genetic coun- 15 seling services under section 1861(s)(2)(II), if such 16 services were furnished by a genetic counselor. 17 ‘‘(2) REQUIRED USE.—Each request for pay- 18 ment, or bill submitted using evaluation and man- 19 agement CPT codes, for covered genetic counseling 20 services (as defined in section 1861(lll)(1)) furnished 21 by a genetic counselor (as defined in section 22 1861(lll)(2)) on or after January 1, 2022, shall in- 23 clude the modifier established under subparagraph 24 (A) for each such service.’’. 25 VerDate Sep 11 2014 01:21 May 25, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1450.IS S1450 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1450 IS (d) ASSIGNMENT OF PAYMENT.—Section 1833(r) of 1 the Social Security Act (42 U.S.C. 1395l(r)) is amended 2 by adding at the end the following new paragraph: 3 ‘‘(3) APPLICATION TO GENETIC COUNSELORS.— 4 The provisions of paragraphs (1) and (2) shall apply 5 with respect to covered genetic counseling services 6 described in section 1861(s)(2)(II) and genetic coun- 7 selors (as defined in section 1861(lll)(2)) in the 8 same manner as such provisions apply with respect 9 to services described in section 1861(s)(2)(K)(ii) and 10 nurse practitioners.’’. 11 (e) CONFORMING AMENDMENT.—Section 12 1862(a)(14) of the Social Security Act (42 U.S.C. 13 1395(y)(a)(14)) is amended by inserting ‘‘covered genetic 14 counseling services,’’ after ‘‘qualified psychologist serv- 15 ices,’’. 16 (f) EFFECTIVE DATE.— 17 (1) IN GENERAL.—The amendments made by 18 this section shall apply to services furnished on or 19 after January 1, 2022. 20 (2) IMPLEMENTATION.—The Secretary of 21 Health and Human Services may implement the 22 amendments made by this section by interim final 23 rule with comment period. 24 Æ VerDate Sep 11 2014 01:21 May 25, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S1450.IS S1450 kjohnson on DSK79L0C42PROD with BILLS