Access to Genetic Counselor Services Act of 2023
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.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2323 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 2323
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
July 13, 2023
Mr. Barrasso (for himself, Mr. Tester, and Mrs. Blackburn) 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 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 2023''.
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
(II);
(B) by adding ``and'' at the end of subparagraph
(JJ); and
(C) by adding at the end the following new
subparagraph:
``(KK) covered genetic counseling services (as defined in
subsection (nnn)(1));''; and
(2) by adding at the end the following new subsection:
``Covered Genetic Counseling Services
``(nnn)(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)(KK),'' 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'' before ``(HH)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (II) with respect to covered
genetic counseling services under section
1861(s)(2)(KK), 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:
``(aa) Use of Modifier With Respect to Genetic Counseling
Services.--
``(1) Establishment.--Not later than January 1, 2024, 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)(KK), 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(nnn)(1)) furnished by a genetic counselor (as defined in
section 1861(nnn)(2)) on or after January 1, 2024, 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)(KK)
and genetic counselors (as defined in section 1861(nnn)(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. 1395y(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, 2024.
(2) Implementation.--The Secretary of Health and Human
Services may implement the amendments made by this section by
interim final rule with comment period.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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