Reducing Hereditary Cancer Act of 2023
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.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 765 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 765
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.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 9, 2023
Ms. Murkowski (for herself and Mr. Cardin) 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 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
2023''.
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) in subparagraph (II), by striking ``and'' at
the end;
(B) in subparagraph (JJ), by inserting ``and'' at
the end; and
(C) by adding at the end the following new
subparagraph:
``(KK) 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:
``(nnn) 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, are 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(nnn), 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)(JJ) for whom, based on
evidence-based, clinical practice guidelines described in section
1861(nnn), 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(nnn), 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.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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