Genomic Answers for Children’s Health Act of 2026

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7118 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 7118

  To amend title XIX of the Social Security Act to clarify that whole 
  genome and whole exome sequencing for children with certain medical 
              needs is covered under the Medicaid program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 15, 2026

Mr. Peters (for himself, Mr. Bilirakis, Mr. Veasey, Mr. Balderson, Mr. 
   Mullin, Mr. Carey, Ms. Houlahan, and Ms. Salazar) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
  To amend title XIX of the Social Security Act to clarify that whole 
  genome and whole exome sequencing for children with certain medical 
              needs is covered under the Medicaid program.

    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 ``Genomic Answers for Children's 
Health Act of 2026''.

SEC. 2. CLARIFYING THAT WHOLE GENOME AND WHOLE EXOME SEQUENCING FOR 
              CHILDREN WITH CERTAIN MEDICAL NEEDS IS COVERED UNDER THE 
              MEDICAID PROGRAM.

    (a) In General.--Section 1905 of the Social Security Act (42 U.S.C. 
1396d) is amended--
            (1) in subsection (r)--
                    (A) by redesignating paragraph (5) as paragraph 
                (6); and
                    (B) by inserting after paragraph (4) the following 
                new paragraph:
            ``(5) Whole genome sequencing and whole exome sequencing 
        (as defined in subsection (kk)), whether furnished in the 
        inpatient or outpatient setting, if ordered by a physician or 
        other provider acting within the provider's scope of practice 
        under State law as a first-tier test for an individual 
        suspected to have a genetic disorder, rare disease, or a health 
        condition of unknown origin, including 1 or more congenital 
        anomalies, a global developmental delay, or an intellectual 
        disability.''; and
            (2) by adding at the end the following new subsection:
    ``(kk) Whole Genome Sequencing and Whole Exome Sequencing.--For 
purposes of subsection (r)(5), the term `whole genome sequencing and 
whole exome sequencing'--
            ``(1) means the determination of a sequence of 
        deoxyribonucleic acid bases in the genome taken or derived from 
        an individual, and, if for the primary benefit of the 
        individual's diagnosis or treatment, a first degree biological 
        relative or relatives of such individual for the purpose of 
        determining whether 1 or more potentially disease-causing 
        genetic variants are present in the genome of such individual 
        or such biological first-degree relative; and
            ``(2) includes--
                    ``(A) the sequencing of the whole genome or the 
                whole exome; and
                    ``(B) any analysis, interpretation, and data report 
                derived from such sequencing.''.
    (b) Additional Updates.--Section 1902(a) of the Social Security Act 
(42 U.S.C. 1396a(a)) is amended--
            (1) in paragraph (88), by striking ``and'' at the end;
            (2) in paragraph (89), by striking the period and inserting 
        ``; and''; and
            (3) by inserting after paragraph (89) the following new 
        paragraph:
            ``(90) provide that payment for whole genome sequencing and 
        whole exome sequencing (as defined in section 1905(kk)) is made 
        separately and is not bundled as part of payment for any other 
        medical assistance.''.
    (c) Outreach and Education.--For purposes of promoting awareness of 
and access to whole genome and exome sequencing under section 1905(r) 
of the Social Security Act (42 U.S.C. 1396d(r)), the Secretary of 
Health and Human Services shall--
            (1) convene national organizations (including at least 
        those organizations representing pediatricians, specialists in 
        pediatric rare diseases, children's hospitals, geneticists, 
        genetic counselors, laboratory test developers), States, 
        hospitals and health systems, individuals with rare diseases, 
        and those national organizations representing Medicaid managed 
        care organizations to identify challenges and opportunities in 
        implementation of the amendments made by this section, 
        including potential best practices that minimize denials of 
        claims for medical assistance under the State plan under title 
        XIX of such Act resulting from use of prior authorization or 
        administrative requirements;
            (2) conduct outreach to national organizations (including 
        at least those organizations representing hospitals, health 
        systems, children's hospitals, pediatricians, and geneticists), 
        States, national organizations representing Medicaid managed 
        care oganizations, national organizations representing rare 
        disease patients and families, and national organizations 
        representing Medicaid-eligible children and their families to 
        ensure they are aware of the early and periodic screening, 
        diagnostic, and treatment services benefit under title XIX of 
        such Act and can benefit from access to required screenings and 
        necessary treatment services; and
            (3) not later than 2 years after the date of the enactment 
        of this Act, publish on the public website of the Department of 
        Health and Human Services a report that includes--
                    (A) payment amounts for whole genome sequencing and 
                whole exome sequencing under each State plan under 
                title XIX of such Act; and
                    (B) information relating to the number of children 
                receiving such sequencing under such State plans, 
                health outcomes, types of services provided as a result 
                of such sequencing, and other such relevant 
                information.
    (d) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Comptroller General of the United States shall do the 
following:
            (1) Collect and analyze feedback regarding implementation 
        of the amendments made by this Act from the organizations and 
        entities described in paragraph (1) or (2) of subsection (b), 
        including--
                    (A) experiences in accessing whole genome 
                sequencing and whole exome sequencing and results 
                pursuant to such amendments, including any barriers to 
                such access;
                    (B) changes to care or services furnished after 
                such sequencing;
                    (C) identification of remaining challenges, if any, 
                related to access to such sequencing for individuals 
                eligible for early and periodic screening, diagnostic, 
                and treatment services under the Medicaid program; and
                    (D) health professional awareness of such 
                amendments.
            (2) Assess the following for impacts on access to such 
        sequencing under such program for such individuals:
                    (A) Prior authorization, which may include 
                assessment of impacts related to delay of care and 
                uncertainty or surprise of payment.
                    (B) Workforce and reimbursement challenges for 
                genetic counselors.
                    (C) The extent to which market cost is aligned with 
                the Medicare clinical laboratory fee schedule and the 
                degree to which the Secretary of Health and Human 
                Services' adjustment of the fee schedule might more 
                accurately reflect market realities and support 
                affordability.
            (3) Make recommendations to the Secretary of Health and 
        Human Services relating to additional guidance or improvements 
        that may be made based on the feedback collected under 
        paragraph (1) and the assessment described in paragraph (2).
    (e) Effective Date.--The amendments made by this section shall 
apply beginning January 1, 2027.
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