What This Bill Does
This bill changes Medicare coverage (the federal health insurance program for people 65 and older) to pay for genetic testing that checks if someone inherited a mutation (a change in genes) that increases cancer risk. The bill also requires Medicare to cover preventive surgeries and more frequent cancer screenings for people found to have these inherited cancer gene mutations.
Who It Affects
Medicare beneficiaries (people covered by Medicare) who have a personal or family history of hereditary cancer gene mutations, or whose family history suggests they may have inherited cancer risk genes.
Key Provisions
- Medicare will cover genetic testing for germline mutations (inherited gene changes) in individuals with a personal or family history of hereditary cancer gene mutations or suspicious family history (Sec. 2a)
- The genetic testing must follow evidence-based clinical practice guidelines (treatment guidelines based on scientific evidence) developed by nationally recognized cancer specialist organizations (Sec. 2a)
- Medicare will cover risk-reducing surgeries (operations that lower cancer risk) for individuals whose guidelines show surgery would reduce their cancer risk (Sec. 3a)
- Medicare will cover cancer screenings including mammography, breast MRI scans, colonoscopy, and PSA testing at frequencies that meet clinical guidelines, at minimum once per year (Sec. 4a)
What Changes
Medicare begins paying for hereditary cancer genetic testing, preventive cancer surgeries, and increased cancer screening frequencies for people with inherited cancer risk mutations when this law takes effect. Previously, Medicare coverage for these services was not specified in the bill text for this population.
Important Definitions
- **Germline mutation testing**: Genetic testing that checks for inherited gene changes associated with increased cancer risk, performed according to guidelines from cancer specialist organizations
- **Risk-reducing surgery**: Operations that reduce the chance of developing cancer based on evidence-based medical guidelines
- **Evidence-based screenings**: Cancer detection tests recommended by medical guidelines, including mammography, breast MRI, colonoscopy, and PSA testing
Effective Date
Testing, surgeries, and screening services furnished on or after the date the bill becomes law.
I
118TH CONGRESS
1ST SESSION H. R. 1526
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 HOUSE OF REPRESENTATIVES
MARCH 9, 2023
Ms. WASSERMAN SCHULTZ (for herself, Mrs. MILLER-MEEKS, Ms. SLOTKIN,
Mr. BUCSHON, Mr. KILMER, Mr. TRONE, Mr. TONKO, Ms. MOORE of
Wisconsin, Ms. BUSH, Mr. COHEN, Mr. LYNCH, Mr. BACON, Mr. SOTO,
Ms. CLARKE of New York, Mr. RUPPERSBERGER, Mr. MFUME, Mr. CAR-
SON, Ms. CASTOR of Florida, Mr. GOTTHEIMER, Mr. FITZPATRICK, and
Ms. SCHAKOWSKY) introduced the following bill; which was referred to
the Committee on Energy and Commerce, and in addition to the Com-
mittee on Ways and Means, for a period to be subsequently determined
by the Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
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 re-
duce the risk for individuals with a germline (inherited)
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mutation associated with a high risk of developing a
preventable cancer.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
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SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Reducing Hereditary
4
Cancer Act’’.
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SEC. 2. HEREDITARY CANCER GENETIC TESTING OF INDI-
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VIDUALS WITH A FAMILY HISTORY OF A HE-
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REDITARY CANCER GENE MUTATION OR PER-
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SONAL OR FAMILY HISTORY SUSPICIOUS FOR
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HEREDITARY CANCER.
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(a) COVERAGE.—Section 1861 of the Social Security
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Act (42 U.S.C. 1395x) is amended—
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(1) in subsection (s)(2)—
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(A) by striking ‘‘and’’ at the end of sub-
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paragraph (II);
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(B) by striking the period and inserting ‘‘;
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and’’ at the end of subparagraph (JJ); and
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(C) by inserting after subparagraph (JJ)
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the following new subparagraph:
19
‘‘(KK) in the case of an individual with a
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personal or family history of a hereditary can-
21
cer gene mutation or a personal or family his-
22
tory suspicious for hereditary cancer, germline
23
mutation testing.’’; and
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(2) by adding at the end the following new sub-
1
section:
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‘‘(nnn) GERMLINE MUTATION TESTING.—The term
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‘germline mutation testing’ means genetic testing for
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germline mutations that is in accordance with evidence-
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based, clinical practice guidelines specifically addressing
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genetic testing, screening, and management of individuals
7
with inherited mutations associated with increased cancer
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risk that—
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‘‘(1) have been developed by a nationally recog-
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nized oncology professional organization, including
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the National Comprehensive Cancer Network, the
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American Society of Clinical Oncology, the Society
13
of Gynecologic Oncology, or any other oncology pro-
14
fessional organization specified by a medicare ad-
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ministrative contractor with a contract under section
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1874A; and
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‘‘(2) in the case of conflicting guidelines devel-
18
oped by more than one nationally recognized oncol-
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ogy professional organization, the least restrictive of
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such guidelines, as determined by such a medicare
21
administrative contractor.’’.
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(b) FREQUENCY.—Section 1862(a)(1) of the Social
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Security Act (42 U.S.C. 1395y(a)(1)) is amended—
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(1) by striking ‘‘and’’ at the end of subpara-
1
graph (O);
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(2) by adding ‘‘and’’ at the end of subpara-
3
graph (P); and
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(3) by adding at the end the following new sub-
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paragraph:
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‘‘(Q) in the case of germline mutation test-
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ing as defined in section 1861(lll), which is per-
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formed more than once with respect to an indi-
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vidual described in such section;’’.
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(c) EFFECTIVE DATE.—The amendments made by
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this section shall apply to testing furnished on or after
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the date of the enactment of this Act.
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SEC. 3. COVERAGE OF CERTAIN PREVENTIVE SURGERIES.
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(a) IN GENERAL.—Section 1862 of the Social Secu-
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rity Act (42 U.S.C. 1395y) is amended by adding at the
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end the following new subsection:
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‘‘(p) COVERAGE OF CERTAIN RISK-REDUCING SUR-
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GERIES.—In the case of an individual described in section
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1861(s)(2)(II) for whom, based on evidence-based, clinical
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practice guidelines described in section 1861(lll), surgery
21
would reduce the risk of developing cancer, such risk-re-
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ducing surgery shall be considered reasonable and nec-
23
essary for treatment
of
illness
under
subsection
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(a)(1)(A).’’.
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(b) EFFECTIVE DATE.—The amendment made by
1
subsection (a) shall apply to items and services furnished
2
on or after the date of the enactment of this Act.
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SEC. 4. COVERAGE OF EVIDENCE-BASED SCREENINGS FOR
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INDIVIDUALS WITH A HEREDITARY CANCER
5
GENE MUTATION.
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(a) IN GENERAL.—Section 1862 of the Social Secu-
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rity Act (42 U.S.C. 1395y), as amended by section 3, is
8
amended by adding at the end the following new sub-
9
section:
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‘‘(q) COVERAGE OF EVIDENCE-BASED SCREENINGS
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FOR INDIVIDUALS WITH A HEREDITARY CANCER GENE
12
MUTATION.—In the case of an individual who is deter-
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mined pursuant to genetic testing to have a hereditary
14
cancer (germline) gene mutation, the Secretary shall in-
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crease any frequency limitations (or other limitations on
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coverage otherwise applicable under this title) for any evi-
17
dence-based screenings furnished to such individual, to be
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in compliance with evidence-based, clinical practice guide-
19
lines described in section 1861(lll), or as determined ap-
20
propriate by the Secretary, but not less frequently than
21
on an annual basis. For the purposes of this subsection,
22
evidence-based screenings shall include screening mam-
23
mography, breast screening MRI, colonoscopy, PSA test-
24
ing, and any additional evidence-based screening modali-
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ties appropriate for high-risk individuals as recommended
1
by such guidelines.’’.
2
(b) CONFORMING
AMENDMENT
FOR
SCREENING
3
MAMMOGRAPHY.—Section 1834(c)(2)(A) of the Social Se-
4
curity Act (42 U.S.C. 1395m(c)(2)(A)) is amended, in the
5
matter preceding clause (i), by striking ‘‘subparagraph
6
(B)’’ and inserting ‘‘subparagraph (B) and section
7
1862(q)’’.
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(c) EFFECTIVE DATE.—The amendments made by
9
this section shall apply to items and services furnished on
10
or after the date of the enactment of this Act.
11
Æ
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