This bill, titled the "Access to Genetic Counselor Services Act of 2026," aims to expand Medicare Part B coverage to include services provided by genetic counselors. It amends the Social Security Act to formally recognize "covered genetic counseling services" as a benefit under Medicare, effective for services furnished on or after January 1, 2027. The legislation defines covered genetic counseling services as those provided by a qualified genetic counselor, along with incident services and supplies, that are legally authorized under state law and would otherwise be covered if performed by a physician. A genetic counselor is defined as an individual who is either state-licensed or, in states without licensing, certified by the American Board of Genetic Counseling and meets additional criteria set by the Secretary. For these services, Medicare will pay 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule amount. The bill also includes provisions for balance billing and clarifies that existing coverage for genetic counseling services provided by physicians or other healthcare providers remains unaffected. This measure seeks to enhance beneficiary access to specialized genetic counseling.
This bill, titled the "Access to Genetic Counselor Services Act of 2026," aims to expand Medicare Part B coverage to include services provided by genetic counselors. It amends the Social Security Act to formally recognize "covered genetic counseling services" as a benefit under Medicare, effective for services furnished on or after January 1, 2027. The legislation defines covered genetic counseling services as those provided by a qualified genetic counselor, along with incident services and supplies, that are legally authorized under state law and would otherwise be covered if performed by a physician. A genetic counselor is defined as an individual who is either state-licensed or, in states without licensing, certified by the American Board of Genetic Counseling and meets additional criteria set by the Secretary. For these services, Medicare will pay 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule amount. The bill also includes provisions for balance billing and clarifies that existing coverage for genetic counseling services provided by physicians or other healthcare providers remains unaffected. This measure seeks to enhance beneficiary access to specialized genetic counseling.