H.R. 6280

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6280 Introduced in House (IH)]

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119th CONGRESS
1st Session
H. R. 6280

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 HOUSE OF REPRESENTATIVES

November 21, 2025

Mr. Smith of Nebraska (for himself and Ms. Castor of Florida) 
introduced the following bill; which was referred to the Committee on 
Energy and Commerce, and in addition to the Committee 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 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 2025''.

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 on or after January 1, 2027, by a 
genetic counselor (as defined in paragraph (2)) and such services and 
supplies furnished as an incident to the provision of such services 
which the genetic counselor is legally authorized to perform under 
State law (or the State regulatory mechanism provided by State law) as 
would otherwise be covered 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, is certified by the 
American Board of Genetic Counseling and meets such other 
criteria as the Secretary establishes.''.
(b) Balance Billing.--Section 1842(b)(18)(C) of the Social Security 
Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the 
following new clause:
``(ix) A genetic counselor (as defined in section 
1861(nnn)(2)).''.
(c) Payment.--Section 1833(a)(1) of the Social Security Act (42 
U.S.C. 1395l(a)(1)) is amended--
(1) by striking ``and (HH)'' and inserting ``(HH)''; and
(2) by inserting before the semicolon at the end the 
following: ``, and (II) with respect to covered genetic 
counseling services (as defined in section 1861(nnn)(1)), the 
amount paid shall be equal to 80 percent of the lesser of (i) 
the actual charge for the services or (ii) 85 percent of the 
fee schedule amount provided under section 1848 that would have 
applied had the genetic counseling services been furnished by a 
physician''.
(d) Conforming Amendment.--Section 1862(a)(14) of the Social 
Security Act (42 U.S.C. 1395(y)(a)(14)) is amended by inserting 
``covered genetic counseling services,'' after ``qualified psychologist 
services,''.
(e) Rule of Construction.--The amendments made by this section 
shall not be construed as preventing physicians and health care 
providers other than genetic counselors from billing for genetic 
counseling services under the Medicare program which are otherwise 
covered under such program.
(f) Implementation.--Notwithstanding any other provision of law, 
the Secretary of Health and Human Services may implement the amendments 
made by this section by interim final rule with comment period.
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