H.R. 7118

[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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