Sponsors (14)
The bill expands covered access to advanced cancer genomic testing and builds workforce capacity to improve precision oncology, but does so with payment and frequency limits that risk reduced lab participation, care restrictions, state fiscal pressure, and uneven benefits for underserved communities.
Medicare beneficiaries, Medicaid enrollees, and children in CHIP (and pregnant women where applicable) gain coverage for advanced cancer genomic and diagnostic tests (Medicare: no Part B deductible; Medicaid/CHIP: mandatory coverage starting Jan 1, 2027), reducing out-of-pocket costs and improving early detection and treatment planning.
Physicians, trainees, and other clinicians will receive expanded education and training in molecular diagnostics and genomic medicine (GME/CME), increasing workforce capacity, access to genetic counseling, and the long-term integration of precision oncology into routine care.
Clinical laboratories and treating clinicians get clearer payment and coverage rules for next-generation sequencing and related services, reducing reimbursement uncertainty and facilitating interpretation and reporting.
Medicare reimbursement set at 80% of a capped amount and generally lower rates could underpay labs, prompting some labs to decline Medicare patients, shift costs to providers, limit test availability, or raise prices for non-Medicare patients, reducing access.
Frequency limits on sequencing (only at diagnosis, recurrence, or certain treatment-planning moments) could prevent clinically useful repeat testing between triggers, potentially harming individual patient care and outcomes.
If increased demand for genomic testing is not matched by reimbursement adjustments and workforce expansion, patients may face access bottlenecks or higher out-of-pocket costs despite coverage expansions.
Based on analysis of 3 sections of legislative text.
Adds Medicare coverage and payment rules for cancer genomic tests, makes them mandatory Medicaid/CHIP benefits (from Jan 1, 2027), and requires an HHS education program on genomic testing.
Introduced February 26, 2025 by Doris Matsui · Last progress February 26, 2025
Adds coverage and payment rules so Medicare pays for a defined set of cancer diagnostic and laboratory genomic tests, exempts those tests from the Medicare Part B deductible, and requires Medicare payment at a specified percentage of the allowable amount. Makes the same tests mandatory benefits under Medicaid and CHIP starting January 1, 2027 (with a state-law exception). Directs HHS, working with the National Human Genome Research Institute, to run an education and awareness program for physicians and the public about genomic testing and to promote training on molecular diagnostics and genetic counseling.