Sponsors (14)
Requires Medicare, Medicaid, and CHIP to cover defined cancer genomic tests, sets Medicare payment/deductible rules, and directs HHS to run genomic testing education programs.
The bill expands access to cancer genomic testing and builds genomic diagnostic capacity—benefiting Medicare, Medicaid/CHIP enrollees, patients, and clinicians—but does so with reimbursement caps, frequency limits, and implementation costs that could reduce lab participation, strain state and federal budgets, and restrict some clinically necessary testing.
Medicare beneficiaries will get advanced cancer genomic tests covered without a Part B deductible, reducing out-of-pocket costs for diagnostic sequencing at diagnosis or recurrence.
Medicaid enrollees, CHIP-covered children, and eligible pregnant women will have mandatory access to cancer diagnostic and laboratory tests beginning Jan 1, 2027, expanding coverage for low-income and vulnerable populations.
Patients with cancer and clinicians will gain broader access to genomic testing and genetic counseling, improving detection of actionable mutations and informing treatment planning.
Clinical laboratories and providers may be underpaid because Medicare payment is set at 80% of a capped amount, potentially shifting costs to providers, reducing lab participation, or limiting patient access to some tests.
Patients could be denied clinically useful repeat sequencing because the law limits frequency to diagnosis, recurrence, and certain treatment-planning scenarios, restricting clinician discretion.
State Medicaid programs will face expanded mandatory benefits, increasing state budgetary obligations and possibly requiring legislative or budget adjustments despite federal matching funds.
Based on analysis of 3 sections of legislative text.
Official title: To facilitate the development of treatments for cancer, and for other purposes.
Introduced February 26, 2025 by Doris Matsui · Last progress February 26, 2025
Adds a new Medicare benefit category requiring coverage and favorable payment treatment for defined cancer diagnostic and laboratory genomic tests, and makes those tests mandatory coverage under Medicaid and CHIP starting January 1, 2027 (with limited state-law timing exceptions). It also directs HHS, with the National Human Genome Research Institute, to run an education and awareness program for clinicians and the public about genomic testing and promote training on molecular diagnostics and genetic counseling in medical education and continuing education. Medicare coverage begins six months after enactment, pays 80% of the allowable test amount (100% when assignment rules apply), exempts the test cost from the Part B deductible, and limits frequency (once at diagnosis, once at recurrence, and as needed for treatment planning/monitoring). Medicaid and CHIP must include these tests as mandatory covered services beginning January 1, 2027, subject to state legislation timing rules.