Sponsors (14)
The bill expands coverage and reduces patient costs for cancer genomic testing while investing in provider training and public awareness, but it increases public program spending and creates payment and coverage rules that could limit repeat testing or reduce provider participation unless reimbursement and workforce capacity keep pace.
Low-income people on Medicaid and many children (and pregnant women where applicable) will gain mandatory coverage for advanced cancer genomic and laboratory tests starting Jan 1, 2027, increasing access to diagnostic care.
Medicare beneficiaries will face substantially lower out-of-pocket costs for covered cancer genomic tests because Part B coinsurance is capped (20% or 0% for assignment-paid tests) and the Part B deductible is waived.
Physician training and public awareness efforts about genomic and molecular diagnostics will strengthen workforce skills and patient understanding, improving diagnosis, targeted treatment decisions, and the likelihood of earlier detection of actionable mutations.
Setting Medicare payment at 80% of the lesser of charge or a specified amount may leave providers unable to recover full costs for expensive sequencing, which could discourage some labs or hospitals from offering those tests and reduce access for patients.
Mandating Medicaid/CHIP coverage for these tests will increase state and federal program costs, creating budgetary pressure on states that could force tradeoffs in other services or require higher state contributions.
Limits on how often genomic tests are covered may leave some patients (especially those with chronic or recurrent cancers) unable to get clinically warranted repeat testing when their clinicians consider it necessary.
Based on analysis of 3 sections of legislative text.
Requires Medicare, Medicaid, and CHIP to cover genomic and other cancer diagnostic lab tests, sets Medicare payment rules and frequency limits, and creates an HHS education program.
Requires Medicare, Medicaid, and CHIP to cover a defined set of cancer diagnostic and laboratory tests (including microarray, DNA/RNA sequencing, whole-exome and other next-generation sequencing) and pays for interpretation of results. For Medicare Part B the bill sets payment rules, waives the Part B deductible for these tests, and limits how often tests may be done; it makes these tests a mandatory Medicaid benefit and requires CHIP coverage beginning in 2027. 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 to promote training on molecular diagnostics in medical education and continuing education.
Introduced February 26, 2025 by Doris Matsui · Last progress February 26, 2025