Sponsors (2)
The bill greatly expands and clarifies coverage and reimbursement for advanced cancer genomic testing and invests in clinician training—improving access and care quality for many—while imposing test-frequency limits, payment caps, and fiscal/state‑level rollout challenges that may leave some patients or providers with added costs and create uneven access.
Medicare beneficiaries, Medicaid enrollees, and children/pregnant women in CHIP will gain defined coverage for advanced cancer genomic/diagnostic tests (Medicare with no Part B deductible; Medicaid mandatory coverage by 1/1/2027; CHIP benchmark-equivalent plans covering targeted children and pregnant women), improving access to clinically important molecular testing.
Clinicians (physicians, genetic counselors) and patients will benefit from new guidance, training, and public awareness efforts that increase clinician competence in genomic testing and patient understanding, likely improving diagnostic accuracy and enabling earlier or more precise targeted cancer treatments.
Clinical laboratories and health systems get an explicit Medicare/Medicaid/CHIP payment pathway with defined payment rules (percent of lesser of charge or §1834A-equivalent), creating clearer reimbursement expectations and greater payment predictability for providers.
Patients and clinicians may have coverage denied for clinically indicated repeat or broader genomic testing because frequency limits (e.g., once at diagnosis) restrict payment flexibility.
Medicare payment limited to 80% of the capped amount (100% for assignment) risks leaving clinical labs or patients responsible for balance billing if actual charges exceed the allowed amount.
State compliance grace periods and any state legislative processes can delay Medicaid coverage in some states, producing uneven access to genomic testing across the country.
Based on analysis of 3 sections of legislative text.
Requires Medicare, Medicaid, and CHIP to cover defined cancer diagnostic and laboratory tests, sets Medicare payment and waives Part B deductible, and funds an HHS genomic testing education program.
Official title: Facilitate the development of treatments for cancers, and for other purposes.
Introduced February 26, 2025 by Roger F. Wicker · Last progress February 26, 2025
Adds Medicare, Medicaid, and CHIP coverage and payment rules that require specific cancer diagnostic and laboratory tests to be covered, sets Medicare payment and cost-sharing rules, phases in effective dates across programs, and limits coverage for tests performed more often than allowed. Directs HHS, with the National Human Genome Research Institute, to run an education and awareness program for clinicians and the public about genomic and molecular diagnostic testing and to promote training for genetic counselors and incorporation of molecular diagnostics into medical education. Affects Medicare and Medicaid benefit rules, CHIP benchmark-equivalent plans, laboratories and providers who order or perform molecular cancer testing, and patients who need cancer diagnostic genomic testing; implementation dates vary (CHIP starts Jan 1, 2025; Medicaid furnishing Jan 1, 2027; Medicare furnishment begins six months after enactment).