Sponsors (2)
The bill would expand Medicare coverage for personalized breast‑cancer risk assessment and improve access—especially in underserved areas—but does so using existing CMI funds, excludes Medicare Advantage enrollees, raises cost and privacy risks from expanded genetic testing and family notification, and could be implemented without proven clinical efficacy or long‑term guarantees.
Medicare Part A/B beneficiaries (ages 40–74), especially women, would gain covered payments for comprehensive breast cancer risk assessments and personalized screening plans.
Medicare beneficiaries receiving assessments would get more detailed, individualized risk estimates (5‑year validated model plus multigene panel and polygenic risk score), enabling more targeted screening and prevention decisions.
People in underserved and rural areas would have improved access through prioritized participation and flexible specimen collection (mailed kits and telehealth/in‑person options), reducing geographic barriers to risk assessment.
The Model excludes Medicare Advantage enrollees, leaving a large portion of Medicare beneficiaries without coverage under the program and creating unequal access depending on enrollment type.
The statute does not require the Secretary to establish clinical efficacy of risk‑stratified screening, so the Model may be implemented before clear evidence of benefit, risking ineffective or harmful care and wasteful spending.
The Model must be funded from existing subsection (f) CMI funds with no new appropriations, which could divert limited funds from other CMI initiatives or programs.
Based on analysis of 2 sections of legislative text.
Directs CMMI to create a Medicare payment model (within 2 years) reimbursing comprehensive breast cancer risk assessments and personalized screening plans for certain beneficiaries 40–74.
Official title: Amend title XI of the Social Security Act to establish a payment model to reimburse providers for furnishing comprehensive breast cancer risk assessments and developing personalized screening and risk-reduction plans, and for other purposes.
Introduced August 5, 2026 by Bill Cassidy · Last progress August 5, 2026
Requires the Center for Medicare and Medicaid Innovation (CMMI) to create a new payment model within two years that reimburses eligible providers for comprehensive breast cancer risk assessments and personalized screening and risk‑reduction plans for certain Medicare beneficiaries age 40–74. The model must define required data elements (genetic panels, polygenic risk scores, breast density, family history, clinical and lifestyle factors), risk categories, delivery options (in‑person and remote specimen collection), prioritized site selection, payment-setting authority, evaluation metrics, reporting timelines, and a seven‑year termination date. Specifies interim and final reporting deadlines (3 and 7 years), requires notifications if the model is delayed or needs additional statutory authority, prioritizes implementation in areas with high breast cancer mortality and limited access, and prohibits new appropriations (model funded from existing subsection (f) funds).