Reducing Hereditary Cancer Act
The Reducing Hereditary Cancer Act would expand Medicare coverage under title XVIII to address inherited cancer risk. It would require germline mutation testing for individuals with a personal or family history suggestive of a hereditary cancer gene mutation (as defined by evidence-based guidelines from major oncology organizations). If someone is found to carry a hereditary cancer gene mutation, the bill also requires coverage for risk-reducing surgeries that guidelines indicate would lower cancer risk, and for a set of evidence-based cancer screenings (with frequency increased to align with guidelines and at least annual). The act also updates how testing frequency is treated under Medicare and makes certain conforming changes to existing screening coverage (notably mammography). Effective dates indicate these changes apply to testing and services furnished after enactment. In short, the bill aims to standardize and broaden Medicare coverage for genetic testing, preventive surgeries, and regular, guideline-based cancer screenings for people at high hereditary risk, with payments tied to established clinical guidelines and ongoing updates.
Key Points
- 1Coverage expansion for hereditary cancer germline testing
- 2- Medicare would cover germline mutation testing for individuals with a personal or family history suggestive of a hereditary cancer gene mutation, based on evidence-based guidelines from recognized oncology professional organizations (e.g., NCCN, ASCO, SGO).
- 3- If guidelines conflict, the least restrictive guideline would determine coverage.
- 4- Testing frequency, if performed more than once for the same individual, would be covered.
- 5Coverage of risk-reducing surgeries
- 6- For individuals meeting the hereditary risk criteria, surgeries that reduce cancer risk and are guided by evidence-based clinical guidelines would be considered reasonable and necessary under Medicare.
- 7Coverage of evidence-based screenings with increased frequency
- 8- Individuals identified as having a hereditary cancer germline mutation would be covered for screenings at a frequency at least annual, and aligned with evidence-based guidelines. Screenings include mammography, breast MRI, colonoscopy, PSA testing, and other guideline-recommended modalities for high-risk individuals.
- 9Conforming amendments and effective dates
- 10- A conforming amendment would add 1862(q) to increase screening frequency under mammography coverage where appropriate.
- 11- All new coverage requirements apply to items and services furnished on or after the date of enactment.