HR4752-119

What This Bill Does

The Reducing Hereditary Cancer Act amends Medicare coverage rules for inherited cancer risk. It adds germline mutation testing as a covered medical service for individuals with a personal or family history of a hereditary cancer gene mutation or a personal or family history suspicious for hereditary cancer. Germline mutation testing must follow evidence-based clinical practice guidelines from nationally recognized oncology professional organizations such as the National Comprehensive Cancer Network, American Society of Clinical Oncology, Society of Gynecologic Oncology, or another organization specified by a Medicare administrative contractor; if guidelines conflict, the least restrictive guideline selected by the contractor applies. The bill bars repeated germline mutation testing for the same individual beyond the defined coverage. It also treats risk-reducing surgery as reasonable and necessary Medicare treatment when evidence-based guidelines say surgery would reduce cancer risk for the covered individual. Finally, when genetic testing shows a hereditary cancer gene mutation, HHS must increase Medicare frequency or coverage limitations for evidence-based screenings to follow the guidelines or HHS judgment, but not less often than annually. Screenings include mammography, breast MRI, colonoscopy, PSA testing, and additional high-risk modalities recommended by guidelines.

Who Benefits and How

Medicare beneficiaries with hereditary cancer risk benefit from covered germline mutation testing. People with inherited cancer mutations benefit from guideline-supported risk-reducing surgeries being treated as reasonable and necessary. High-risk Medicare patients benefit from at least annual evidence-based screenings when guidelines support more frequent monitoring. Oncology providers benefit from clearer Medicare coverage tied to nationally recognized clinical guidelines.

Who Bears the Burden and How

HHS Secretary must implement coverage for testing, surgeries, and increased screening frequency limits. Medicare administrative contractors must apply oncology guidelines and resolve conflicts using the least restrictive approach. Medicare trust funds and federal taxpayers bear costs of additional testing, screening, and risk-reducing procedures. Clinical laboratories must deliver germline testing consistent with guideline-based coverage requirements.

Key Provisions

• Adds Medicare coverage for germline mutation testing for beneficiaries with hereditary cancer risk.
• Defines testing through nationally recognized oncology clinical practice guidelines.
• Provides that guideline-supported risk-reducing surgery is reasonable and necessary treatment.
• Requires increased screening frequency for beneficiaries with hereditary cancer gene mutations, at least annually.
• Includes mammography, breast MRI, colonoscopy, PSA testing, and other high-risk screening modalities.