Legislation Seeks Medicare Recognition of Genetic Counselors to Expand Access to Care

In October, representatives Erik Paulsen (R-MN) and Dave Loebsack (D-IA), in collaboration with the National Society of Genetic Counselors, introduced a piece of legislation that would allow the Centers for Medicare & Medicaid Services (CMS) to recognize certified genetic counselors as health care providers, so that they can receive payment for counseling Medicare beneficiaries.

“Medicare policy currently pays for genetic testing and genetic counseling, but not when performed by genetic counselors,” Shanna Gustafson, MPH, MS, CGC, senior client executive at InformedDNA, said in an interview with CURE. “This bill will help to correct this discrepancy and bring Medicare in line with many health plans across the country.”

Under the existing CMS rules, beneficiaries may only see a genetic counselor under the supervision of a physician that is currently caring for them, also known as “incident to.”

“Thus, if a patient is under the care of a practice or center that does not employ its own genetic counselors, he/she must be referred first to a physician in a competing center and then seen by the associated genetic counselor,” Gustafson explained. “These extra steps place a burden on patients and are a barrier to accessing services.”

In turn, the H.R. 7083 bill — also known as “Access to Genetic Counselors Services Act of 2018” – could allow for patients to have improved access to genetic counselor services. In addition, it is projected to save Medicare up to $6.5 billion over 10 years.

“It will also increase access to quality genetic health care services for Medicare beneficiaries at a time in which personalized medicine and genetic health care is increasing in importance and relevance to most patients,” Gustafson said

Genetic counselors play an integral role in helping patients to make decisions about genetic testing based on their family history and genetics and to understand the risk or potential diagnosis of an inherited health condition like cancer, and in turn, what a patient’s options may be.

“They investigate family medical history to identify genetic risks, discuss medical and emotional implications of genetic testing and results, educate and facilitate patient-centered decision-making and work as a team member with other health care providers,” Gustafson added.

Awareness for this initiative, which has been in the works among the profession since the early 1990s, was promoted in conjunction with the second annual Genetic Counselor Awareness Day. This day — held on Nov. 8 – was designed to help raise awareness about genetic counselors and to help consumers understand the important and supportive role genetic counselors can play in health care.

Lastly, Gustafson hopes the bill also negates the misconception that genetic counselors are difficult to access for patients. “The profession has worked very hard to counter this by improving education and by adapting service delivery to meet patient needs,” she added. “The bill will additionally help with this.”