Some Context
Did you know that Medicare beneficiaries can have genetic testing and genetic counseling but not by board-certified genetic counselors - the largest group of medical genetics professionals in the country?
The US Centers for Medicaid and Medicare (CMS) currently provide coverage of medical services for 60 million US beneficiaries. CMS covers the cost of genetic testing and allows healthcare providers to bill for genetic counseling services. However, because CMS doesn’t recognize genetic counselors as healthcare providers, genetic counselors cannot see patients independently and be reimbursed for their services. This gap in reimbursement coverage creates a barrier to care by decreasing access to appropriately trained health care professionals, increasing costs to CMS, causing longer wait-times for appointments and medical errors due to incorrect interpretation of genetic information by non-genetics trained providers.
Luckily, there is a solution.
H.R. 3235 - Access to Genetic Counselor Services Act of 2019, was the previous bill and H.R. 2144 - “Access to Genetic Counselor Services Act,” is the new bill introduced in the U.S. House of Representatives March 23, 2021 that would authorize the U.S. Centers for Medicare and Medicaid Services (CMS) to recognize certified genetic counselors (CGCs) as healthcare providers thereby rectifying this significant gap in coverage for US Medicare beneficiaries.
To better understand the importance of the Access to Genetic Counselor Services Act, it is important to understand some basic facts about genetic counseling in the United States.
01
Genetic counselors are healthcare providers who have masters degrees in medical genetics and counseling and are board-certified and licensed in over 30 states.
Board-certification, state licensure and continuing education provide assurances to the public, employers, and insurers that all practicing genetic counselors have the knowledge, skills, and expertise needed to meet the needs of patients and their medical colleagues.
02
There are over 5000 genetic counselors in the United States currently and that number is expected to double in the next ten years.
In contrast, there are currently about 1500 medical geneticists (some MD and some PhDs and not all of them see patients) and less than 100 new geneticists certified every two years.
This study showed that there are about 2 clinical geneticists per 1 million citizens!
03
The deficit of medical geneticists causes decreased access to genetic counseling services and increased wait-times for appointments.
While medical geneticists and genetic counselors often work in tandem, recognizing genetic counselors as healthcare providers will allow genetic counselors to independently see those patients that are within their scope of practice and increase patient access to timely, appropriate care.
04
Access to genetic counselors has been shown to decrease errors in genetic testing and information provided to patients and increase patient satisfaction.
With over ten new genetic tests introduced everyday, both health care providers and consumers are faced with a dizzying array of genetic testing choices. The advanced training of genetic counselors enables them to decide on appropriate tests, interpret genetic test results and to guide and support patients seeking more information.
05
Recognizing genetic counselors as healthcare providers is expected to result in significant cost saving to CMS
by increasing the use of appropriate genetic tests and decreasing the rate at which genetic counseling services are currently being billed.
H.R. 2144 will allow CMS beneficiaries to be seen by genetic counselors ensuring that they receive the benefits of the rapidly advancing field of medical genetics in a timely, cost-effective and professional manner.