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Genetic counseling has been shown to empower patients, decrease genetic test ordering errors and decrease healthcare costs. Yet even with all these benefits, many people face challenges accessing genetic counselors when they need one. New legislation — H.R. 7083 the “Access to Genetic Counselor Services Act” bill — currently before U.S. Congress aims to improve Medicare beneficiaries access to genetic counselors. Looking at the questions — what is a genetic counselor and what does a genetic counselor do — will help illustrate the impact of this proposed legislation.

What Is a Genetic Counselor?

Genetic counselors are healthcare providers with master’s degrees in genetic counseling. They are board-certified by the American College of Genetic Counseling and many states require genetic counselors to be licensed to practice in their state. Genetic counselors provide genetic counseling to people of all ages and have many specialties including pediatrics, oncology, assisted fertility, among others.

What Does a Genetic Counselor Do?

Genetic counselors work with patients to help them understand their personal and family history. They provide genetic risk-assessment and communicate important genetic concepts to patients and to health care providers. By working with patients to help them become better educated about their health risk and options, genetic counselors enable patients to make better, well-informed decisions about their health care and genetic testing. Genetic counselors also help select the correct genetic tests for their patients if appropriate. With over 10 new genetic tests appearing in the market daily, selecting the right test for patients saves money and reduces the amount of inappropriate testing.

Can Everyone See a Genetic Counselor?

While in theory anyone can see a genetic counselor, barriers to accessing genetic counseling services exist. With about 5,000 genetic counselors in the United States serving 325 million Americans, access to genetic counseling is limited by geography and by numbers. Cost can be another barrier, as can insurance coverage. While many insurance plans cover genetic counseling, Medicare does not allow genetic counselors to bill directly for their services, and not all medical practices employ genetic counselors because of the reimbursement issue.

What Is Medicare?

Medicare is the single largest provider of insurance in the United States and currently provides insurance for 44 million beneficiaries or about 15 percent of the U.S population. Medicare is a government insurance program that is overseen by the U.S. Centers for Medicare and Medicaid Services. Because it is a government program, changes to coverage and billing must be made through legislation.

What Does Medicare Cover Now?

Currently there is a paradox in what Medicare covers regarding genetic counseling. Genetic counseling is covered by Medicare, but Medicare doesn’t recognize genetic counselors as health professionals, thus genetic counselors cannot bill Medicare for their services directly. Instead, they have to bill and provide genetic counselor services under the supervision of a physician, which leads to convoluted billing and referral practices. Because of this paradox, access to genetic counseling for beneficiaries of Medicare can be difficult and have unfortunate repercussions.

What Are Problems Caused By the Current Medicare System?

Many patients with Medicare coverage receive genetic counseling from physicians or nurse practitioners that may have less genetics training than a genetic counselor, or they have to be referred to a physician that has a genetic counselor on staff and become part of the physician’s medical practice before meeting with the genetic counselor. This complicated referral process decreases access, increases wait time and ultimately increases the cost of genetic counseling.

What Is H.R. 7083?

In a bipartisan effort, former Congressman Erik Paulsen (R-Minnesota) and Congressman Dave Loebsack (D-Iowa) sponsored the bill (H.R 7083) to improve Medicare beneficiaries access to genetic counselors. Passage of this bill, written with input from the National Society of Genetic Counselors (NSGC), will change the current Medicare policies that limit access to genetic counseling services. Increasing access to genetic counselors will lead to more accurate risk assessments, increase appropriate medical management and decrease healthcare costs.

How Do Genetic Counselors Feel About H.R 7083?

In a press release, Erica Ramos, MS LCGC, past president of the NSGC states that “Adding genetic counselors as qualified Medicare providers is an important link in achieving optimal health system performance. We already know genetic counselors improve the quality of care and reduce costs, and when this passes we’ll be accessible to a larger population.” In short, improving access improves care.