Policy and Law

Federal Policy and Law

Access to Genetic Counselor Services Act (HR 2144)

Introduced in the US House of Representatives March 23, 2021.

Summary: The Access to Genetic Counselor Services Act provides coverage of services furnished by certified genetic counselors under part B of the Medicare program. Genetic counselors are those licensed by states as such, or for those in states without licensure, the Secretary of HHS will set criteria through regulation (likely ABGC certification).

  • Other practitioners that currently provide the service will not be affected.
  • Genetic counselors would be paid at 85 percent of the physician fee schedule.
  • If E/M codes are used for billing the service, a CPT-code modifier would be used to note that the service was done by a genetic counselor.
  • Genetic counselors would be able to assign reimbursement to their employers.

Genetic Information Nondiscrimination Act (GINA) of 2008

GINA is a federal law that prohibits discrimination in health coverage and employment based on genetic information. GINA does not cover life insurance, disability insurance, or long-term care insurance. For more information on GINA, click here.

Other existing Federal Anti-Discrimination Laws and how they apply to genetics.

The Affordable Care Act (ACA)

The ACA has important implications for health care and coverage for all Americans, including for families dealing with genetic conditions.  Healthcare.gov

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Wisconsin Policy and Law

Genetic Counselor Licensure

Initiated by the Wisconsin Genetic Counselors Association (WIGCA), a group of bipartisan Wisconsin lawmakers have introduced SB 259 and AB255 to the 2021-2022 legislature which provides for regulation and licensing for the practice of genetic counseling. To learn more, visit the WIGCA website.

(Wisconsin State Statute 253.13) Commonly known as the “Newborn Screening Statute,” this requires that all babies born in the state of Wisconsin are screened for certain conditions before leaving the hospital. These conditions are sometimes called “hidden disorders” since they are difficult or impossible to diagnose just by looking at a baby. If a baby is identified as having a “hidden disorder” by the screening process, treatment can be provided to lessen or even prevent symptoms. More information is available on the Newborn Screening website.

  • (Wisconsin State Statute 253.12) This statute mandated the creation of a Birth Defects Registry. This registry allows health care providers to confidentially report birth defects with parent consent. This information can then be used to identify birth defects risk factors, decrease incidence of birth defects and facilitate service provision to children and families. More information is available at the Birth Defects Prevention and Surveillance System website.

(Wisconsin State Statute 111.372) This statute discusses the use of genetic testing in employment situations. By law, genetic discrimination in hiring, firing, or setting conditions and terms of employment is prohibited.

(Wisconsin State Statute 631.89) By this statute, health insurers are prohibited from requiring genetic testing or using genetic tests or genetic information to discriminate.