NSGC Advocacy: Telehealth and Genetic Services for Medicare Patients

By John Richardson, NSGC Senior Director of Policy and Government Relations

We know it is a very busy time for our members dealing with issues surrounding the COVID-19 pandemic.

As you might have heard, CMS recently loosened telemedicine and licensure regulations to allow hospitals and others to deliver more telehealth services to federal beneficiaries. This should help mitigate the spread of COVID-19, as it will allow patients to receive care at home. While the emergency policy is great, it won’t help genetic counselors deliver services to Medicare patients because you are not recognized practitioners under the Social Security Act.

CMS policies focus on federal health insurance programs – not commercial health plans. Individual states are also waiving telemedicine and some licensure requirements for those health services and plans regulated at the state level. Genetic counselors should be able to provide telehealth and be reimbursed as long as the non-federal health plan allows it – and they should.  

Many genetic counselors are moving out of hospitals and healthcare facilities during the COVID-19 emergency, or are planning to do so. When this occurs, these genetic counselors have no way to meet “incident to” (supervision) requirements for Medicare patients. This could impede the delivery of genetic services to Medicare beneficiaries who may need emergent genetic testing to make treatment decisions.

NSGC is working hard to create a solution:

  • We have requested that Congress enact H.R. 3235, or similar language, through one of the emergency COVID -19 packages moving through Congress. There will likely be an April legislative package. Including these provisions will help ensure the patients who need life-saving genetic services can receive them. Services may include support for testing that informs time-sensitive surgical and therapeutic treatment decisions, especially for oncology and cardiology patients.
  • NSGC submitted Section 1135 waivers to all the CMS Regional Offices on March 20, 2020. The waiver requested the CMS Regional Offices to suspend “incident to” requirements for certified genetic counselors so they can seamlessly deliver services to Medicare beneficiaries. We have yet to hear a response, however, employers of genetic counselors and most importantly, states can also request their health departments and governors’ offices. Many states have received 1135 waivers for licensure and even supervision. However, these waivers affect current regulation, so they likely do not apply to genetic counselors. NSGC is working to clarify this point. Some of you, through your institution’s government relations office, have and are requesting governors also make the request and this should help.

NSGC will inform you when/if it receives a response to its waiver request. In the meantime, we request you contact your member of Congress to inform them that your services to Medicare beneficiaries are being disrupted and they should act now to pass H.R. 3235.

This article was published in the March 2020 Advocate Newsletter.

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