HR1620119th CongressWALLET

Finn Sawyer Access to Cancer Testing Act

Sponsored By: Representative Matsui

Introduced

Summary

Mandatory expansion of coverage for cancer diagnostic and laboratory tests across Medicare, Medicaid, and CHIP would require payers to cover advanced genomic and laboratory testing for people with cancer. The bill would also create a national education and awareness program on genomic testing for clinicians and the public.

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  • Medicare beneficiaries: The bill would cover tests like microarray analysis, DNA and RNA sequencing, whole-exome sequencing and the interpretation of those tests. Tests would be allowed at diagnosis, at recurrence, or as needed for treatment planning or monitoring, and Medicare payment would be 80% of the lesser of the actual charge or the typical lab rate, or 100% when payment is assigned.
  • Low-income families and children on Medicaid and CHIP: Medicaid would add these cancer diagnostic and laboratory tests as mandatory medical assistance and include them in benchmark coverage. CHIP would require coverage for targeted low-income children and, if a state elects pregnancy-related assistance, for targeted low-income pregnant women beginning January 1, 2027.
  • Clinicians and the public: The Secretary of Health and Human Services, in coordination with the National Human Genome Research Institute, would run an education and awareness program on genomic testing. The program would promote inclusion of molecular diagnostics education in graduate medical education and continuing medical education to improve detection and treatment planning.

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 2 benefits, 0 costs, 1 mixed.

Medicaid and CHIP would cover cancer tests

Medicaid and CHIP would have to cover cancer diagnostic and lab tests for people with a cancer diagnosis. Coverage in both programs would apply to care on or after January 1, 2027. In CHIP, pregnant women would be covered only if the State offers pregnancy-related assistance. States could get extra time if their legislature must pass a law; in those States, coverage could start after the first quarter following the next regular session.

Medicare cancer tests covered, with limits

Medicare would cover certain cancer diagnostic and lab tests for people diagnosed with cancer. The Part B deductible would not apply to these tests. Medicare would pay labs 80% of the lower of the lab charge or a Medicare-based amount, or 100% if payment is on an assignment basis. Tests that report the same genetic content could be covered once at diagnosis, once at recurrence, and again only if needed for treatment planning or monitoring. These rules would start 6 months after enactment.

National education on genomic testing

HHS, with the National Human Genome Research Institute, would run a program to teach doctors and the public about genomic testing. It would explain when testing is useful and the role of genetic counselors. It would push medical schools and continuing education to include training on molecular tests at cancer diagnosis and recurrence.

Sponsors & CoSponsors

Sponsor

Matsui

CA • D

Cosponsors

  • Bilirakis

    FL • R

    Sponsored 2/26/2025

  • Thompson (CA)

    CA • D

    Sponsored 2/26/2025

  • Grijalva

    AZ • D

    Sponsored 2/26/2025

  • Bacon

    NE • R

    Sponsored 2/26/2025

  • Wasserman Schultz

    FL • D

    Sponsored 2/26/2025

  • Landsman

    OH • D

    Sponsored 2/26/2025

  • Himes

    CT • D

    Sponsored 2/26/2025

  • Tlaib

    MI • D

    Sponsored 2/26/2025

  • Sewell

    AL • D

    Sponsored 2/26/2025

  • Davis (NC)

    NC • D

    Sponsored 2/26/2025

  • Gottheimer

    NJ • D

    Sponsored 5/21/2025

  • Tonko

    NY • D

    Sponsored 11/7/2025

  • Pingree

    ME • D

    Sponsored 11/10/2025

Roll Call Votes

No roll call votes available for this bill.

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