PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
Version 00 · Introduced in House · Feb 26, 2025
Finn Sawyer Access to Cancer Testing Act
This bill provides for coverage of certain cancer diagnostic and laboratory tests under Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). Specifically, the bill provides for coverage of microarray analysis, DNA and RNA sequencing, whole-exome sequencing, and other next-generation sequencing for individuals diagnosed with cancer.
Additionally, the Department of Health and Human Services must establish an education and awareness program for physicians and the public about genomic testing and the role of genetic counselors.
People & committees
Rep. Matsui, Doris O. [D-CA-7] · D–CA
Legislative record
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Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
Source last updated: Dec 5, 2025. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-02-26 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
This proposal would require Medicare, Medicaid, and the Children’s Health Insurance Program to cover specified genetic tests and explanations of results for people diagnosed with cancer. It sets conditions for repeat testing and Medicare payment. It would also require federal education for doctors and the public about genomic testing—testing genetic material—and the role of genetic counselors.
(KK) cancer diagnostic and laboratory tests (as defined in subsection (nnn)) furnished on or after the date that is 6 months after the date of the enactment of this subparagraph.
(B) explanation and interpretation of any analysis or sequencing described in subparagraph (A); furnished to an individual diagnosed with cancer.
(2) Mandatory coverage Section 1902(a)(10)(A) of such Act is amended, in the matter preceding clause (i), by striking and (30) and inserting (30), and (32).
Regardless of the type of coverage elected by a State under subsection (a), beginning January 1, 2027, child health assistance provided under such coverage for targeted low-income children and, in the case that the State elects to provide pregnancy-related assistance under such coverage pursuant to section 2112, such pregnancy-related assistance for targeted low-income pregnant women (as defined in section 2112(d)), shall include coverage of cancer diagnostic and laboratory tests (as defined in section 1861(nnn)).
The Secretary of Health and Human Services, in coordination with the Director of the National Human Genome Research Institute, shall carry out an education and awareness program for physicians and the general public on what genomic testing is, how can be used, and the role of genetic counselors.
The covered tests would include microarray analysis and several ways of reading genetic material: DNA sequencing, RNA sequencing, whole-exome sequencing, and other next-generation sequencing. A clinical laboratory would have to furnish and report the testing. Coverage would include explaining and interpreting results and would apply to people diagnosed with cancer.
The term cancer diagnostic and laboratory tests means— (A) microarray analysis, DNA sequencing, RNA sequencing, whole-exome sequencing, and other forms of next-generation sequencing furnished and reported by a clinical laboratory (as defined in section 353(a) of the Public Health Service Act); and (B) explanation and interpretation of any analysis or sequencing described in subparagraph (A); furnished to an individual diagnosed with cancer.
When a test reports the same genetic content, it could be furnished once at diagnosis, once at each recurrence, and as necessary to plan treatment or monitor cancer progression or response to treatment. This is not an absolute one-test limit.
When an individual test as described in paragraph (1) reports out the same genetic content, it may only be furnished with respect to an individual diagnosed with a cancer— (A) once upon the diagnosis of such cancer; (B) once upon any recurrence of such cancer; and (C) as necessary for purposes of planning treatment or monitoring the progression of such cancer or the response of such cancer to treatment.
Medicare would pay 80% of the lower of the actual test charge or the amount calculated under the referenced clinical laboratory payment rules. The percentage would be 100% for tests paid on an “assignment-related basis,” a payment category whose underlying rules are not reproduced in the supplied text.
with respect to cancer diagnostic and laboratory tests (as defined in section 1861(nnn)), the amount paid shall be an amount equal to 80 percent (or 100 percent, in the case of such tests for which payment is made on an assignment-related basis) of the lesser of the actual charge for the test or the amount that would have been determined for such test under section 1834A had such test been a clinical diagnostic laboratory test
The Medicare deductible—the amount a patient ordinarily must pay before coverage begins—addressed by this amendment would not apply to these tests.
(14) such deductible shall not apply with respect to cancer diagnostic and laboratory tests (as defined in section 1861(nnn)).
The bill would add tests performed more frequently than the new coverage rules allow to Medicare’s payment exclusions.
(3) Exclusion modification Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended
(Q) in the case of cancer diagnostic and laboratory tests (as defined in section 1861(nnn)), which are performed more frequently than is covered under such section;
The bill would add the defined cancer tests to Medicaid’s covered medical assistance and make their coverage mandatory through an amendment to the state-plan requirements.
(b) Medicaid (1) Inclusion as medical assistance Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended
(32) cancer diagnostic and laboratory tests (as defined in section 1861(nnn)); and
(2) Mandatory coverage Section 1902(a)(10)(A) of such Act is amended, in the matter preceding clause (i), by striking and (30) and inserting (30), and (32).
Medicaid’s benchmark coverage provisions, which govern a form of benefit package, would expressly include these cancer tests beginning January 1, 2027. The existing benefit-package rules are not reproduced.
(3) Inclusion in benchmark coverage Section 1937(b)(5) of such Act is amended by inserting before the period at the end the following: , and beginning January 1, 2027, coverage of cancer diagnostic and laboratory tests (as defined in section 1861(nnn)).
The Medicare coverage language specifies services furnished at least six months after enactment. A separate effective-date clause located under Medicaid says amendments made by “this section” apply to services furnished on or after January 1, 2027. That wording leaves uncertainty about how the two timing provisions interact.
(KK) cancer diagnostic and laboratory tests (as defined in subsection (nnn)) furnished on or after the date that is 6 months after the date of the enactment of this subparagraph.
(4) Effective date (A) In general The amendments made by this section shall apply with respect to items and services furnished on or after January 1, 2027.
A Medicaid state plan or waiver could receive extra compliance time if the Secretary of Health and Human Services determines that state legislation is needed. The protection would last until the first day of the first calendar quarter after the first regular legislative session that begins after enactment ends. Each year of a two-year session would count separately. The protection concerns failure to meet the added requirements, not other compliance failures.
In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), or waiver of such plan, that the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet any requirement imposed by amendments made by this section, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act.
For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature.
Starting January 1, 2027, the Children’s Health Insurance Program would have to cover these tests for the low-income children covered by the provision, regardless of the coverage type a state chooses. The requirement would also apply to low-income pregnant women when a state elects to provide the specified pregnancy-related assistance.
Regardless of the type of coverage elected by a State under subsection (a), beginning January 1, 2027, child health assistance provided under such coverage for targeted low-income children and, in the case that the State elects to provide pregnancy-related assistance under such coverage pursuant to section 2112, such pregnancy-related assistance for targeted low-income pregnant women (as defined in section 2112(d)), shall include coverage of cancer diagnostic and laboratory tests (as defined in section 1861(nnn)).
The Secretary of Health and Human Services would have to coordinate with the National Human Genome Research Institute’s director to run an education and awareness program for physicians and the public. It would address what genomic testing is, how it can be used, and the role of genetic counselors.
The Secretary of Health and Human Services, in coordination with the Director of the National Human Genome Research Institute, shall carry out an education and awareness program for physicians and the general public on what genomic testing is, how can be used, and the role of genetic counselors.
The education program would have to encourage medical training about molecular diagnostics—tests that can detect mutations—when cancer is diagnosed or returns. This would include graduate and continuing medical education, including cancer specialty services. The provision requires encouragement rather than directly requiring schools or physicians to adopt training.
The education and awareness program under subsection (a) shall encourage the inclusion in graduate medical education and continuing medical education (including for specialty oncology services) of education and training on the importance of molecular diagnostics at diagnosis and reoccurrence of cancer to detect mutations.
The supplied actions snapshot, updated December 5, 2025, records introduction in the House on February 26, 2025, and referral that day to the Energy and Commerce and Ways and Means committees. This snapshot does not establish subsequent legislative action or enactment.
Source snapshot updated 2025-12-05T21:51:33Z.
2025-02-26: Introduced in House
2025-02-26: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2025-02-26. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy change attached to appropriations was identified in the complete supplied introduced text. This conclusion does not establish absence in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for a particular recipient or place was identified in the complete supplied introduced text. This is a text-only conclusion; formal earmark status and accompanying materials are not established.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow preferential carve-out was identified in the complete supplied introduced text under the requested definition. Ordinary program coverage and routine implementation accommodations do not alone qualify. This conclusion is limited to this version.
Full text preserved for this analysis. Legislative record snapshot: Dec 5, 2025. How PlainBill uses AI