New Law Widens Access to Genetic Counseling but Licensure and Coverage Barriers Persist

Heather A. Zierhut, PhD, MS, CGC, and Adam H. Buchanan, MS, MPH, LGC
Published: Tuesday, Oct 09, 2018
Heather A. Zierhut, PhD,

Heather A. Zierhut, PhD, MS, CGC
Telehealth, a universal term for the use of digital information and communication technologies to remotely1 access healthcare services, is improving availability of healthcare services, particularly for patients in rural areas. Data from a wide range of medical specialties have demonstrated that telehealth can improve access while maintaining quality.2-4 Private payers have been influential in supporting telehealth initiatives, with more than 30 states mandating coverage.5,6 Yet limitations on Medicaid and Medicare reimbursement of telehealth have hampered broad implementation of this promising service delivery model.7-9

HR 1892, the budget agreement signed into law in February 2018,10 is being hailed for removing some of these limitations and improving access to care for Medicare recipients. The law contains provisions from the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 201711 and other telehealth bills that seek to expand Medicare coverage of telehealth services. Previously unrecognized uses of telehealth under Medicare Part B will now be allowable benefits, assuming they are clinically relevant and meet established requirements (section 303). In addition, accountable care organizations can access a variety of telehealth services with fewer restrictions (section 304). The bill also allows beneficiaries to choose whether they want to use telehealth options.

The potential for expanded coverage of telehealth is welcome news for several medical specialties, particularly those that offer limited access in rural areas. One such field is genetic counseling. Genetic counselors help people understand and adapt to the medical, psychological, and familial implications of hereditary cancer.12 They also help identify patients who may benefit from genetic testing and direct them to the most appropriate testing. The process of genetic counseling is particularly well suited to telehealth as it is primarily conducted via consultations that involve a communication process that can occur by phone or video. Cancer genetic counselors have seen a rapid expansion of telehealth services (telegenetics) in recent years. Although patient access to cancer genetic counseling varies widely across the United States, the demand for genetic counseling is increasing, as cancer patients’ germline mutation status increasingly has implications for cancer treatment decisions.13-17 For instance, individuals with germline pathogenic variants in BRCA1/2 genes and a growing list of cancer types (eg, ovarian, prostate) are eligible for treatment with poly ADP ribose polymerase (PARP) inhibitors.18 Accordingly, genetic counselors in oncology have reported increased referral volume due to the FDA approval of PARP inhibitors in the settings of treatment-resistant ovarian cancer.18 Additionally, the immunotherapy pembrolizumab has now been approved by the FDA to treat tumors that exhibit mismatch repair deficiency, a hallmark of Lynch syndrome, and have progressed on prior treatment.19 Further, a broadening list of cancer presentations are being recognized as being associated with higher likelihood of germline etiology, including metastatic prostate cancer.20,21

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