The Finn Sawyer Access to Cancer Testing Act would extend coverage for cancer diagnostic and laboratory tests under federal programs, with a focus on genomic testing such as microarray analysis, DNA sequencing, RNA sequencing, and whole-exome sequencing. The tests and their interpretation would be defined and enabled for coverage six months after enactment.
The bill also adjusts payment rules for these tests and introduces a frequency cap tied to diagnosis, recurrence, and treatment planning or monitoring. In addition, the legislation adds Medicaid and CHIP coverage for cancer diagnostic and laboratory tests beginning in 2027 and requires an education and awareness program on genomic testing for physicians and the public.
The overall aim is to accelerate access to advanced diagnostics as a pathway to better cancer treatment options and to align federal health programs with modern genomic technologies, while providing an education framework to support implementation.
At a Glance
What It Does
Expands Medicare coverage for cancer diagnostic and laboratory tests defined as genomic testing (microarray, DNA/RNA sequencing, whole-exome sequencing) furnished after a six-month post-enactment window. It also sets payment parameters and a testing frequency framework.
Who It Affects
Medicare beneficiaries with cancer, clinical laboratories performing genomic tests, and providers ordering tests; state Medicaid programs and their enrollees; CHIP-eligible children and pregnant women.
Why It Matters
Establishes a federal baseline for access to modern genomic diagnostics, potentially shaping downstream treatment decisions and data generation while expanding coverage to more vulnerable populations.
More articles like this one.
A weekly email with all the latest developments on this topic.
What This Bill Actually Does
The bill creates a formal place for genomic cancer testing within key federal programs. It defines what counts as cancer diagnostic and laboratory tests and covers those tests when furnished at least six months after enactment.
The tests include sequencing and microarray analyses, along with the professional interpretation of results, all delivered by a clinical laboratory and used to inform cancer care.
Medicare changes include a new payment framework: coverage would be 80 percent of the lower of the test’s actual charge or the standard rate (with full payment in some assignment-based cases). It also adds a frequency rule for repeating tests with the same genetic content—limited to diagnosis, cancer recurrence, or use in planning, monitoring, or adjusting treatment.The legislation expands Medicaid and CHIP to require coverage of cancer diagnostic and laboratory tests, with the Medicaid expansion taking effect within the 2027 timeframe and CHIP coverage for targeted low-income children and pregnant women beginning the same year.
Separately, the bill mandates an education and awareness program on genomic testing for physicians and the public, including incorporating molecular diagnostics training into medical education and continuing education.Taken together, the bill seeks to remove financial barriers to cutting-edge cancer diagnostics and to build capacity for clinicians to use these tests effectively, while ensuring states and federal programs coordinate on funding and implementation in a phased timeline.
The Five Things You Need to Know
The bill defines cancer diagnostic and laboratory tests to include next-generation sequencing and interpretation.
Medicare would cover these tests for items furnished six months after enactment and pay 80% of the lesser of charge or the standard rate.
A frequency rule limits repeat testing with the same genetic content to diagnosis, recurrence, or planning/monitoring.
Medicaid and CHIP are expanded to require coverage of these tests, with full implementation by January 1, 2027.
An education program on genomic testing for physicians and the public is mandated, including training in molecular diagnostics.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Medicare coverage of cancer diagnostic and laboratory tests
The bill amends 1861 to add a new subsection defining cancer diagnostic and laboratory tests (nnn) to include microarray analysis, DNA sequencing, RNA sequencing, whole-exome sequencing, and related interpretations provided to a person diagnosed with cancer. Coverage of these tests begins six months after enactment as described, expanding the types of genomic diagnostics that Medicare will reimburse.
Medicare payment and testing frequency
Section 1833 is amended to pay 80 percent (or 100 percent for tests paid on an assignment basis) of the lesser of the actual charge or the amount that would be determined under 1834A for these tests. Section 1862 is amended to add an exclusion that allows coverage for cancer diagnostic and laboratory tests performed more frequently than currently covered under the act, to accommodate ongoing diagnostic or monitoring needs.
Medicaid and CHIP expansion and effective date
Medicaid is amended to include cancer diagnostic and laboratory tests as medical assistance, with mandatory coverage starting on the effective date specified, and the overall program updated to reflect these tests. Section 1937(b)(5) is amended to require coverage beginning January 1, 2027. CHIP is amended to ensure coverage for targeted low-income children and, where applicable, pregnant women, beginning in 2027. An exemption allows state plans time to adjust where required by new coverage rules.
Education and awareness program on genomic testing
The Secretary of Health and Human Services, in coordination with the National Human Genome Research Institute, must run an education and awareness program about genomic testing for physicians and the public. The program includes promoting the use of molecular diagnostics in graduate medical education and continuing medical education, and it emphasizes the role of genetic counselors in cancer care.
This bill is one of many.
Codify tracks hundreds of bills on Healthcare across all five countries.
Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries diagnosed with cancer who gain access to genomic testing as part of covered services, improving diagnostic and treatment planning.
- Clinical laboratories performing cancer genomic testing gain clearer reimbursement pathways and a defined coverage timeline.
- Oncologists and other cancer care providers benefit from a standardized coverage framework to inform testing decisions and patient counseling.
- State Medicaid programs and enrollees gain expanded coverage for diagnostic testing, reducing out-of-pocket costs.
- CHIP-eligible targeted low-income children and, where applicable, pregnant women gain access to cancer diagnostic tests as part of comprehensive coverage.
Who Bears the Cost
- The federal government (CMS) would incur higher costs from expanded Medicare coverage and increased payments.
- State Medicaid programs would incur costs associated with the mandatory coverage expansion and implementation.
- Healthcare providers and laboratories may incur administrative costs to implement new coverage, reporting, and counseling requirements.
- The education and awareness program imposes ongoing costs on federal and state levels to develop and disseminate genomic testing information.
- Potential shifts in private payer coverage as public program standards influence broader market practices.
Key Issues
The Core Tension
The central dilemma is whether rapid, wide-scale access to advanced genomic testing can be funded and implemented in a way that meaningfully improves cancer care without creating unsustainable cost pressures on federal and state programs.
The bill’s broad expansion of genomic testing coverage aims to improve cancer care, but it introduces budgetary considerations for Medicare and Medicaid and could affect utilization patterns. While frequency rules and six-month coverage delays provide guardrails, the large-scale expansion of advanced diagnostics raises questions about the long-term cost implications and the proper balance between access and sustainability.
The state-by-state implementation pathway and the need for provider education add complexity to rollout, as does the requirement for an education program that must reach a wide professional audience. These tensions warrant close attention as the bill moves through the legislative process.
Try it yourself.
Ask a question in plain English, or pick a topic below. Results in seconds.