PREFERRED Screening Act
- Sponsor
- Sen. Cassidy, Bill [R-LA]
- Committees
- Finance Committee (primary)
- Last action
- Aug 5, 2026
Bottom line
This bill creates a Medicare payment model to incentivize personalized breast cancer risk assessment and tailored screening/prevention plans, potentially shifting from a one-size-fits-all approach to more targeted care.
What it actually does
This bill establishes a new payment model under Medicare (Title XI of the Social Security Act) to reimburse healthcare providers for comprehensive breast cancer risk assessments and personalized screening/risk-reduction plans for eligible individuals aged 40-75. The model aims to test whether this personalized approach changes the furnishing of breast cancer screening and risk-reduction services, with a particular focus on integrating genetic and lifestyle factors.
Proponents argue
Supporters argue that current breast cancer screening guidelines are often generalized and do not adequately account for individual risk factors, leading to both over-screening for some and under-screening for others. They contend that personalized risk assessments, incorporating genetic and lifestyle factors, will lead to more effective and efficient early detection and prevention strategies, ultimately improving patient outcomes and potentially reducing long-term healthcare costs by preventing advanced cancers.
Opponents contend
Critics might raise concerns about the complexity and cost of implementing such a comprehensive model, particularly the integration of advanced genetic testing and polygenic risk scores into routine care. They may also question the clinical efficacy of risk-stratified screening, noting that the bill explicitly states it does not require establishing this efficacy, and worry about potential disparities in access to these advanced services, especially in underserved areas, despite the bill's prioritization efforts.
The bill is relatively short and clearly structured, allowing an informed reader to grasp its core provisions within the given time.
Section 2, amending Section 1115A of the Social Security Act, adding subsection (h)(1).
Creation of a Comprehensive Breast Cancer Risk Assessment Payment Model
This provision mandates the Secretary of Health and Human Services to establish a new payment model within two years. This model will reimburse eligible healthcare providers for conducting detailed breast cancer risk assessments and creating individualized screening and risk-reduction plans for Medicare beneficiaries aged 40-75. The primary goal is to evaluate if this personalized approach alters the delivery of breast cancer services.
Supporters argue
Supporters argue this model addresses a critical gap in current breast cancer care by moving beyond age-based screening to a more precise, individualized approach, which could lead to earlier detection for high-risk individuals and reduce unnecessary interventions for low-risk ones.
Critics contend
Some might argue that establishing a payment model without first requiring proof of clinical efficacy for risk-stratified screening (as explicitly stated in the bill) could lead to significant expenditure on unproven methods.
Tradeoffs
Balances the desire for personalized medicine and early intervention against the need for robust evidence of clinical efficacy and cost-effectiveness before widespread implementation.
Section 2, amending Section 1115A, adding subsection (h)(2)(A).
Mandated Data Collection for Risk Assessments
This section specifies the information that must be collected for each risk assessment, including genetic testing results (for specific genes like BRCA1/2, PALB2, etc.), polygenic risk scores, family history, breast density, and clinical/lifestyle factors. This data will be used with a validated risk model to estimate a 5-year breast cancer risk and assign individuals to risk categories (e.g., high-risk, elevated-risk).
Section 2, amending Section 1115A, adding subsection (h)(2)(B).
Development of Tailored Care Plans
This provision outlines the mandatory components of the personalized plans. These include recommendations for adjusted screening frequency and modality (mammography, MRI, ultrasound), referrals for enhanced surveillance (especially for high-risk individuals), counseling on modifiable risk factors (weight, activity, alcohol), counseling for high-risk individuals on endocrine risk-reducing medications, and referrals for genetic counseling. Plans must also notify first-degree relatives who might benefit from genetic testing and be communicated to the individual's primary care provider and integrated into their medical record.
Section 2, amending Section 1115A, adding subsection (h)(4).
Ensuring Diverse Provider Participation and Access
The bill specifies that eligible providers include physicians, nurse-midwives, nurse practitioners, physician assistants, and certified genetic counselors, regardless of their existing Medicare supplier status. It also mandates that the Secretary ensure a mix of academic medical centers, community-based practices, and facilities serving rural populations participate. Priority for selection is given to providers in states with high breast cancer mortality, health professional shortage areas, medically underserved areas, or rural areas with limited access to genetic counseling.
Section 2, amending Section 1115A, adding subsection (h)(5).
Reimbursement for Comprehensive Assessments
This provision directs the Secretary to establish a payment amount for the comprehensive breast cancer risk assessment and personalized plan. When determining this amount, the Secretary must consider factors such as the clinical time and complexity involved, the interpretation of genetic and breast density data, the time needed for plan development, and comparable services under existing Medicare physician fee schedules. The payment amount can be adjusted based on evaluation results.
Section 2, amending Section 1115A, adding subsections (h)(6) and (h)(9).
Robust Monitoring and Future Recommendations
The bill mandates a comprehensive evaluation of the model using primary, secondary, and exploratory measures, stratified by age. These measures include assessing the proportion of individuals receiving assessments, adherence to plans, utilization of advanced screening (MRI) and risk-reducing medications, and the model's cost-effectiveness over 10- and 20-year horizons. The Secretary must submit interim (3 years) and final (7 years) reports to Congress and relevant agencies, including recommendations on whether to expand or make the model permanent, potentially including Medicare Advantage plans.
This clause states that nothing in the subsection shall be construed to require the Secretary to establish the clinical efficacy of risk-stratified breast cancer screening.
Section 2, amending Section 1115A, adding subsection (h)(1)(E).
Why it matters:This phrasing is standard legislative practice to clarify scope or intent, but it is substantively significant as it allows the model to proceed as a test without prior definitive proof of the efficacy of the underlying clinical approach it aims to test.
Case for: Supporters would argue that this clause is necessary to allow for the testing of innovative models. Requiring full clinical efficacy before testing a payment model would create a 'chicken and egg' problem, hindering progress in personalized medicine. The model itself is designed to gather data that could inform future efficacy assessments.
Case against: Critics might contend that launching a payment model for a strategy whose clinical efficacy is not yet established could lead to significant healthcare spending on services that may not ultimately improve patient outcomes, potentially diverting resources from proven interventions.
Estimated impact: Potentially significant, as it allows for the expenditure of Medicare funds on a model testing a clinical approach whose efficacy is not yet fully proven, impacting the overall cost-effectiveness and public health outcomes of the program.
This provision states that no additional funds are authorized to be appropriated for this model, and the Secretary shall carry it out using funds otherwise available under subsection (f) of Section 1115A.
Section 2, amending Section 1115A, adding subsection (h)(10).
Why it matters:This is a critical fiscal detail. It signals that the program is not seeking new budget authority but will rely on existing funds, which can make it more palatable to fiscal conservatives. However, it means other programs funded under 1115A(f) might see their resources reallocated.
Case for: Proponents would argue this demonstrates fiscal responsibility by not requesting new taxpayer money, instead leveraging existing resources within the Centers for Medicare & Medicaid Innovation (CMMI) to test an important new model.
Case against: Critics might argue that reallocating existing funds from CMMI's broader portfolio could detract from other potentially valuable innovation models or strain CMMI's overall capacity if the new model proves to be expensive.
Estimated impact: This provision means the model's costs will be absorbed within CMMI's existing budget, potentially impacting the funding available for other innovation initiatives. The specific dollar impact depends on the model's actual expenditure.