The American Society of Human Genetics (ASHG; Bethesda, Md.) joined the National Society of Genetic Counselors (NSGC) in supporting state licensure of certified genetic counselors. The organizations say that licensure helps to ensure both access to genomic services and a uniform level of quality by genetics professionals. Currently, 16 states issue licenses for genetic counselors, and five additional states have passed licensure laws. Connecticut’s law is the most recent, with licensure becoming effective as of Oct. 1.

With the rapid expansion of genomic testing, there is anticipated to be increased demand for genetic counseling services. While most envision genetic counselors to have a direct clinical role in pre- and post-test counseling (and the majority do—84 percent report their primary role as clinical care), genetic counselors also work to ensure appropriate ordering of genomic tests.

ASHG says that licensure is also important because it provides counselors with the credentials many hospitals need to approve billing and reimbursement for services. In order for genomic medicine to continue to proliferate, ASHG encourages the remaining 29 states to license certified genetic counselors. In its September statement supporting state licensure, ASHG says that to receive and maintain licensure, providers would need to receive a degree in genetic counseling, pass a national-level exam to receive certification, and fulfill continuing education requirements. These criteria follow closely with NSGC’s guiding principles that the organization uses to promote model legislation.

"NSGC supports state licensure of genetic counselors in accordance with our guiding principles, which aim to ensure that licensing laws cover a similar scope across states and maximize flexibility among states in how genetic counselors practice," says Joy Larsen Haidle, NSGC president, in a statement. The guiding principles include a proposed scope of work; qualifications for licensure (having certification with the American Board of Genetic Counseling or the American Board of Medical Genetics, now known as ABMGG-American Board of Medical Genetics and Genomics); reciprocity for "visiting" genetic counselors licensed in other states; and requirements for continuing education.

The calls for state licensure come at a time when there is emerging evidence that in community settings, despite rising genetic testing volumes, utilization of genetic counseling is lagging. For instance, a study published Oct. 1 in JAMA Oncology found that most U.S. women undergoing BRCA mutation testing for hereditary breast and ovarian cancer do not receive recommended genetic counseling. It remains unknown why test-ordering physicians failed to recommend genetic counseling. This large study is the first to analyze community-setting data among commercially insured women to evaluate adherence to professional guidelines establishing testing criteria and recommendations for counseling. In the study, just over one-third of nearly 6,500 women undergoing comprehensive BRCA testing received genetic counseling from a genetics clinician prior to testing. Despite the low numbers of referral for counseling, individuals who reported receiving pretest genetic counseling were more than twice as likely to meet guideline-based testing criteria and showed significantly greater knowledge about BRCA and satisfaction with testing.

Takeaway: Expanding licensure of genetic counselors to the remaining 29 states, may expand access to professional genomic service and ensure uniformity in quality of services rendered.

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