II 

117TH CONGRESS 

2D SESSION S. 4873 

To amend title XVIII of the Social Security Act to waive cost-sharing for 

advance care planning services, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 15, 2022 

Mr. WARNER (for himself, Ms. COLLINS, Ms. BALDWIN, and Ms. KLOBUCHAR) introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to waive 

cost-sharing for advance care planning services, and for 

other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Improving Access to 

5 Advance Care Planning Act’’. 

6 SEC. 2. MEDICARE COVERAGE OF ADVANCE CARE PLAN7 NING SERVICES. 

8 (a) ADVANCE CARE PLANNING SERVICES DE9 FINED.—Section 1861 of the Social Security Act (42 


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1 U.S.C. 1395x) is amended by adding at the end the fol2 lowing new subsection: 

3 ‘‘(lll) ADVANCE CARE PLANNING SERVICES.— 

4 ‘‘(1) IN GENERAL.—The term ‘advance care 

5 planning services’ means a visit between an eligible 

6 practitioner (as defined in paragraph (2)) enrolled 

7 under section 1866(j) and an individual, a family 

8 member of such individual, or a surrogate des9 ignated by such individual, to discuss— 

10 ‘‘(A) the health care preferences of such 

11 individual; 

12 ‘‘(B) future health care decisions that may 

13 need to be made by, or on behalf of, such indi14 vidual; and 

15 ‘‘(C) advance directives or other standard 

16 forms, which may be completed by, or on behalf 

17 of, such individual. 

18 ‘‘(2) ELIGIBLE PRACTITIONER.—For purposes 

19 of paragraph (1), the term ‘eligible practitioner’ 

20 means— 

21 ‘‘(A) a physician (as defined in subsection 

22 (r)); 

23 ‘‘(B) a physician assistant (as defined in 

24 subsection (aa)(5)); 


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1 ‘‘(C) a nurse practitioner (as defined in 

2 subsection (aa)(5)); 

3 ‘‘(D) a clinical nurse specialist (as defined 

4 in subsection (aa)(5)); or 

5 ‘‘(E) a clinical social worker (as defined in 

6 subsection (hh)(1)) who possesses— 

7 ‘‘(i) a relevant care planning certifi8 cation; or 

9 ‘‘(ii) experience providing care plan10 ning conversations or similar services, as 

11 defined by the Secretary.’’. 

12 (b) NO APPLICATION OF COINSURANCE OR DEDUCT13 IBLE UNDER PART B.— 

14 (1) AMOUNT.—Section 1833(a)(1) of the Social 

15 Security Act (42 U.S.C. 1395l(a)(1)) is amended— 

16 (A) by striking ‘‘and (DD)’’ and inserting 

17 ‘‘(DD)’’; and 

18 (B) by inserting before the semicolon at 

19 the end the following: ‘‘and (EE) with respect 

20 to advance care planning services (as defined in 

21 section 1861(lll)), the amounts paid shall be 

22 100 percent of the lesser of the actual charge 

23 for the services or the amount determined 

24 under the fee schedule established under section 

25 1848(b)’’. 


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1 (2) WAIVER OF APPLICATION OF DEDUCT2 IBLE.—The first sentence of section 1833(b) of the 

3 Social Security Act (42 U.S.C. 1395l(b)) is amend4 ed— 

5 (A) by striking ‘‘and (12)’’ and inserting 

6 ‘‘(12)’’; and 

7 (B) by inserting before the period the fol8 lowing: ‘‘, and (13) such deductible shall not 

9 apply with respect to advance care planning 

10 services (as defined in section 1861(lll))’’. 

11 (c) EFFECTIVE DATE.—The amendments made by 

12 this section shall apply to items and services furnished on 

13 or after January 1, 2023. 

14 SEC. 3. HHS PROVIDER OUTREACH. 

15 (a) OUTREACH.—The Secretary of Health and 

16 Human Services (in this section referred to as the ‘‘Sec17 retary’’) shall conduct outreach to physicians and appro18 priate non-physician practitioners participating under the 

19 Medicare program under title XVIII of the Social Security 

20 Act with respect to Medicare payment for advance care 

21 planning counseling services furnished to individuals to 

22 discuss their health care preferences, identified by HCPCS 

23 codes 99497 and 99498 (or any successor to such codes). 

24 Such outreach shall include a new, comprehensive, one25 time education initiative to inform such physicians and 


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1 practitioners of the addition of such services as a covered 

2 benefit under the Medicare program, including the re3 quirements for eligibility for such services. 

4 (b) REPORT.—Not later than 1 year after the date 

5 of enactment of this Act, the Secretary shall submit to 

6 the Committee on Ways and Means and the Committee 

7 on Energy and Commerce of the House of Representatives 

8 and the Committee on Finance of the Senate a report on 

9 the outreach conducted under subsection (a). Such report 

10 shall include a description of the methods used for such 

11 outreach. 

12 SEC. 4. MEDPAC REPORT ON THE FURNISHING OF AD13 VANCE CARE PLANNING SERVICES AND THE 

14 USE OF ADVANCE CARE PLANNING CODES 

15 UNDER THE MEDICARE PROGRAM. 

16 (a) STUDY.—The Medicare Payment Advisory Com17 mission (in this paragraph referred to as the ‘‘Commis18 sion’’) shall conduct a study on advance care planning 

19 under the Medicare program under title XVIII of the So20 cial Security Act. Such study shall include an analysis 

21 of— 

22 (1) the furnishing of advance care planning 

23 services to Medicare beneficiaries, including— 

24 (A) which providers are trained to provide 

25 such services; 


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1 (B) which providers are eligible to provide 

2 such services under the Medicare program; 

3 (C) the length and frequency of the visits 

4 for furnishing such services; and 

5 (D) any barriers related to providers fur6 nishing, or beneficiaries being furnished, such 

7 services; 

8 (2) the use of advance care planning Current 

9 Procedural Terminology (CPT) codes to bill for the 

10 furnishing of advance care planning services to 

11 Medicare beneficiaries, including— 

12 (A) circumstances under which codes other 

13 than advance care planning CPT codes are used 

14 to bill for such services under the Medicare pro15 gram and why providers do not use advance 

16 care planning CPT codes; and 

17 (B) any barriers to providers using ad18 vance care planning CPT codes to bill for such 

19 services under the Medicare program; and 

20 (3) such other items determined appropriate by 

21 the Commission. 

22 (b) REPORT.— 

23 (1) IN GENERAL.—Not later than June 30, 

24 2024, the Commission shall submit to the Com25 mittee on Ways and Means and the Committee on 


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1 Energy and Commerce of the House of Representa2 tives and the Committee on Finance of the Senate 

3 a report on the study conducted under subsection 

4 (a), together with recommendations for such legisla5 tion and administrative action as the Commission 

6 determines appropriate. 

Æ 


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