Improving Access to Advanced Care Planning Act

To amend title XVIII of the Social Security Act to waive cost-sharing for advance care planning services, and for other purposes. 1. Short title This Act may be cited as the Improving Access to Advanced Care Planning Act 2. Medicare coverage of advance care planning services (a) Advance care planning services defined Section 1861 of the Social Security Act ( 42 U.S.C. 1395x (lll) Advance care planning services (1) The term advance care planning services (A) the health care preferences of such individual; (B) future health care decisions that may need to be made by, or on behalf of, such individual; and (C) advance directives or other standard forms, which may be completed by, or on behalf of, such individual. (2) For purposes of paragraph (1), the term eligible practitioner (A) a physician (as defined in subsection (r)); (B) a physician assistant (as defined in subsection (aa)(5)); (C) a nurse practitioner (as defined in subsection (aa)(5)); (D) a clinical nurse specialist (as defined in subsection (aa)(5)); or (E) a clinical social worker (as defined in subsection (hh)(1)) that possesses— (i) a relevant care planning certification; or (ii) experience providing care planning conversations or similar services, as defined by the Secretary. . (b) No application of coinsurance or deductible under part B (1) Amount Section 1833(a)(1) of the Social Security Act ( 42 U.S.C. 1395l(a)(1) (A) by striking and (DD) (DD) (B) by inserting before the semicolon at the end the following: and (EE) with respect to advance care planning services (as defined in section 1861(lll)), the amounts paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under the fee schedule established under section 1848(b) (2) Waiver of application of deductible The first sentence of section 1833(b) of the Social Security Act ( 42 U.S.C. 1395l(b) (A) by striking and (12) (12) (B) by inserting , and (13) such deductible shall not apply with respect to advance care planning services (as defined in section 1861(lll)) section 1861(s)(10)(A) (c) Effective date The amendments made by this section shall apply to advance care planning services furnished on or after January 1, 2023. 3. HHS provider outreach and report (a) Outreach The Secretary of Health and Human Services (in this section referred to as the Secretary 42 U.S.C. 1395 et seq. (b) HHS report on provider outreach Not later than one year after the date of enactment of this Act, the Secretary of Health and Human Services shall submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report on the outreach conducted under subsection (a). Such report shall include a description of the methods used for such outreach. 4. MedPAC study and report on provision of advance care planning services and use of advance care planning codes (a) Study The Medicare Payment Advisory Commission (in this section referred to as the Commission 42 U.S.C. 1395 et seq. (1) the furnishing of advance care planning services to Medicare beneficiaries, including— (A) which providers are trained to provide such services; (B) which providers are eligible to provide such services under the Medicare program; (C) the length and frequency of the visits for furnishing such services; and (D) any barriers related to providers furnishing, or beneficiaries being furnished, such services; (2) the use of advance care planning Current Procedural Terminology (CPT) codes to bill for the furnishing of advance care planning services to Medicare beneficiaries, including— (A) circumstances under which codes other than advance care planning CPT codes are used to bill for such services under the Medicare program and why providers do not use advance care planning CPT codes; and (B) any barriers to providers using advance care planning CPT codes to bill for such services under the Medicare program; and (3) such other items determined appropriate by the Commission. (b) Report Not later than June 30, 2024, the Commission shall submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives, and the Committee on Finance of the Senate, a report on the study conducted under subsection (a), including recommendations for legislative and administrative action as the Commission determines appropriate.

Summary: Improving Access to Advanced Care Planning Act This bill provides statutory authority for Medicare coverage of advance care planning services. It also (1) allows such services to be provided by clinical social workers, and (2) waives the coinsurance and deductible for such services (regardless of whether the services are provided as part of an annual wellness visit). The Centers for Medicare & Medicaid Services must conduct outreach about Medicare coverage of advance care planning services; the Medicare Payment Advisory Commission must study and report on the provision and utilization of such services.