Improving Access to Advance Care Planning Act
Bill: S.4873 | Sponsor: Sen. Warner, Mark R. (D-VA)
Policy area: Health

Summary:
Improving Access to Advance 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.

To amend title XVIII of the Social Security Act to waive cost-sharing 
      for advance care planning services, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Improving Access to Advance Care 
Planning Act''.

SEC. 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) is amended by adding at the end 
the following new subsection:
    ``(lll) Advance Care Planning Services.--
            ``(1) In general.--The term `advance care planning 
        services' means a visit between an eligible practitioner (as 
        defined in paragraph (2)) enrolled under section 1866(j) and an 
        individual, a family member of such individual, or a surrogate 
        designated by such individual, to discuss--
                    ``(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) Eligible practitioner.--For purposes of paragraph 
        (1), the term `eligible practitioner' means--
                    ``(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)) who 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)) is amended--
                    (A) by striking ``and (DD)'' and inserting 
                ``(DD)''; and
                    (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)) is amended--
                    (A) by striking ``and (12)'' and inserting 
                ``(12)''; and
                    (B) by inserting before the period the following: 
                ``, and (13) such deductible shall not apply with 
                respect to advance care planning services (as defined 
                in section 1861(lll))''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2023.

SEC. 3. HHS PROVIDER OUTREACH.

    (a) Outreach.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall conduct outreach to 
physicians and appropriate non-physician practitioners participating 
under the Medicare program under title XVIII of the Social Security Act 
with respect to Medicare payment for advance care planning counseling 
services furnished to individuals to discuss their health care 
preferences, identified by HCPCS codes 99497 and 99498 (or any 
successor to such codes). Such outreach shall include a new, 
comprehensive, one-time education initiative to inform such physicians 
and practitioners of the addition of such services as a covered benefit 
under the Medicare program, including the requirements for eligibility 
for such services.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the Secretary 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.

SEC. 4. MEDPAC REPORT ON THE FURNISHING OF ADVANCE CARE PLANNING 
              SERVICES AND THE USE OF ADVANCE CARE PLANNING CODES UNDER 
              THE MEDICARE PROGRAM.

    (a) Study.--The Medicare Payment Advisory Commission (in this 
paragraph referred to as the ``Commission'') shall conduct a study on 
advance care planning under the Medicare program under title XVIII of 
the Social Security Act. Such study shall include an analysis of--
            (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.--
            (1) In general.--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), together 
        with recommendations for such legislation and administrative 
        action as the Commission determines appropriate.
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