Improving Access to Advanced Care Planning Act
Bill: H.R.8840 | Sponsor: Rep. Blumenauer, Earl (D-OR)
Policy area: Health

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.

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 Advanced 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) 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) 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)) 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)) 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 ``, and (13) such deductible shall 
                not apply with respect to advance care planning 
                services (as defined in section 1861(lll))'' after 
                ``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.

SEC. 3. HHS PROVIDER OUTREACH AND REPORT.

    (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 
(42 U.S.C. 1395 et seq.) 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 eligibility 
requirements for such services.
    (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.

SEC. 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'') shall conduct a study on 
advance care planning services under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) analyzing--
            (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.
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