New legislation may improve advance care planning

Sen. Mark R. Warner (D-VA)

Journalists may want to keep an eye on new companion bills recently introduced in the House and Senate. The legislation would expand access to critical advance planning services in Medicare and allow people with serious illness to access more advance care planning services.

The Improving Access to Advance Care Planning Act would allow social workers to provide advance care planning (ACP) services, remove beneficiary cost-sharing, promote increased education for providers on current ACP codes, and improve reporting on barriers to providing ACP services and billing the corresponding codes. The bill was introduced in the Senate by Mark R. Warner (D-VA) and Susan Collins (R-ME) and in the House by Rep. Earl Blumenauer (D-OR).

“Decisions about care planning are some of the hardest for a family to make, but they’re also some of the most important. One of my biggest regrets was not having early conversations about care planning with my own mom, who suffered from Alzheimer’s for 11 years and was unable to speak for nine of those years,” said Warner in a statement. “Folks with a serious illness deserve to have a say over what their care should look like, and families deserve the certainty of knowing they are honoring their loved ones’ wishes.”

Medicare Part B currently pays for voluntary advance care planning as part of a beneficiary’s annual wellness visit. It may also cover this service as part of a person’s medical treatment, but in that case, deductibles and co-insurance would apply.

Advance care planning is a crucial part of medical care and is designed to help providers treat patients in ways consistent with their wishes and may also reduce unnecessary health care use and spending, according to the Coalition to Transform Advanced Care (C-TAC). However, many people don’t address it until sudden or serious illness strikes. C-TAC found that beneficiaries don’t necessarily take advantage of conversations with physicians about this topic, and widespread racial inequities in addressing the issue persist.

The bipartisan bill would help provide an opportunity for patients to have a structured discussion with their health care providers about their goals and treatment options so they can make their choices known and develop a plan of care in consultation with their loved ones, according to Collins. “This can be a difficult topic for many families to address, but advance care planning has been shown to increase satisfaction and improve health outcomes because people with advance directives are more likely to get the care that they want, in the setting they prefer, and avoid the care that they don’t want,” she said.

What the bill will do

This bill would codify Medicare coverage of ACP services and also expand eligible providers who can bill for such services to include clinical social workers with experience in care planning. It would also remove beneficiary coinsurance and deductibles for ACP visits — including those that occur outside of an annual Medicare annual wellness visit — to ensure that beneficiaries are not deterred from seeking these services and providers are not deterred from offering them.

“Improving Medicare coverage of voluntary discussions with providers about living wills, power of attorney, and other end-of-life treatment preferences can allow for these delicate and complex conversations to happen in a thoughtful manner,” said Blumenauer in introducing the bill in the House.

The Improving Access to Advance Care Planning Act would also require two reports: one that directs CMS to educate providers on the ACP codes and report to Congress on such activities, and one that directs the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on barriers to providing and receiving ACP services despite the ability to bill for them, and barriers to billing the code itself.

Numerous patient and family advocacy organizations support the legislation, including the Coalition to Transform Advanced Care (C-TAC), LeadingAge, National Association for Home Care & Hospice, National Partnership for Healthcare and Hospice Innovation, Center for Medicare Advocacy, Respecting Choices, USAging, Social Work Hospice & Palliative Care Network, Smarter Health Care Coalition, and the Consumer Coalition for Quality Health Care.

“End-of-life issues are nuanced and complicated, which is why it’s so vital that older adults and families have good access to advance care planning. This bill is an important step toward greater, affordable access to planning that all Americans need,” said Katie Smith Sloan, President, and CEO, LeadingAge, in a statement.

Sens. Tammy Baldwin (D-WI) and Amy Klobuchar (D-MN) joined Collins and Warner in introducing the legislation in the Senate.

While many people are reluctant to discuss “what if” scenarios when it comes to their health, this legislation is a good opportunity for reporters to highlight the need for providers, beneficiaries, and family members to have those conversations.

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