WASHINGTON – U.S. Sens. Mark R. Warner (D-VA) and Susan Collins (R-ME) introduced bipartisan and bicameral legislation to expand access to critical advance care planning (ACP) services in Medicare that allow people, especially those with serious illness, to plan for their care and have their choices honored when it matters most. The Improving Access to Advance Care Planning Act would help more Americans access critical ACP services by allowing social workers to provide ACP services, removing beneficiary cost-sharing, and promoting increased education for providers on current ACP codes, and improved reporting on barriers to providing ACP services and billing the corresponding codes. This legislation was introduced in the U.S. House of Representatives by Congressman 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 Sen. Warner. “I’m proud to introduce this bill because 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.”

“Unfortunately, most patients do not routinely make advance plans for their care in the event that they are diagnosed with a serious or life-threatening illness.  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,” said Sen. Collins. “The bipartisan bill we are introducing today would help provide an opportunity for patients to have a structured discussion with their health care providers about their goals and treatment options so that they can make their choices known and develop a plan of care in consultation with their loved ones.”

“I have been working to improve end of life care for well over a decade,” said Rep. Blumenauer. “Despite what was rated as the PolitiFact lie of the year during the Affordable Care Act debate over so-called ‘death panels,’ we won. Medicare has finally started paying physicians to help families understand their choices. This legislation will make advance care planning more accessible, allowing more of these conversations to happen and ensuring people’s wishes are heard, respected, and enforced.”

Specifically, this legislation would codify Medicare coverage of ACP services – a longtime priority for Sen. Warner, who first introduced legislation to improve planning options for patients in 2015. Today’s bill would also expand eligible providers that 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 happen 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. The bill 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 MedPAC to study and report to Congress on (A) barriers to providing and receiving ACP services despite the ability to bill for them, and (B) barriers to billing the code itself.

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

Bill text is available here. 

This legislation has the support of a number of patient and family advocacy organizations, 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, Consumer Coalition for Quality Health Care.

“Those of us working to improve care for those impacted by serious illness have known that high copays for Advance Care Planning were a barrier to equitable, patient-centered care. Thanks to the tenacity of our C-TAC team and members of congress passionate about our issue, we’ve been able to help remedy this technicality in the law that now increases access to critical conversations between patients and their clinicians by eliminating copays and including social workers who are now eligible to be reimbursed for these services as part of the care team. A sincere thank you to Sen. Warner (D-VA) and Sen. Collins (R-ME) and Rep. Blumenauer (D-OR-3) for continuing to be the voice of the patient and family,” said Jon Broyles, CEO, The Coalition to Transform Advanced Care (C-TAC).

“The Social Work Hospice and Palliative Care Network (SWHPN) strongly supports the inclusion of clinical social workers in the definition of eligible practitioners who can bill for Medicare Advance Care Planning counseling services. As key members of the interdisciplinary team, clinical social workers are already well-trained to have meaningful conversations around Advance Care Planning with patients and families. This bill would have a direct and immediate impact on the ability for clinical social workers to bill for these services, reducing an important barrier to care and greatly enhancing the provision of these conversations,” said Jessica Strong, Executive Director, Social Work Hospice and Palliative Care Network.

“We applaud Senators Warner (D-VA) and Susan Collins (R-ME) and Representative Blumenauer (D-OR-3) for introducing the Improving Access to Advanced Care Planning Act. Advance Care Planning (ACP) is essential to ensuring that an individual’s care preferences are understood and honored during serious illness and at the end of life. The pandemic reinforced again how critical these conversations are for patients, families, and those that care for them. If enacted, this bill would bolster the health system’s ACP capacity by allowing properly trained clinical social workers to get reimbursed for these services, while also requiring a comprehensive provider education outreach campaign on the value of using Medicare’s ACP billing codes. Importantly, the legislation would also remove any beneficiary cost-sharing associated with these codes, a key equity-focused change that will address an oft-cited barrier to patient and provider willingness to engage in these discussions. NAHC is proud to support this thoughtful framework for improving our nation’s approach to advance care planning,” said William Dombi, President, The National Association for Home Care & Hospice (NAHC). 

“NPHI is proud to stand with C-TAC and others in support of the Improving Access to Advance Care Planning (ACP) Act.” Said Carole Fisher, President of NPHI. “As a national collective of community-based advanced illness care providers, NPHI and its members understand the importance of ensuring all Medicare beneficiaries have genuine access to counseling regarding their choices and preferences at the end-of-life. As we know, hospice services are often dramatically underutilized due to late referrals and a lack of prior planning. Engaging in ACP conversations earlier in the disease progression can improve quality of life for beneficiaries and lessen the burden on caregivers. We look forward to working with C-TAC, Congress, and others to pass this important legislation,” said Carole Fisher President, National Partnership for Healthcare and Hospice Innovation (NPHI). 

“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. With members delivering care across all settings of aging services, LeadingAge recognizes the importance of acknowledging the preferences and beliefs of people and their families to deliver quality care. We hope greater access to these conversations will improve end-of-life and help providers meet unique patient needs,” said Katie Smith Sloan, President and CEO, LeadingAge. 

“Including licensed clinical social workers as eligible practitioners, allowing them to bill for Medicare ACP counseling services, will address one of the major barriers to access to ACP services faced today.  Social workers are an important part of the healthcare system and have the appropriate training and skills to facilitate high quality ACP conversations. Providing reimbursement for them to do so will expand the pool of resources available to provide ACP counseling services, thereby improving access,” said Carole Montgomery MD, FHM, MHSA, Executive Medical Director, Respecting Choices. 

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