Improving Access to Advance Care Planning Act
This bill, titled the Improving Access to Advance Care Planning Act, would expand Medicare coverage for advance care planning (ACP) and reduce financial barriers for beneficiaries. It defines ACP services, expands who can provide them, begins Medicare payment for ACP services (with certain rules) immediately after enactment, and eliminates patient cost-sharing for ACP services beginning January 1, 2027. The bill also broadens telehealth provisions to ensure ACP can be delivered remotely without geographic restrictions, requires a one-time CMS provider outreach effort about ACP codes (99497 and 99498), and mandates MedPAC to study ACP use and coding with a formal report due by mid-2027, including recommendations for further actions. In short, the bill aims to normalize and fund ACP discussions under Medicare, widen who can offer these services (including non-physician providers), promote telehealth access, and assess how ACP is being billed and utilized, with the notable policy shift of eliminating patient cost-sharing starting in 2027.
Key Points
- 1Definition and eligibility for ACP services and practitioners
- 2- ACP services are defined as discussions about health care preferences, future decisions, and advancement directives, delivered by an eligible practitioner (physicians, certain non-physician clinicians, social workers with specified credentials or experience, or other practitioners the Secretary approves).
- 3Medicare payment for ACP services
- 4- The Secretary must pay for ACP services furnished after enactment, with rules to avoid duplicative payments and to ensure payment is made to only one applicable provider per period. Payment would not require an annual wellness visit or initial preventive physical examination as a condition.
- 5Elimination of cost-sharing for ACP services
- 6- Starting January 1, 2027, ACP services furnished under Medicare would be paid at 100% of the lesser of the actual charge or the amount determined by the program, effectively removing cost-sharing (deductibles and similar patient costs) for these services.
- 7Telehealth improvements
- 8- Geographic restrictions for telehealth ACP services would be removed, allowing ACP delivered via telehealth to be treated like other telehealth services for purposes of furnishing ACP.
- 9Outreach and evaluation
- 10- The Secretary must conduct a one-time, comprehensive outreach initiative to inform eligible providers about ACP payment and coverage, using CPT/HCPCS codes 99497 and 99498 (or successors).
- 11- MedPAC is tasked with studying ACP provision and coding practices, producing a report by June 30, 2027, with recommendations for legislative or administrative action.