Warner & Collins Reintroduce Bipartisan Legislation to Expand Access to Advance Care Planning

WASHINGTON - U.S. Sens. Mark R. Warner (D-VA) and Susan Collins (R-ME) reintroduced bipartisan 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.

"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 they want, in the setting they prefer, and avoid the care that they don't want," said Sen. Collins. "This 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 that they can make their choices known and develop a plan of care in consultation with their loved ones."

Specifically, the Improving Access to Advance Care Planning Act would:

1. Codify and expand Medicare coverage of ACP services - a longtime priority for Sen. Warner, who first introduced legislation to improve planning options for patients in 2015. This bill would expand eligible providers that can bill for such services to include clinical social workers with experience in care planning.
2. 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.
3. Educate heath care providers by directing CMS to conduct an education campaign on the ACP billing options and report to Congress on such activities
4. Study areas of improvement - by directing the Medicare Payment Advisory Commission (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.
5. Make permanent the ability to provide advance care planning services over telehealth in Medicare.
6. Align the definitions of advance care planning used in the statute to ensure consistency of this service.

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, the National Partnership for Healthcare and Hospice Innovation (NPHI), the National Alliance for Care at Home, the Center for Medicare Advocacy, the Consumer Coalition for Quality Health Care, MyDirectives, and the Smarter Health Care Coalition.

"Those of us working to improve care for individuals impacted by serious illness have known that high copays for Advance Care Planning were a barrier to patient-centered care. Thanks to Senators Warner (D-VA) and Collins (R-ME), who are passionate about these issues, we will be able to help remedy this technicality in the law and increase access to critical conversations between patients and their clinicians by eliminating copays and including social workers who will be eligible to be reimbursed for these services as part of the care team. A sincere thank you the Senators and their staff for continuing to be the voice of the patient and family," said Jon Broyles, CEO, The Coalition to Transform Advanced Care (C-TAC).

"Planning ahead can bring clarity to the often nuanced and complicated issues that sometimes arrive in critical healthcare situations or at end-of-life. Improving access to cost-effective care planning that all Americans need, as this bill will do, will bring peace of mind to millions of older adults and their family members," said Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services. "What's more, because our nonprofit and mission-driven members deliver care across all aging services settings, 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 serious illness care through the end-of-life and help providers meet unique patient needs."

"NPHI is proud to stand with the hospice and palliative care community in strong support of the Improving Access to Advance Care Planning (ACP) Act." Said Carole Fisher, President of NPHI. "As a national organization comprised of nearly 120 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 in part 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 Congress and our partners to pass this important legislation," said Carole Fisher President, National Partnership for Healthcare and Hospice Innovation (NPHI).

"The National Alliance for Care at Home applauds Senators Warner (D-VA) and Susan Collins (R-ME) for reintroducing the Improving Access to Advanced Care Planning Act. As a physician who has worked directly with patients both planning for and facing serious illness, I know firsthand the role that advance care planning (ACP) plays in delivering compassionate, patient-centered support that ensures individuals' values and preferences guide their care," said Dr. Steve Landers, CEO of the National Alliance for Care at Home. "By making it easier for providers to engage in ACP with patients, this bill will help strengthen our healthcare system, ensuring individuals get the right care at the right time and often delivering better outcomes for less cost."

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