Lawmakers Introduce Bill to Break Down Advance Care Planning Barriers

U.S. Sen. Susan Collins (R-Maine) and Mark Warner (D-Va.) recently introduced legislation aimed at improving access to advance care planning services among patients with serious illness.

The Improving Access to Advance Care Planning Act would expand utilization of these services by removing Medicare payment barriers faced by both providers and patients.

The bill proposes to “wave,” or remove, Medicare beneficiary cost-sharing for advance care planning services. In backing it, Collins and Warner also pressed payers to widen the scope of staff who can bill for these services, citing limited billing parameters that hinder patient access.

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“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,” Collins said in a statement. “The bipartisan bill we are introducing 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.”

U.S. Sen. Tammy Baldwin (D-Wis.) and Amy Klobuchar (D-Minn.) joined in introducing the bill, which received bipartisan, bicameral support.

A companion legislation has also hit the U.S. House of Representatives floor, introduced by Congressman Earl Blumenauer (D-Ore.).

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If enacted, it would remove beneficiary coinsurance and deductibles for advance care planning visits to ensure that beneficiaries are “not deterred from seeking these services,” and providers are also “not deterred from offering them,” according to the bill’s language.

The Coalition to Transform Advanced Care (C-TAC) is among the organizations in support of the bill.

“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,” C-TAC CEO Jon Broyles said in a statement.

Other supporters include organizations such as the Center for Medicare Advocacy, LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Partnership for Healthcare and Hospice Innovation (NPHI), Respecting Choices, and the Social Work Hospice & Palliative Care Network (SWHPN).

The legislation would also “expand eligible providers that can bill for such services,” according to the bill’s language.

Currently, the scope of “eligible providers” of these services is limited to clinicians, specifically physicians, physician assistants, clinical nurse specialists and nurse practitioners, along with clinical social workers.

The bill proposes to expand this definition to include more of the interdisciplinary care team, including non-clinical staff such as social workers with experience in care planning.

“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,” SWHPN Executive Director Jessica Strong said in a statement. “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.”

Including licensed social workers in the scope of eligible providers who can bill for advance care planning services addressed a major roadblock in reimbursement, according to Dr. Carole Montgomery, executive medical director at Respecting Choices.

Providing reimbursement for social workers will expand the pool of resources available to provide these services, “thereby improving access,” Montgomery said.

The bill outlines two reporting requirements that would accomplish goals in removing hurdles on the provider side.

One requirement would direct the U.S. Centers for Medicare & Medicaid Services (CMS) to ramp up education for providers on existing advance care planning and corresponding billing codes.

The other directs the Medicare Payment Advisory Commission (MedPAC) to study and report barriers to advance care planning beyond billing, as well as those that exist within coding parameters.

“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,” LeadingAge President and CEO Katie Smith Sloan said in a statement. “We hope greater access to these conversations will improve end-of-life and help providers meet unique patient needs.”

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