Improving Access to Advance Care Planning Act
- Bill Number
- S. 2865
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-09-18: Read twice and referred to the Committee on Finance.
- Last Updated
- 2025-12-17T15:38:49Z
AI-Generated Summary
Purpose
The Improving Access to Advance Care Planning Act aims to make it easier for Medicare beneficiaries to discuss and plan their future health care preferences by expanding coverage, removing financial barriers, and supporting providers through education and telehealth options. Advance care planning involves conversations about an individual's health wishes, future medical decisions, and legal documents like advance directives (instructions for care if someone cannot speak for themselves).
Key Provisions
- Definition of Services: Adds a new category under Medicare for "advance care planning services," which includes discussions led by qualified professionals (such as doctors, physician assistants, nurse practitioners, clinical nurse specialists, or certified clinical social workers) with patients, family members, caregivers, or representatives. These discussions cover health preferences, potential future decisions, and completing advance directives.
- Payment and Coverage: Medicare will pay for these services under the physician fee schedule starting from the date of enactment, but only to one provider per service period to avoid duplicates. No prior wellness visit or preventive exam is required for coverage.
- Waiver of Cost-Sharing: Starting January 1, 2027, Medicare Part B will cover 100% of the cost for these services, eliminating deductibles (the initial amount beneficiaries pay out-of-pocket) and coinsurance (the percentage beneficiaries pay after deductible).
- Telehealth Expansion: Removes location restrictions, allowing these services to be provided via telehealth (remote video or phone consultations) anywhere, effective immediately upon enactment.
- Alignment of Terms: Updates Medicare definitions to consistently use "advance care planning" instead of outdated terms like "end-of-life planning" in wellness visits and preventive exams.
- Outreach by HHS: The Department of Health and Human Services (HHS) must conduct a one-time education campaign for Medicare providers about billing these services using specific codes (HCPCS 99497 and 99498). HHS will report on this outreach to Congress within one year of completion.
- MEDPAC Study and Report: The Medicare Payment Advisory Commission (MEDPAC) will study how these services are provided, including provider training, eligibility, visit details, barriers for patients and providers, and billing code usage. MEDPAC must submit a report with recommendations to Congress by June 30, 2027.
Significant Changes to Existing Law
- Introduces a dedicated definition and payment structure for advance care planning services, which were previously optional or bundled into other visits without dedicated coverage.
- Eliminates all out-of-pocket costs for these services under Medicare Part B from 2027, a shift from current rules where beneficiaries often pay 20% coinsurance.
- Expands telehealth flexibility beyond existing COVID-era rules by waiving geographic limits specifically for these services.
- Replaces inconsistent terminology in Medicare law to standardize references to advance care planning.
- Mandates new outreach and a formal study, which were not previously required.
Potential Impacts
- On Citizens: Medicare beneficiaries (primarily those 65 and older or with disabilities) will have freer access to planning discussions without financial hurdles, potentially improving patient control over end-of-life care and reducing unwanted treatments. This could lower family stress during health crises.
- On Government Agencies: HHS gains responsibilities for outreach and reporting, increasing administrative workload but promoting better use of Medicare funds. MEDPAC's study may lead to future policy tweaks. Overall, Medicare spending could rise due to increased service use, though it might offset costs by avoiding expensive late-stage care.
- On International Relations: No direct impacts, as this is a domestic health policy focused on U.S. Medicare.
Main Stakeholders Affected
- Medicare Beneficiaries: Primary beneficiaries of cost-free access and telehealth options, especially those with chronic illnesses or nearing end-of-life.
- Healthcare Providers: Physicians, nurses, social workers, and others eligible to bill for these services; they benefit from payments and education but must adhere to single-provider rules.
- HHS and CMS (Centers for Medicare & Medicaid Services): Responsible for implementing coverage, payments, telehealth rules, and outreach.
- MEDPAC and Congress: Involved in oversight, studies, and potential future legislation based on findings.
- Families and Caregivers: Indirectly affected through easier involvement in planning discussions.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens patient rights under Medicare by formalizing advance care planning as a covered benefit, aligning with existing laws on patient autonomy (e.g., right to refuse treatment). It avoids conflicts with privacy laws like HIPAA by focusing on voluntary discussions.
- Constitutional: No major issues; supports equal protection by reducing access barriers for Medicare users, potentially aiding underserved rural or low-income groups via telehealth.
- Political: Promotes bipartisan goals of improving elderly care and controlling health costs, as introduced by Senators Warner (D) and Collins (R). Could spark debates on Medicare spending but encourages preventive planning to cut long-term expenses. The delayed cost-sharing waiver (2027) allows time for budget adjustments.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Recent Actions
- 2025-09-18: Read twice and referred to the Committee on Finance.
- 2025-09-18: Introduced in Senate
Bill Versions
- Improving Access to Advance Care Planning Act — issued 2025-09-18 — PDF (10 pages)