[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 4873 Introduced in Senate (IS)]
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117th CONGRESS
2d Session
S. 4873
To amend title XVIII of the Social Security Act to waive cost-sharing
for advance care planning services, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 15, 2022
Mr. Warner (for himself, Ms. Collins, Ms. Baldwin, and Ms. Klobuchar)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to waive cost-sharing
for advance care planning services, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improving Access to Advance Care
Planning Act''.
SEC. 2. MEDICARE COVERAGE OF ADVANCE CARE PLANNING SERVICES.
(a) Advance Care Planning Services Defined.--Section 1861 of the
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end
the following new subsection:
``(lll) Advance Care Planning Services.--
``(1) In general.--The term `advance care planning
services' means a visit between an eligible practitioner (as
defined in paragraph (2)) enrolled under section 1866(j) and an
individual, a family member of such individual, or a surrogate
designated by such individual, to discuss--
``(A) the health care preferences of such
individual;
``(B) future health care decisions that may need to
be made by, or on behalf of, such individual; and
``(C) advance directives or other standard forms,
which may be completed by, or on behalf of, such
individual.
``(2) Eligible practitioner.--For purposes of paragraph
(1), the term `eligible practitioner' means--
``(A) a physician (as defined in subsection (r));
``(B) a physician assistant (as defined in
subsection (aa)(5));
``(C) a nurse practitioner (as defined in
subsection (aa)(5));
``(D) a clinical nurse specialist (as defined in
subsection (aa)(5)); or
``(E) a clinical social worker (as defined in
subsection (hh)(1)) who possesses--
``(i) a relevant care planning
certification; or
``(ii) experience providing care planning
conversations or similar services, as defined
by the Secretary.''.
(b) No Application of Coinsurance or Deductible Under Part B.--
(1) Amount.--Section 1833(a)(1) of the Social Security Act
(42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and (DD)'' and inserting
``(DD)''; and
(B) by inserting before the semicolon at the end
the following: ``and (EE) with respect to advance care
planning services (as defined in section 1861(lll)),
the amounts paid shall be 100 percent of the lesser of
the actual charge for the services or the amount
determined under the fee schedule established under
section 1848(b)''.
(2) Waiver of application of deductible.--The first
sentence of section 1833(b) of the Social Security Act (42
U.S.C. 1395l(b)) is amended--
(A) by striking ``and (12)'' and inserting
``(12)''; and
(B) by inserting before the period the following:
``, and (13) such deductible shall not apply with
respect to advance care planning services (as defined
in section 1861(lll))''.
(c) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2023.
SEC. 3. HHS PROVIDER OUTREACH.
(a) Outreach.--The Secretary of Health and Human Services (in this
section referred to as the ``Secretary'') shall conduct outreach to
physicians and appropriate non-physician practitioners participating
under the Medicare program under title XVIII of the Social Security Act
with respect to Medicare payment for advance care planning counseling
services furnished to individuals to discuss their health care
preferences, identified by HCPCS codes 99497 and 99498 (or any
successor to such codes). Such outreach shall include a new,
comprehensive, one-time education initiative to inform such physicians
and practitioners of the addition of such services as a covered benefit
under the Medicare program, including the requirements for eligibility
for such services.
(b) Report.--Not later than 1 year after the date of enactment of
this Act, the Secretary shall submit to the Committee on Ways and Means
and the Committee on Energy and Commerce of the House of
Representatives and the Committee on Finance of the Senate a report on
the outreach conducted under subsection (a). Such report shall include
a description of the methods used for such outreach.
SEC. 4. MEDPAC REPORT ON THE FURNISHING OF ADVANCE CARE PLANNING
SERVICES AND THE USE OF ADVANCE CARE PLANNING CODES UNDER
THE MEDICARE PROGRAM.
(a) Study.--The Medicare Payment Advisory Commission (in this
paragraph referred to as the ``Commission'') shall conduct a study on
advance care planning under the Medicare program under title XVIII of
the Social Security Act. Such study shall include an analysis of--
(1) the furnishing of advance care planning services to
Medicare beneficiaries, including--
(A) which providers are trained to provide such
services;
(B) which providers are eligible to provide such
services under the Medicare program;
(C) the length and frequency of the visits for
furnishing such services; and
(D) any barriers related to providers furnishing,
or beneficiaries being furnished, such services;
(2) the use of advance care planning Current Procedural
Terminology (CPT) codes to bill for the furnishing of advance
care planning services to Medicare beneficiaries, including--
(A) circumstances under which codes other than
advance care planning CPT codes are used to bill for
such services under the Medicare program and why
providers do not use advance care planning CPT codes;
and
(B) any barriers to providers using advance care
planning CPT codes to bill for such services under the
Medicare program; and
(3) such other items determined appropriate by the
Commission.
(b) Report.--
(1) In general.--Not later than June 30, 2024, the
Commission shall submit to the Committee on Ways and Means and
the Committee on Energy and Commerce of the House of
Representatives and the Committee on Finance of the Senate a
report on the study conducted under subsection (a), together
with recommendations for such legislation and administrative
action as the Commission determines appropriate.
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