[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2865 Introduced in Senate (IS)]
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119th CONGRESS
1st Session
S. 2865
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 18 (legislative day, September 16), 2025
Mr. Warner (for himself and Ms. Collins) 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:
``(nnn) Advance Care Planning Services.--
``(1) In general.--The term `advance care planning
services' means services provided by an eligible practitioner
(as defined in paragraph (2)) to an individual, a family member
of such individual, a caregiver of such individual, or such
individual's representative, 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));
``(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; or
``(F) any other practitioner determined appropriate
by the Secretary.''.
(b) Encouraging Advance Care Planning.--
(1) Payment.--Section 1848(b) of the Social Security Act
(42 U.S.C. 1395w-4(b)) is amended by adding at the end the
following new paragraph:
``(13) Encouraging advance care planning services.--
``(A) In general.--In order to encourage advance
care planning services, the Secretary shall, subject to
subparagraph (B), make payments (as the Secretary
determines to be appropriate) under this section for
advance care planning services (as defined in section
1861(nnn)) furnished on or after the date of enactment
of this paragraph.
``(B) Policies related to payment.--In carrying out
this paragraph, with respect to advance care planning
services, the Secretary--
``(i) shall make payment to only 1
applicable provider for such services furnished
to an individual during a period;
``(ii) shall not make a payment under
subparagraph (A) if such payment would be
duplicative of a payment that is otherwise made
under this title for such services; and
``(iii) shall not require that an annual
wellness visit (as defined in section
1861(hhh)) or an initial preventive physical
examination (as defined in section 1861(ww)) be
furnished as a condition of payment for such
services.''.
(2) Removing cost-sharing responsibilities for advance care
planning services under part b of the medicare program.--
Section 1833 of the Social Security Act (42 U.S.C. 1395l) is
amended--
(A) in subsection (a)(1)--
(i) in subparagraph (GG), by striking
``and'' at the end; and
(ii) in subparagraph (HH), by striking the
semicolon at the end and inserting the
following: ``, and (II) with respect to advance
care planning services (as described in section
1848(b)(13)) furnished on or after January 1,
2027, the amount paid shall be an amount equal
to 100 percent of the lesser of the actual
charge for such services or the amount
determined under such section;'' and
(B) in subsection (b), in the first sentence--
(i) by striking ``, and (13)'' and
inserting ``(13)''; and
(ii) by striking ``section 1861(n).'' and
inserting the following: ``section 1861(n), and
(14) such deductible shall not apply with
respect to advance care planning services (as
described in section 1848(b)(13)) furnished on
or after January 1, 2027''.
(c) Improvements To Advance Care Planning Through Telehealth.--
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is
amended--
(1) in paragraph (4)(C)--
(A) in clause (i), in the matter preceding
subclause (I), by striking ``and (7)'' and inserting
``(7), and (10)''; and
(B) in clause (ii)(X), by inserting ``or paragraph
(10)'' before the period at the end; and
(2) by adding at the end the following new paragraph:
``(10) Treatment of advance care planning services.--The
geographic requirements described in paragraph (4)(C)(i) shall
not apply with respect to telehealth services furnished on or
after the date of enactment of this paragraph for purposes of
furnishing advance care planning services (as defined in
section 1861(nnn)).''.
(d) Aligning Definitions.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended--
(1) in subsection (ww)--
(A) in paragraph (1), by striking ``end-of-life
planning (as defined in paragraph (3))'' and inserting
``advance care planning (as defined in subsection
(nnn))''; and
(B) by striking paragraph (3); and
(2) in subsection (hhh)(2)--
(A) by redesignating subparagraph (I) as
subparagraph (J);
(B) by redesignating subparagraph (I) as
subparagraph (J); and
(C) by inserting after subparagraph (H) the
following new subparagraph:
``(I) Advance care planning services (as defined in
subsection (nnn)).''.
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 services
furnished to individuals to discuss their health care preferences,
identified by Healthcare Common Procedure Coding System (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 beneficiary eligibility for such services.
(b) Report.--Not later than 1 year after the date of completion of
the outreach described in subsection (a), the Secretary shall submit to
the Committee on Finance of the Senate and the Committee on Ways and
Means and the Committee on Energy and Commerce of the House of
Representatives 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
section 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.--Not later than June 30, 2027, the Commission shall
submit to the Committee on Finance of the Senate and the Committee on
Ways and Means and the Committee on Energy and Commerce of the House of
Representatives 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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