II
118THCONGRESS
2
DSESSION S. 3
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
DECEMBER20 (legislative day, DECEMBER16), 2024
Mr. W
ARNER(for himself, Ms. COLLINS, Ms. BALDWIN, and Ms. KLO-
BUCHAR) 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 Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Improving Access to 4
Advance Care Planning Act’’. 5
SEC. 2. MEDICARE COVERAGE OF ADVANCE CARE PLAN-6
NING SERVICES. 7
(a) A
DVANCECAREPLANNINGSERVICESDE-8
FINED.—Section 1861 of the Social Security Act (42 9
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U.S.C. 1395x) is amended by adding at the end the fol-1
lowing new subsection: 2
‘‘(nnn) A
DVANCECAREPLANNINGSERVICES.— 3
‘‘(1) I
N GENERAL.—The term ‘advance care 4
planning services’ means a visit between an eligible 5
practitioner (as defined in paragraph (2)) enrolled 6
under section 1866(j) and an individual, a family 7
member of such individual, or a surrogate des-8
ignated by such individual, to discuss— 9
‘‘(A) the health care preferences of such 10
individual; 11
‘‘(B) future health care decisions that may 12
need to be made by, or on behalf of, such indi-13
vidual; and 14
‘‘(C) advance directives or other standard 15
forms, which may be completed by, or on behalf 16
of, such individual. 17
‘‘(2) E
LIGIBLE PRACTITIONER.—For purposes 18
of paragraph (1), the term ‘eligible practitioner’ 19
means— 20
‘‘(A) a physician (as defined in subsection 21
(r)); 22
‘‘(B) a physician assistant (as defined in 23
subsection (aa)(5)); 24
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‘‘(C) a nurse practitioner (as defined in 1
subsection (aa)(5)); 2
‘‘(D) a clinical nurse specialist (as defined 3
in subsection (aa)(5)); or 4
‘‘(E) a clinical social worker (as defined in 5
subsection (hh)(1)) who possesses— 6
‘‘(i) a relevant care planning certifi-7
cation; or 8
‘‘(ii) experience providing care plan-9
ning conversations or similar services, as 10
defined by the Secretary.’’. 11
(b) N
OAPPLICATION OFCOINSURANCE ORDEDUCT-12
IBLEUNDERPARTB.— 13
(1) A
MOUNT.—Section 1833(a)(1) of the Social 14
Security Act (42 U.S.C. 1395l(a)(1)) is amended— 15
(A) in subparagraph (GG), by striking 16
‘‘and’’ at the end; and 17
(B) in subparagraph (HH), by striking the 18
semicolon at the end and inserting the fol-19
lowing: ‘‘and (II) with respect to advance care 20
planning services (as defined in section 21
1861(nnn)) furnished on or after January 1, 22
2026, the amounts paid shall be 100 percent of 23
the lesser of the actual charge for the services 24
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or the amount determined under the fee sched-1
ule established under section 1848(b)’’. 2
(2) W
AIVER OF APPLICATION OF DEDUCT -3
IBLE.—The first sentence of section 1833(b) of the 4
Social Security Act (42 U.S.C. 1395l(b)) is amend-5
ed— 6
(A) by striking ‘‘, and (13)’’ and inserting 7
‘‘(13)’’; and 8
(B) by striking ‘‘section 1861(n).’’ and in-9
serting the following: ‘‘section 1861(n), and 10
(14) such deductible shall not apply with re-11
spect to advance care planning services (as de-12
fined in section 1861(nnn)) furnished on or 13
after January 1, 2026’’. 14
(c) E
FFECTIVEDATE.—The amendments made by 15
this section shall apply to items and services furnished on 16
or after January 1, 2026. 17
SEC. 3. HHS PROVIDER OUTREACH. 18
(a) O
UTREACH.—The Secretary of Health and 19
Human Services (in this section referred to as the ‘‘Sec-20
retary’’) shall conduct outreach to physicians and appro-21
priate non-physician practitioners participating under the 22
Medicare program under title XVIII of the Social Security 23
Act with respect to Medicare payment for advance care 24
planning counseling services furnished to individuals to 25
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discuss their health care preferences, identified by 1
Healthcare Common Procedure Coding System (HCPCS) 2
codes 99497 and 99498 (or any successor to such codes). 3
Such outreach shall include a new, comprehensive, one- 4
time education initiative to inform such physicians and 5
practitioners of the addition of such services as a covered 6
benefit under the Medicare program, including the re-7
quirements for eligibility for such services. 8
(b) R
EPORT.—Not later than 1 year after the date 9
of enactment of this Act, the Secretary shall submit to 10
the Committee on Ways and Means and the Committee 11
on Energy and Commerce of the House of Representatives 12
and the Committee on Finance of the Senate a report on 13
the outreach conducted under subsection (a). Such report 14
shall include a description of the methods used for such 15
outreach. 16
SEC. 4. MEDPAC REPORT ON THE FURNISHING OF AD-17
VANCE CARE PLANNING SERVICES AND THE 18
USE OF ADVANCE CARE PLANNING CODES 19
UNDER THE MEDICARE PROGRAM. 20
(a) S
TUDY.—The Medicare Payment Advisory Com-21
mission (in this section referred to as the ‘‘Commission’’) 22
shall conduct a study on advance care planning under the 23
Medicare program under title XVIII of the Social Security 24
Act. Such study shall include an analysis of— 25
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(1) the furnishing of advance care planning 1
services to Medicare beneficiaries, including— 2
(A) which providers are trained to provide 3
such services; 4
(B) which providers are eligible to provide 5
such services under the Medicare program; 6
(C) the length and frequency of the visits 7
for furnishing such services; and 8
(D) any barriers related to providers fur-9
nishing, or beneficiaries being furnished, such 10
services; 11
(2) the use of advance care planning Current 12
Procedural Terminology (CPT) codes to bill for the 13
furnishing of advance care planning services to 14
Medicare beneficiaries, including— 15
(A) circumstances under which codes other 16
than advance care planning CPT codes are used 17
to bill for such services under the Medicare pro-18
gram and why providers do not use advance 19
care planning CPT codes; and 20
(B) any barriers to providers using ad-21
vance care planning CPT codes to bill for such 22
services under the Medicare program; and 23
(3) such other items determined appropriate by 24
the Commission. 25
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(b) REPORT.— 1
(1) I
N GENERAL.—Not later than June 30, 2
2026, the Commission shall submit to the Com-3
mittee on Ways and Means and the Committee on 4
Energy and Commerce of the House of Representa-5
tives and the Committee on Finance of the Senate 6
a report on the study conducted under subsection 7
(a), together with recommendations for such legisla-8
tion and administrative action as the Commission 9
determines appropriate. 10
Æ
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