Congress Takes Up Bill to Expand Advance Care Planning

U.S. Senators Mark R. Warner (D-Va.) and Susan Collins (R-Maine) have introduced a bill designed to foster greater access to advance care planning (ACP) among Medicare beneficiaries.

If enacted, the Improving Access to Advance Care Planning Act would permit social workers to conduct ACP services, remove co-pays and patient fees, and promote provider education about associated billing codes. The bill also contains provisions to improve reporting on barriers to ACP utilization. 

Rep. Earl Blumenauer (D-Ore.) introduced similar legislation in the U.S. House of Representatives.

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“Decisions about care planning are some of the hardest for a family to make, but they’re also some of the most important,” Warner said in a statement. “One of my biggest regrets was not having early conversations about care planning with my own mom, who suffered from Alzheimer’s for 11 years and was unable to speak for nine of those years.”

Research has shown that advance care planning can boost hospice and palliative care utilization, reduce high-acuity care and associated costs, and increase the likelihood that patients will receive goal-concordant care.

However, societal factors and poor coordination among health care providers can limit its effectiveness.

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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 press release. “This can be a difficult topic for many families to address, but advance care planning has been shown to increase satisfaction and improve health outcomes because people with advance directives are more likely to get the care that they want, in the setting they prefer, and avoid the care that they don’t want.”

The new bipartisan legislation would allow clinical social workers to provide ACP services if they possess a relevant certification or are experienced in conducting care planning conversations. Currently, physicians, other licensed independent practitioners, and clinical nurse specialists can conduct ACP conversations under Medicare rules.

The bill would also require the Medicare Payment Advisory Commission (MedPAC) to research advance care planning rules, practices, and barriers to utilization within the Medicare program and report their findings to Congress.

“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,” said Katie Smith Sloan, president and CEO, LeadingAge.This bill is an important step toward greater, affordable access to planning that all Americans need.”

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