119-s2865

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2865 Introduced in Senate

    (IS) ]

<DOC>

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.
 <all>