Improve Access to ACP #ACPequity

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Support New Bill to Improve Access ACP

Since its inception, C-TAC has be a leading advocate of Advance Care Planning (ACP) as an important part of ongoing serious illness conversations that happen between clinicians, patients and their unpaid caregivers.

Over the last two years, C-TAC worked with CMS and the US Preventative Service Task Force to eliminate the disproportionally high Medicare copay for ACP that occurs when this service is held outside the annual wellness visit. C-TAC members shared with us the difficulty they had using the ACP billing codes due to the copays and research shows providers avoid offering ACP to save their patients these charges. Furthermore, new evidence has revealed that these copays also disproportionately affect communities of color. Beyond the patient cost, the billing codes allow only physicians, nurse practitioners, and physician assistants to be reimbursed by Medicare for ACP. This contrasts with systems like the Veterans Administration (VA) where social workers handle these conversations. Therefore, patient cost sharing and the limit on how many clinicians can bill for these services combine to reduce access to this important process, especially among historically disadvantaged communities.

After months of back and forth, these agencies informed C-TAC that they did not have the legal authority to eliminate the copays. We knew our champions in congress were the solution to this problem.

The bills were introduced by Rep. Blumenauer (D-OR-3), as H.R8840 in the House, and Sen. Warner (D-VA), Sen. Collins (R-ME), Sen. Baldwin (D-WI), and Sen. Klobuchar (D-MN) have introduced S.4873 in the Senate.

Please view and share our ACPequity Bill Policy Meeting Recap

Key Elements of the Legislation

1. Remove the copay/cost-sharing for Medicare Advance Care Planning (ACP) counseling in all situations.
2. Include licensed clinical social workers in the definition of eligible practitioners who can bill for Medicare ACP counseling services.
3. Educate providers about the ACP counseling codes and the value of the ACP Counseling, and report back to Congress on those activities.
4. Direct MEDPAC to do a study to evaluate ACP under the Medicare program.

Waive patient co-pay/cost-sharing and deductibility of Medicare ACP counseling services (CPT codes 99497 & 99498)

• The current Medicare advance care planning billing codes include a 20% standard cost-sharing and deductible payment unless the conversation takes place during a Medicare Annual Wellness Visit. As these discussions are frequently initiated by specialists that have even higher co-pay rates, this vital conversation about their goals of care and treatment preferences can be too expensive for many.
• Analysis of these codes show they are not yet widely in use and, the cost-sharing, when done outside of an Annual Wellness Visit disproportionately affects people from underserved and under-resourced racial and ethnic communities.
• Cost-sharing and deductible payments are barriers to Medicare beneficiary use of advance care planning services and increase health disparities.

Include clinical social workers in the definition of eligible practitioners who can bill for Medicare Advance Care Planning counseling services.

• Currently, only physicians, nurse practitioners, and physician assistants can bill for Medicare’s advance care planning directly. This reduces access to advance care planning in clinical settings where these providers may be scarce.
• Clinical social workers have the training and experience to have these conversations and are often the care team member having these conversations with patients and families already. We should empower them to be able to facilitate these conversations on care and reimburse them for doing so.

Provide appropriate training for health care professions who are eligible practitioners for billing for Medicare Advance Care Planning counseling services.

• Patients and clinicians understand the value of these conversations but run into structural barriers, including the scarce numbers of trained and qualified providers eligible to provide these services and get paid for doing so.
• Given the fact that ACP codes are being underutilized for various reasons, including social determinants of health, both providers and patients (and their families) need to be educated about the availability of this voluntary ACP counseling.
• Health care professionals who are eligible practitioners for using the ACP billing codes should be trained on how to identify appropriate patients and how to successfully engage, record, and implement the preferences of the patient.

Those of us working to improve care for those impacted by serious illness have known that high copays for ACP were a barrier to equitable, patient-centered care. Thanks to the tenacity of our C-TAC team and members of Congress passionate about our issue, we’ve been able to help remedy this technicality in the bill that would increase access to critical conversations between patients and their clinicians.

– Jon Broyles, CEO of C-TAC