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.
In a bipartisan show of support, the Improving Access to Advance Care Planning Act bill was filed today by long-time patient rights champions 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.
This bill aims to 1. remove the copay (cost-sharing) for Advance Care Planning (ACP) for beneficiaries enrolled in 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 4. direct MEDPAC to do a study to evaluate ACP under the Medicare program.
We look forward to seeing you at our virtual press conference
Thursday, September 29th at 2pm ET.
Join us in a Q&A and thanking our legislative champions who worked with us.
Recent C-TAC Media on the #ACPequity Bill:
How an Advance Care Planning Bill Could Impact Hospices and Medicare
Helpful Resources:
https://thectac.org/our-work/public-policy/improving-access-to-acp/
ACP Bill | Policy Update and Q&A – The Coalition to Transform Advanced Care (thectac.org)
Congressional Record | Congress.gov | Library of Congress
