Comments Submitted on CMS’ Proposal to Allow Payment for Advance Care Planning Discussions


The National Association for Home Care & Hospice (NAHC) has submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding CMS’ proposal to add new codes recognizing separate payment for advance care planning, as part of the proposed changes to the Medicare physician fee schedule in the Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016. CMS proposed changing CPT codes 99497 and 99498 from “inactive” to “active” to allow payment for advance care planning discussions. CMS’ comment period on the proposal closed on September 8 (see previous NAHC Report article here), and according to reports CMS received approximately 600 comments regarding the advance care planning proposal, of which approximately 500 were in support.

NAHC, which has a long-held position supporting advance care consultations as part of patient planning and decision-making relative to serious illness, joined with other organizations earlier this year in urging CMS to include coverage of such planning in its 2016 physician payment rule. Following CMS’ release of the proposal, NAHC also submitted comments on the proposal to CMS in an individual letter, as well as in a group letter with other aging and health organizations, that expressed support for the new codes, and provided comments on the standards and goals that should be included in advance care planning conversations. “We applaud CMS for proposing this change,” NAHC stated.

In addition to expressing support for the change to allow payment to physicians for advance care planning discussions, NAHC advocated for a mechanism to allow payment for advance care planning discussions by other professionals, such as palliative care interdisciplinary team members. “As a patient’s condition changes through the course of an illness it is not uncommon for the patient’s direct relationship with a physician to become less prominent and the patient’s direct relationship with another professional (for instance, nurse practitioner, physician’s assistant, palliative care nurse or social worker) to become more prominent,” NAHC stated. “There are numerous reasons for this, including the fact that the patient sometimes can no longer physically travel to see a physician so other health providers visit the patient in their home or that some physicians and NPs have turned care over to home care providers and are not actively seeing the patient.”

Following are further recommendations for CMS that were submitted by NAHC and the organizations that signed the group letter on the advance care planning proposal:

  • Expand the scope of services payable under the advance care planning benefit to incorporate non-face-to-face services where necessary, such as communicating with designated family caregivers who are not able to attend in-person appointments, answering clarifying and follow up questions, or providing coordination and referrals to non-medical professionals such as clergy or legal services.
  • Develop clear standards for practices that furnish advance care planning services—such as, required adoption of certified electronic health records or required demonstrated use of evidence-based policies, procedures, and training—to ensure that practices have the capability to furnish these services at a high quality.
  • Proactively and explicitly engage an individual’s family and caregivers in the development of a care plan to ensure that the individual’s abilities, culture, values, and faith are respected and care instructions and action steps are more likely to be understood and followed.
  • Utilize technology to help make necessary information more readily available and actionable, connect all people who have a role in an individual’s care plan, and provide a shared platform for the ongoing maintenance and management of an individual’s care and wellbeing.
  • The Department of Health and Human Services should finalize the standards for patient information capture released in the 2015 Certified Health IT proposed rule, and CMS should then apply the standards to advance care planning in Medicare, to facilitate not only the documentation of the presence of an advance directive, but also allow for the viewing of the content.
  • Consider connecting provider reimbursements to the quality outcomes of advance care planning and not to the process alone.
  • Consider ways to make these codes work for beneficiaries and providers, such as allowing payment for these services for all Medicare beneficiaries, not only to ‘manage and treat’ a current condition, but also as a preventative service.
  • Eliminate cost sharing, as beneficiaries may forgo this service if it is coupled with an out-of-pocket cost.
  • Commit to significant beneficiary and provider education on the benefit.

CMS is expected to release the final payment rule for CY 2016 in the coming weeks. To read NAHC’s individual letter commenting on the advance care planning proposal, click here. To read the group letter from NAHC and other organizations, click here.