TRENTON – Senator Richard J. Codey (D-Essex and Morris) lauded the latest proposal by the Centers for Medicare & Medicaid Services, a measure that would better enable seniors and Medicare beneficiaries to make important decisions about the care they receive and when they receive it. Senator Codey is the sponsor of a bill (S-2435) that would provide Medicaid coverage for advance care planning and a resolution (SCR-145) urging the CMS to provide Medicare reimbursement for voluntary advance care planning.
“I commend the efforts of the CMS for addressing an issue that I have felt strongly about, that is protecting our senior citizens from the vulnerabilities they face in managing their own health care. As baby boomers begin to approach the latter stages of life, advance care planning will be of utmost importance for them,” said Senator Codey. “We should encourage seniors to have the difficult conversations about their medical care with their physicians and families before it’s too late because it will give them a greater sense of control and ownership over their own destiny and will help alleviate any fears or anxieties they have as they relate to their health care and well-being.”
Advance care planning is a service that includes early conversations between patients and their practitioners, both before an illness progresses and during the course of treatment, to decide on the delivery of care that suits their needs and preserves their dignity in the event that they are unable, because of incapacity, to make those instructions at a later date. It includes the use of advance health care directives, health care powers of attorney, and medical orders for life-sustaining treatment that can be administered effectively within the healthcare system.
Based on the recommendations of the American Medical Association (AMA) and other stakeholders, the CMS proposes to establish separate payment and a payment rate for two advance care planning services provided to Medicare beneficiaries by physicians and other practitioners. Establishing separate payment for advance care planning codes provides beneficiaries and practitioners with a greater opportunity and flexibility to use planning sessions at the most appropriate time for patients and their families.
“Seniors should have the ability to make informed end-of-life health care choices that are known and documented by their families and physicians while they are still capable of making and communicating those decisions, and rest assured that those wishes will be respected when the time comes,” added Senator Codey. “Having these conversations is an integral part of the deeply personal services a doctor provides to patients, and the proposal for Medicare to pay for such counseling is recognition of its importance and necessity to quality health care services.”
An increasing number of private health insurance plans reimburse physicians for advance care planning discussions held with patients, but the federal Medicare program and most state Medicaid programs do not. The Medicare statute currently provides coverage for advance care planning under the “Welcome to Medicare” visit available to all Medicare beneficiaries, but these services may be not be needed until a later date following enrollment. At least two other state Medicaid programs, in Colorado and Oregon, cover advance care planning.
CMS is accepting public comments on whether Medicare should pay separately for advance care planning services, and if so, how much, until September 8, 2015. The final rule will be published in the fall, and would take effect January 1, 2016.
A federal agency within the U.S. Department of Health and Human Services, CMS administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children’s Health Insurance Program and health insurance portability standards. Medicare currently insures over 50 million individuals in the United States.