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Recent CMS Rule Change Regarding Advance Care Planning Under Medicare


Medicare’s Role in Advance Care Planning:

Recently, the Centers for Medicare & Medicaid Services (“CMS”) finalized provisions to empower patients and their families regarding advance care planning.  Beginning in 2016, consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress, CMS finalized its proposal that supports patient and family centered care for seniors and other Medicare beneficiaries by enabling them to discuss advance care planning with their providers.

 According to CMS, this rule finalizes a proposal that will better enable seniors and other Medicare beneficiaries to make important decisions that give them control over the type of care they receive and when they receive it.

 The Medicare statute previously provided coverage for advance care planning under the “Welcome to Medicare” visit available to all Medicare beneficiaries, but seniors may not need these services when they first enroll. Establishing separate payment for advance care planning codes to recognize additional practitioner time to conduct these conversations provides beneficiaries and practitioners greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families.

 For Medicare beneficiaries who choose to pursue it, 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 type of care that is right for them.

 For more information from CMS, please visit,

 For a fact sheet of frequently asked questions regarding this new CMS rule prepared by the Henry J. Kaiser Family Foundation, please visit,

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