Sec. 50342. GAO study and report on longitudinal comprehensive care planning services under Medicare part B
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The Comptroller General shall conduct a study on the establishment under part B of the Medicare program under title XVIII of the Social Security Act of a payment code for a visit for longitudinal comprehensive care planning services. Such study shall include an analysis of the following to the extent such information is available: The frequency with which services similar to longitudinal comprehensive care planning services are furnished to Medicare beneficiaries, which providers of services and suppliers are furnishing those services, whether Medicare reimbursement is being received for those services, and, if so, through which codes those services are being reimbursed.
Whether, and the extent to which, longitudinal comprehensive care planning services would overlap, and could therefore result in duplicative payment, with services covered under the hospice benefit as well as the chronic care management code, evaluation and management codes, or other codes that already exist under part B of the Medicare program. Any barriers to hospitals, skilled nursing facilities, hospice programs, home health agencies, and other applicable providers working with a Medicare beneficiary to engage in the care planning process and complete the necessary documentation to support the treatment and care plan of the beneficiary and provide such documentation to other providers and the beneficiary or the beneficiary's representative.
Any barriers to providers, other than the provider furnishing longitudinal comprehensive care planning services, accessing the care plan and associated documentation for use related to the care of the Medicare beneficiary. Potential options for ensuring that applicable providers are notified of a patient’s existing longitudinal care plan and that applicable providers consider that plan in making their treatment decisions, and what the challenges might be in implementing such options.
Stakeholder's views on the need for the development of quality metrics with respect to longitudinal comprehensive care planning services, such as measures related to— the process of eliciting input from the Medicare beneficiary or from a legally authorized representative and documenting in the medical record the patient-directed care plan; the effectiveness and patient-centeredness of the care plan in organizing delivery of services consistent with the plan; the availability of the care plan and associated documentation to other providers that care for the beneficiary; and the extent to which the beneficiary received services and support that is free from discrimination based on advanced age, disability status, or advanced illness.
Stakeholder's views on how such quality metrics would provide information on— the goals, values, and preferences of the beneficiary; the documentation of the care plan; services furnished to the beneficiary; and outcomes of treatment. Stakeholder's views on— the type of training and education needed for applicable providers, individuals, and caregivers in order to facilitate longitudinal comprehensive care planning services; the types of providers of services and suppliers that should be included in the interdisciplinary team of an applicable provider; and the characteristics of Medicare beneficiaries that would be most appropriate to receive longitudinal comprehensive care planning services, such as individuals with advanced disease and individuals who need assistance with multiple activities of daily living.
Stakeholder's views on the frequency with which longitudinal comprehensive care planning services should be furnished. Not later than 18 months after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under subsection (a), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate. In this section: The term applicable provider means a hospice program (as defined in subsection (dd)(2) of section 1861 of the Social Security Act ( 42 U.S.C. 1395ww )) or other provider of services (as defined in subsection
(u)of such section) or supplier (as defined in subsection
(d)of such section) that— furnishes longitudinal comprehensive care planning services through an interdisciplinary team; and meets such other requirements as the Secretary may determine to be appropriate. The term Comptroller General means the Comptroller General of the United States. The term interdisciplinary team means a group that— includes the personnel described in subsection (dd)(2)(B)(i) of such section 1861; may include a chaplain, minister, or other clergy; and may include other direct care personnel. The term longitudinal comprehensive care planning services means a voluntary shared decisionmaking process that is furnished by an applicable provider through an interdisciplinary team and includes a conversation with Medicare beneficiaries who have received a diagnosis of a serious or life-threatening illness. The purpose of such services is to discuss a longitudinal care plan that addresses the progression of the disease, treatment options, the goals, values, and preferences of the beneficiary, and the availability of other resources and social supports that may reduce the beneficiary’s health risks and promote self-management and shared decisionmaking. The term Secretary means the Secretary of Health and Human Services.
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Sec. 50342
GAO study and report on longitudinal comprehensive care planning services under Medicare part B
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