Advance care planning has long been recognized as the right thing to do for patients. What’s changing is that regulators are beginning to treat it as an expected operational capability, not a program enhancement. A convergence of recent CMS activity and federal legislation makes clear that organizations investing in scalable ACP infrastructure now will be better positioned for what’s coming.

CMS Is Signaling Broad Expectations

The clearest indicator of this shift is the scale of CMS’s attention. The agency’s 2025 Measures Under Consideration list includes an Advance Care Planning measure across 15 programs — MIPS, ESRD, Hospital Value-Based Purchasing, Home Health, SNFs, rehabilitation, psychiatric facilities, and more. When a single measure appears this broadly, it’s not a pilot. It’s the beginning of infrastructure expectations.

The specific proposed measure, MUC2025-020, establishes a standardized way to track whether ACP was completed or discussed during inpatient care. It applies to adults 18 and older — a meaningful expansion from existing measures that largely focus on adults 65 and above — and includes documentation of an advance directive, identification of a surrogate decision-maker, or a record that ACP was offered and declined.

For health plans, the breadth of programs under consideration has direct implications for quality performance and reimbursement. For health systems, it signals that ACP documentation will increasingly be part of how inpatient and post-acute care is evaluated. CMS is also previewing complementary measures around patient life goals and well-being, pointing toward a broader shift: care should be organized around what patients actually want, not just what clinicians default to under pressure.

Federal Legislation Is Reinforcing the Direction

CMS activity alone would be notable. But two pieces of bipartisan federal legislation introduced in late 2024 point to a durable, cross-institutional shift in how ACP is being prioritized.

The Medicare Advance Planning (MAP) for Care Act would prompt Medicare beneficiaries to create an advance directive during enrollment: embedding ACP at the point of coverage initiation. For payors, this is significant: it positions advance care planning as a member engagement and care alignment responsibility from the very start of the member relationship, not a downstream clinical activity. The Legacy Act, introduced separately, addresses a persistent gap in ACP infrastructure, ensuring that advance directives are stored securely and retrievable when they’re actually needed. Documentation that exists but can’t be accessed at the moment of a care decision has limited clinical value. The Legacy Act is a direct response to that failure point.

Together, these two bills create a complementary framework: one prompts creation, the other ensures retrieval. Both reinforce that ACP is being treated as health system infrastructure, not a one-time clinical conversation.

What This Means for Payors

For Medicare Advantage plans and ACOs, the implications are concrete. Quality measure performance is increasingly tied to care that reflects patient preferences, and ACP is foundational to that. Plans that build scalable, digital ACP capabilities now will be better positioned to meet emerging measure requirements, support their highest-risk populations, and demonstrate the kind of whole-person care that differentiates high-performing plans.

The MAP for Care Act, if enacted, would also create a natural enrollment touchpoint for member ACP engagement. Plans that already have the infrastructure to support this won’t need to scramble. Those that don’t will be building under pressure.

What This Means for Health Systems

For health systems, the inpatient focus of MUC2025-020 deserves particular attention. When ACP documentation is missing or inaccessible at the time of hospitalization, care tends to default to urgency rather than patient values. That’s not just a quality problem, it’s a cost problem, and increasingly, an accountability problem. The measure’s inclusion across Hospital IQR, Home Health QRP, and MIPS means ACP documentation will touch multiple performance reporting streams simultaneously.

Post-acute settings face similar exposure. SNFs, rehabilitation facilities, and home health providers all fall within the measure’s scope, creating accountability across the full care continuum rather than at a single point of contact.

The Bigger Shift: ACP Is for Everyone

It’s worth naming something that tends to get lost in policy discussions: advance care planning is not synonymous with end-of-life planning. The expansion of CMS’s proposed measure to adults 18 and older reflects this. Proactive care planning, understanding what matters to a patient, who speaks for them, and what they want if they can’t speak for themselves — is relevant across the lifespan and across care settings.

Organizations that treat ACP as an end-of-life workflow will find themselves underprepared for a regulatory environment that is clearly moving in a different direction. The question for both payors and health systems is not whether to build scalable ACP infrastructure, but how quickly.