I did some looking, and found a document listing the regulations. Caution: big download.

I believe this is the relevant portion, based on a document search for "end of life."

^Comment: We received a number of comments from physicians, health care providers, and others urging us to add voluntary advance care planning as an element to the definitions of both the "first annual wellness visit" and the "subsequent annual wellness visit." They base their recommendation upon a number of recent research studies, and the inclusion by statute of a similar element in the existing initial preventive physical examination (IPPE) benefit. One commenter noted that "the new wellness visit was wisely designed to build on the initial preventive physical exam, providing an ongoing, systematic focus on wellness and prevention by harmonizing Medicare services into a coordinated benefit." Another commenter stated that "the AWV provides an appropriate setting for providers to initiate voluntary conversations about future care wishes, as they counsel beneficiaries on other aspects of their health and achieving their personal health goals." The commenter added that the "care plans discussed in the 'Welcome to Medicare visit' should not be frozen in time, but revisited as an important component of patient wellness."

Response: We agree that voluntary advance care planning should be added as an element of the definitions of both the "first annual wellness visit" and the "subsequent annual wellness visit" based on the evidence described below, and the inclusion of a similar element in the IPPE benefit (also referred to as the Welcome to Medicare visit), since January 1, 2009. We believe that this will help the physician to better align the personal prevention plan services with the patient’s personal priorities and goals.

Recently, Detering and colleagues (British Medical Journal 2010; 340:c1345) reported that "advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives." Silveira and colleagues (New England Journal of Medicine 2010; 362:1211–8) reported that "data suggest that most elderly patients would welcome these discussions." Lastly, a study by Fischer and colleagues (Journal of the American Geriatric Society 2010; 58:400–401) found "no evidence that these (advance directive) discussions or completing an advance directive lead to harm." Based on the available evidence and other relevant information, we are adding to the final regulation a definition of the term "voluntary advance care planning" to read as follows:

"Voluntary advance care planning" means, for purposes of this section, verbal or written information regarding the following areas:

(1) An individual’s ability to prepare an advance directive in the case where an injury or illness causes the individual to be unable to make health care decisions.

(2) Whether or not the physician is willing to follow the individual's wishes as expressed in an advance directive. This definition is based on the definition of "end-of-life planning", which is included as an element of the IPPE as described in section 1861(ww)(3) of the Act. Thus, the addition of "voluntary advance care planning" to the AWVs extends to those visits a similar element to the one already in the one-time IPPE.

We are also revising the definitions of the terms "First annual wellness visit" and "Subsequent annual wellness visit" by inserting a new element (ix) to the definition of the term "first annual wellness visit" and a new element (vii) to the definition of the term "subsequent annual wellness visit" in § 410.15 (a) of the final regulation text that would read as follows: "Voluntary advance care planning as that term is defined in this section upon agreement with the individual."^

If this is the regulation being discussed - and I think it is - then it isn't as bad as I thought it was based on the articles written about it. It seems to be simply an extension of an existing policy from "initial visit only" to "annual visits." Anybody else read it differently?

(A slap on my wrist for sliding past my own rule of finding the source material on my own instead of listening to journalists.)

This writer has a similar take on it. But to be fair, apparently the "voluntary" is a recent addition since the original legislation.