II 

118TH CONGRESS 

1ST SESSION S. 669 

To amend title XVIII of the Social Security Act to expand access to 

psychological and behavioral services. 

IN THE SENATE OF THE UNITED STATES 

MARCH 7, 2023 

Mr. BROWN (for himself, Ms. COLLINS, Mr. HEINRICH, and Mr. MULLIN) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to expand 

access to psychological and behavioral services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Increasing Mental 

5 Health Options Act of 2023’’. 

6 SEC. 2. EXPANDING ELIGIBILITY FOR INCENTIVES TO 

7 PRACTICE IN RURAL AND UNDERSERVED 

8 AREAS. 

9 Section 1833(m) of the Social Security Act (42 

10 U.S.C. 1395l(m)) is amended— 


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1 (1) in paragraph (1)— 

2 (A) by inserting ‘‘(A)’’ before ‘‘In the 

3 case’’; and 

4 (B) by adding at the end the following new 

5 subparagraph: 

6 ‘‘(B) In the case of services furnished by a clinical 

7 psychologist (as defined by the Secretary for purposes of 

8 section 1861(ii)) in a year (beginning with 2025) to an 

9 individual, who is covered under the insurance program 

10 established by this part and who incurs expenses for such 

11 services, in an area that is designated (under section 

12 332(a)(1)(A) of the Public Health Service Act) as a health 

13 professional shortage area as identified by the Secretary 

14 prior to the beginning of such year, in addition to the 

15 amount otherwise paid under this part, there also shall 

16 be paid to the clinical psychologist (or to an employer or 

17 facility in the cases described in clause (A) of section 

18 1842(b)(6)) (on a monthly or quarterly basis) from the 

19 Federal Supplementary Medical Insurance Trust Fund an 

20 amount equal to 10 percent of the payment amount for 

21 the service under this part’’; and 

22 (2) in paragraph (2), by inserting ‘‘or clinical 

23 psychologist’’ after ‘‘physician’’. 


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1 SEC. 3. ELIMINATING UNNECESSARY OVERSIGHT AND AP2 PROVAL REQUIREMENTS FOR BEHAVIORAL 

3 HEALTH SERVICES PROVIDED BY CLINICAL 

4 PSYCHOLOGISTS. 

5 (a) COMPREHENSIVE OUTPATIENT REHABILITATION

6 FACILITIES.—Section 1835(a)(2)(E)(iii) of the Social Se7 curity Act (42 U.S.C. 1395n(a)(2)(E)(iii)) is amended by 

8 inserting ‘‘, except that an individual receiving qualified 

9 psychologist services as described in section 1861(ii) may 

10 be under the care of a clinical psychologist with respect 

11 to such services to the extent authorized under State law’’ 

12 before the semicolon. 

13 (b) SKILLED NURSING FACILITIES.—Section 

14 1819(b) of such Act (42 U.S.C. 1395i–3(b)) is amended— 

15 (1) in paragraph (5)(G), by inserting ‘‘clinical 

16 psychologist,’’ after ‘‘nurse practitioner,’’; and 

17 (2) in paragraph (6)(A), by inserting ‘‘, except 

18 that a resident receiving qualified psychologist serv19 ices as described in section 1861(ii) may be under 

20 the supervision of a clinical psychologist with respect 

21 to such services to the extent authorized under State 

22 law’’ before the semicolon. 

23 (c) PARTIAL HOSPITALIZATION SERVICES.— 

24 (1) Section 1835(a)(2)(F)(iii) of the Social Se25 curity Act (42 U.S.C. 1395n(a)(2)(F)(iii)) is amend26 ed by inserting ‘‘, except that an individual receiving 


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1 qualified psychologist services as described in section 

2 1861(ii) may be under the care of a clinical psychol3 ogist with respect to such services to the extent au4 thorized under State law’’ before the period. 

5 (2) Section 1861(ff)(1) of such Act (42 U.S.C. 

6 1395x(ff)(1)) is amended by inserting ‘‘(or, in the 

7 case of qualified psychologist services, under the su8 pervision of a clinical psychologist to the extent au9 thorized under State law)’’ after ‘‘under the super10 vision of a physician’’. 

11 (d) HOME HEALTH SERVICES.— 

12 (1) Section 1861(m) of such Act (42 U.S.C. 

13 1395x(m)) is amended— 

14 (A) in paragraph (6), by striking ‘‘and’’ at 

15 the end; 

16 (B) in paragraph (7), by inserting ‘‘and’’ 

17 after the semicolon; and 

18 (C) by inserting after paragraph (7) the 

19 following new paragraph: 

20 ‘‘(8) an individual receiving qualified psycholo21 gist services may be under the care of a clinical psy22 chologist with respect to such services to the extent 

23 authorized under State law;’’. 


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1 (2) Section 1891(a)(3)(F) of such Act (42 

2 U.S.C. 1395bbb(a)(3)(F)) is amended by inserting 

3 ‘‘clinical psychologist,’’ after ‘‘physician,’’. 

4 (e) INPATIENT PSYCHIATRIC HOSPITAL SERVICES.— 

5 Section 1814(a)(2)(A) of such Act (42 U.S.C. 

6 1395f(a)(2)(A)) is amended by inserting ‘‘(or, in the case 

7 of qualified psychologist services, under the supervision of 

8 a clinical psychologist to the extent authorized under State 

9 law)’’ after ‘‘under the supervision of a physician’’. 

10 (f) RULE OF CONSTRUCTION.—In accordance with 

11 section 410.71(e) of title 42, Code of Federal Regulations 

12 (or any successor regulation), nothing in the provisions of, 

13 and amendments made by, this section shall be construed 

14 as changing or eliminating existing requirements regard15 ing clinical consultation by clinical psychologists with a 

16 beneficiary’s physician, in accordance with accepted pro17 fessional ethical norms and taking into consideration pa18 tient confidentiality. 

19 (g) EFFECTIVE DATE.—The amendments made by 

20 this section shall apply to services furnished on or after 

21 January 1, 2025. 

Æ 


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