I 

111TH CONGRESS 

1ST SESSION H. R. 1693 

To amend title XVIII of the Social Security Act to provide for the coverage 

of marriage and family therapist services and mental health counselor 

services under part B of the Medicare Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 24, 2009 

Mr. GORDON of Tennessee (for himself, Mrs. NAPOLITANO, and Mr. LEWIS

of Georgia) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for the coverage of marriage and family therapist services 

and mental health counselor services under part B of 

the Medicare Program, and for other purposes. 

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 ‘‘Seniors Mental Health 

5 Access Improvement Act of 2009’’. 


smartinez on PROD1PC64 with BILLS
2 

•HR 1693 IH

1 SEC. 2. COVERAGE OF MARRIAGE AND FAMILY THERAPIST 

2 SERVICES AND MENTAL HEALTH COUNSELOR 

3 SERVICES UNDER PART B OF THE MEDICARE 

4 PROGRAM. 

5 (a) COVERAGE OF SERVICES.— 

6 (1) IN GENERAL.—Section 1861(s)(2) of the 

7 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

8 amended— 

9 (A) in subparagraph (DD), by striking 

10 ‘‘and’’ after the semicolon at the end; 

11 (B) in subparagraph (EE), by inserting 

12 ‘‘and’’ after the semicolon at the end; and 

13 (C) by adding at the end the following new 

14 subparagraph: 

15 ‘‘(FF) marriage and family therapist serv16 ices (as defined in subsection (hhh)(1)) and 

17 mental health counselor services (as defined in 

18 subsection (hhh)(3));’’. 

19 (2) DEFINITIONS.—Section 1861 of such Act 

20 (42 U.S.C. 1395x) is amended by adding at the end 

21 the following new subsection: 

22 ‘‘Marriage and Family Therapist Services 

23 ‘‘(hhh)(1) The term ‘marriage and family therapist 

24 services’ means services performed by a marriage and 

25 family therapist (as defined in paragraph (2)) for the diag26 nosis and treatment of mental illnesses, which the marVerDate Nov 24 2008 05:22 Mar 25, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1693.IH H1693

smartinez on PROD1PC64 with BILLS
3 

•HR 1693 IH

1 riage and family therapist is legally authorized to perform 

2 under State law (or the State regulatory mechanism pro3 vided by State law) of the State in which such services 

4 are performed, as would otherwise be covered if furnished 

5 by a physician or as an incident to a physician’s profes6 sional service, but only if no facility or other provider 

7 charges or is paid any amounts with respect to the fur8 nishing of such services. 

9 ‘‘(2) The term ‘marriage and family therapist’ means 

10 an individual who— 

11 ‘‘(A) possesses a master’s or doctoral degree 

12 which qualifies for licensure or certification as a 

13 marriage and family therapist pursuant to State 

14 law; 

15 ‘‘(B) after obtaining such degree has performed 

16 at least 2 years of clinical supervised experience in 

17 marriage and family therapy; and 

18 ‘‘(C) in the case of an individual performing 

19 services in a State that provides for licensure or cer20 tification of marriage and family therapists, is li21 censed or certified as a marriage and family thera22 pist in such State. 

23 ‘‘(3) The term ‘mental health counselor services’ 

24 means services performed by a mental health counselor (as 

25 defined in paragraph (4)) for the diagnosis and treatment 


smartinez on PROD1PC64 with BILLS
4 

•HR 1693 IH

1 of mental illnesses which the mental health counselor is 

2 legally authorized to perform under State law (or the 

3 State regulatory mechanism provided by the State law) of 

4 the State in which such services are performed, as would 

5 otherwise be covered if furnished by a physician or as inci6 dent to a physician’s professional service, but only if no 

7 facility or other provider charges or is paid any amounts 

8 with respect to the furnishing of such services. 

9 ‘‘(4) The term ‘mental health counselor’ means an 

10 individual who— 

11 ‘‘(A) possesses a master’s or doctor’s degree in 

12 mental health counseling or a related field; 

13 ‘‘(B) after obtaining such a degree has per14 formed at least 2 years of supervised mental health 

15 counselor practice; and 

16 ‘‘(C) in the case of an individual performing 

17 services in a State that provides for licensure or cer18 tification of mental health counselors or professional 

19 counselors, is licensed or certified as a mental health 

20 counselor or professional counselor in such State.’’. 

21 (3) PROVISION FOR PAYMENT UNDER PART

22 B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 

23 1395k(a)(2)(B)) is amended by adding at the end 

24 the following new clause: 


smartinez on PROD1PC64 with BILLS
5 

•HR 1693 IH

1 ‘‘(v) marriage and family therapist 

2 services (as defined in section 

3 1861(hhh)(1)) and mental health counselor 

4 services (as defined in section 

5 1861(hhh)(3));’’. 

6 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

7 of such Act (42 U.S.C. 1395l(a)(1)) is amended— 

8 (A) by striking ‘‘and (W)’’ and inserting 

9 ‘‘(W)’’; and 

10 (B) by inserting before the semicolon at 

11 the end the following: ‘‘, and (X) with respect 

12 to marriage and family therapist services and 

13 mental health counselor services under section 

14 1861(s)(2)(FF), the amounts paid shall be 80 

15 percent of the lesser of the actual charge for 

16 the services or 75 percent of the amount deter17 mined for payment of a psychologist under sub18 paragraph (L)’’. 

19 (5) EXCLUSION OF MARRIAGE AND FAMILY

20 THERAPIST SERVICES AND MENTAL HEALTH COUN21 SELOR SERVICES FROM SKILLED NURSING FACILITY

22 PROSPECTIVE PAYMENT SYSTEM.—Section 

23 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 

24 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar25 riage and family therapist services, mental health 


smartinez on PROD1PC64 with BILLS
6 

•HR 1693 IH

1 counselor services,’’ after ‘‘qualified psychologist 

2 services,’’. 

3 (6) INCLUSION OF MARRIAGE AND FAMILY

4 THERAPISTS AND MENTAL HEALTH COUNSELORS AS

5 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec6 tion 1842(b)(18)(C) of such Act (42 U.S.C. 

7 1395u(b)(18)(C)) is amended by adding at the end 

8 the following new clauses: 

9 ‘‘(vii) A marriage and family therapist 

10 (as defined in section 1861(hhh)(2)). 

11 ‘‘(viii) A mental health counselor (as 

12 defined in section 1861(hhh)(4)).’’. 

13 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV14 ICES PROVIDED IN CERTAIN SETTINGS.— 

15 (1) RURAL HEALTH CLINICS AND FEDERALLY

16 QUALIFIED HEALTH CENTERS.—Section 

17 1861(aa)(1)(B) of such Act (42 U.S.C. 

18 1395x(aa)(1)(B)) is amended by striking ‘‘or by a 

19 clinical social worker (as defined in subsection 

20 (hh)(1))’’ and inserting ‘‘by a clinical social worker 

21 (as defined in subsection (hh)(1)), by a marriage 

22 and family therapist (as defined in subsection 

23 (hhh)(2)), or by a mental health counselor (as de24 fined in subsection (hhh)(4))’’. 


smartinez on PROD1PC64 with BILLS
7 

•HR 1693 IH

1 (2) HOSPICE PROGRAMS.—Section 

2 1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 

3 1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 

4 one marriage and family therapist or mental health 

5 counselor’’ after ‘‘social worker’’. 

6 (c) AUTHORIZATION OF MARRIAGE AND FAMILY

7 THERAPISTS AND MENTAL HEALTH COUNSELORS TO

8 DEVELOP DISCHARGE PLANS FOR POST-HOSPITAL SERV9 ICES.—Section 1861(ee)(2)(G) of such Act (42 U.S.C. 

10 1395x(ee)(2)(G)) is amended by inserting ‘‘including 

11 those marriage and family therapists and mental health 

12 counselors meeting appropriate qualification standards as 

13 issued by the Secretary’’ after ‘‘social worker, qualified 

14 personnel’’. 

15 (d) EFFECTIVE DATE.—The amendments made by 

16 this section shall apply with respect to services furnished 

17 on or after January 1, 2010. 

Æ 


smartinez on PROD1PC64 with BILLS