II 

117TH CONGRESS 

1ST SESSION S. 828 

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 SENATE OF THE UNITED STATES 

MARCH 18, 2021 

Mr. BARRASSO (for himself and Ms. STABENOW) 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 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 ‘‘Mental Health Access 

5 Improvement Act of 2021’’. 


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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 (GG), by striking 

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

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

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

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

14 subparagraph: 

15 ‘‘(II) marriage and family therapist services (as 

16 defined in subsection (lll)(1)) and mental health 

17 counselor services (as defined in subsection 

18 (lll)(3));’’. 

19 (2) DEFINITIONS.—Section 1861 of the Social 

20 Security Act (42 U.S.C. 1395x) is amended by add21 ing at the end the following new subsection: 

22 ‘‘Marriage and Family Therapist Services; Marriage and 

23 Family Therapist; Mental Health Counselor Serv24 ices; Mental Health Counselor 

25 ‘‘(lll)(1) The term ‘marriage and family therapist 

26 services’ means services performed by a marriage and 


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1 family therapist (as defined in paragraph (2)) for the diag2 nosis and treatment of mental illnesses, which the mar3 riage and family therapist is legally authorized to perform 

4 under State law (or the State regulatory mechanism pro5 vided by State law) of the State in which such services 

6 are performed, as would otherwise be covered if furnished 

7 by a physician or as an incident to a physician’s profes8 sional service, but only if no facility or other provider 

9 charges or is paid any amounts with respect to the fur10 nishing of such services. 

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

12 an individual who— 

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

14 which qualifies for licensure or certification as a 

15 marriage and family therapist pursuant to State 

16 law; 

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

18 at least 2 years of clinical supervised experience in 

19 marriage and family therapy; and 

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

21 services in a State that provides for licensure or cer22 tification of marriage and family therapists, is li23 censed or certified as a marriage and family thera24 pist in such State. 


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

2 means services performed by a mental health counselor (as 

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

4 of mental illnesses which the mental health counselor is 

5 legally authorized to perform under State law (or the 

6 State regulatory mechanism provided by the State law) of 

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

8 otherwise be covered if furnished by a physician or as inci9 dent to a physician’s professional service, but only if no 

10 facility or other provider charges or is paid any amounts 

11 with respect to the furnishing of such services. 

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

13 individual who— 

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

15 mental health counseling or a related field; 

16 ‘‘(B) after obtaining such a degree has per17 formed at least 2 years of supervised mental health 

18 counselor practice; and 

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

20 services in a State that provides for licensure or cer21 tification of mental health counselors or professional 

22 counselors, is licensed or certified as a mental health 

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

24 (3) PROVISION FOR PAYMENT UNDER PART

25 B.—Section 1832(a)(2)(B) of the Social Security 


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1 Act (42 U.S.C. 1395k(a)(2)(B)) is amended by add2 ing at the end the following new clause: 

3 ‘‘(v) marriage and family therapist 

4 services (as defined in section 1861(lll)(1)) 

5 and mental health counselor services (as 

6 defined in section 1861(lll)(3));’’. 

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

8 of the Social Security Act (42 U.S.C. 1395l(a)(1)) 

9 is amended— 

10 (A) by striking ‘‘and (CC)’’ and inserting 

11 ‘‘(CC)’’; and 

12 (B) by inserting before the semicolon at 

13 the end the following: ‘‘, and (DD) with respect 

14 to marriage and family therapist services and 

15 mental health counselor services under section 

16 1861(s)(2)(II), the amounts paid shall be 80 

17 percent of the lesser of the actual charge for 

18 the services or 75 percent of the amount deter19 mined for payment of a psychologist under sub20 paragraph (L)’’. 

21 (5) EXCLUSION OF MARRIAGE AND FAMILY

22 THERAPIST SERVICES AND MENTAL HEALTH COUN23 SELOR SERVICES FROM SKILLED NURSING FACILITY

24 PROSPECTIVE PAYMENT SYSTEM.—Section 

25 1888(e)(2)(A)(ii) of the Social Security Act (42 


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1 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 

2 ‘‘marriage and family therapist services (as defined 

3 in section 1861(lll)(1)), mental health counselor 

4 services (as defined in section 1861(lll)(3)),’’ after 

5 ‘‘qualified psychologist services,’’. 

6 (6) INCLUSION OF MARRIAGE AND FAMILY

7 THERAPISTS AND MENTAL HEALTH COUNSELORS AS

8 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec9 tion 1842(b)(18)(C) of the Social Security Act (42 

10 U.S.C. 1395u(b)(18)(C)) is amended by adding at 

11 the end the following new clauses: 

12 ‘‘(vii) A marriage and family therapist (as de13 fined in section 1861(lll)(2)). 

14 ‘‘(viii) A mental health counselor (as defined in 

15 section 1861(lll)(4)).’’. 

16 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV17 ICES PROVIDED IN CERTAIN SETTINGS.— 

18 (1) RURAL HEALTH CLINICS AND FEDERALLY

19 QUALIFIED HEALTH CENTERS.—Section 

20 1861(aa)(1)(B) of the Social Security Act (42 

21 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 

22 by a clinical social worker (as defined in subsection 

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

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

25 and family therapist (as defined in subsection 


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1 (lll)(2)), or by a mental health counselor (as defined 

2 in subsection (lll)(4))’’. 

3 (2) HOSPICE PROGRAMS.—Section 

4 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 

5 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in6 serting ‘‘, marriage and family therapist, or mental 

7 health counselor’’ after ‘‘social worker’’. 

8 (c) AUTHORIZATION OF MARRIAGE AND FAMILY

9 THERAPISTS AND MENTAL HEALTH COUNSELORS TO

10 DEVELOP DISCHARGE PLANS FOR POST-HOSPITAL SERV11 ICES.—Section 1861(ee)(2)(G) of the Social Security Act 

12 (42 U.S.C. 1395x(ee)(2)(G)) is amended by inserting ‘‘, 

13 including a marriage and family therapist and a mental 

14 health counselor who meets qualification standards estab15 lished by the Secretary’’ before the period at the end. 

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

17 this section shall apply with respect to services furnished 

18 on or after January 1, 2022. 

Æ 


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