I 

109TH CONGRESS 

1ST SESSION H. R. 1946 

To amend title XVIII of the Social Security Act to expand and improve 

coverage of mental health services under the Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 27, 2005 

Mr. STARK introduced the following bill; which was referred to the Committee 

on Ways and Means, and in addition to the Committee on Energy and 

Commerce, 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 expand 

and improve coverage of mental health services under 

the Medicare Program. 

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; TABLE OF CONTENTS. 

4 (a) IN GENERAL.—This Act may be cited as the 

5 ‘‘Medicare Mental Health Modernization Act of 2005’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

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TITLE I—ESTABLISHING PARITY FOR MENTAL HEALTH 

SERVICES 

Sec. 101. Elimination of lifetime limit on inpatient mental health services. 

Sec. 102. Parity in treatment for outpatient mental health services. 

TITLE II—EXPANDING COVERAGE OF COMMUNITY-BASED 

MENTAL HEALTH SERVICES 

Sec. 201. Coverage of intensive residential services. 

Sec. 202. Coverage of intensive outpatient services. 

TITLE III—IMPROVING BENEFICIARY ACCESS TO MEDICARECOVERED SERVICES 

Sec. 301. Excluding clinical social worker services from coverage under the 

medicare skilled nursing facility prospective payment system 

and consolidated payment. 

Sec. 302. Coverage of marriage and family therapist services. 

Sec. 303. Coverage of mental health counselor services. 

Sec. 304. Study of coverage criteria for Alzheimer’s disease and related mental 

illnesses. 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Older people have the highest rate of suicide 

4 of any population in the United States, and the sui5 cide rate of that population increases with age, with 

6 individuals 65 and older accounting for 20 percent 

7 of all suicide deaths in the United States, while com8 prising only 13 percent of the population of the 

9 United States. 

10 (2) Disability due to mental illness in individ11 uals over 65 years old will become a major public 

12 health problem in the near future because of demo13 graphic changes. In particular, anxiety, dementia, 

14 depression, schizophrenia, among other conditions, 

15 will all present special problems for this age group. 

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1 (3) Major depression is strikingly prevalent 

2 among older people, with between 8 and 20 percent 

3 of older people in community studies and up to 37 

4 percent of those seen in primary care settings expe5 riencing symptoms of depression. 

6 (4) Anxiety disorders rival depression in their 

7 prevalence among older people with a rate of 11.4 

8 percent in persons aged 55 and older. 

9 (5) Almost 20 percent of the population of indi10 viduals age 55 and older, experience specific mental 

11 disorders that are not part of normal aging. 

12 (6) Unrecognized and untreated depression, 

13 Alzheimer’s disease, anxiety, late-life schizophrenia, 

14 and other mental conditions can be severely impair15 ing and may even be fatal. 

16 (7) Substance abuse, particularly the abuse of 

17 alcohol and prescription drugs, among adults 65 and 

18 older is one of the fastest growing health problems 

19 in the United States, with 17 percent of this age 

20 group suffering from addiction or substance abuse. 

21 While addiction often goes undetected and untreated 

22 among older adults, aging and disability makes the 

23 body more vulnerable to the effects of alcohol and 

24 drugs, further exacerbating other age-related health 

25 problems. Medicare coverage for addiction treatment 

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1 of the elderly needs to recognize these special 

2 vulnerabilities. 

3 (8) The disabled are another population receiv4 ing inadequate mental health care through medicare. 

5 According to the Centers for Medicare & Medicaid 

6 Services, medicare is the primary health care cov7 erage for the 5,000,000 nonelderly, disabled people 

8 on Social Security Disability Insurance. Up to 40 

9 percent of these individuals have a diagnosis of men10 tal illness. 

11 (9) The current medicare benefit structure dis12 criminates against the millions of Americans who 

13 suffer from mental illness and maintains an out14 dated bias toward institutionally based service deliv15 ery. According to the report of the Surgeon General 

16 on mental health for 1999, intensive outpatient serv17 ices, such as psychiatric rehabilitation and assertive 

18 community treatment, represent state-of-the-art 

19 mental health services. These evidence-based com20 munity support services help people with psychiatric 

21 disabilities improve their ability to function in the 

22 community and reduce hospitalization rates by 30 to 

23 60 percent, even for people with the most severe 

24 mental illnesses. 

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1 TITLE I—ESTABLISHING PARITY 

2 FOR MENTAL HEALTH SERVICES 

3 SEC. 101. ELIMINATION OF LIFETIME LIMIT ON INPATIENT 

4 MENTAL HEALTH SERVICES. 

5 (a) IN GENERAL.—Section 1812 of the Social Secu6 rity Act (42 U.S.C. 1395d) is amended— 

7 (1) in subsection (b)— 

8 (A) in paragraph (1), by adding ‘‘or’’ at 

9 the end; 

10 (B) in paragraph (2), by striking ‘‘; or’’ at 

11 the end and inserting a period; and 

12 (C) by striking paragraph (3); and 

13 (2) by striking subsection (c). 

14 (b) EFFECTIVE DATE.—The amendments made by 

15 subsection (a) shall apply to items and services furnished 

16 on or after January 1, 2006. 

17 SEC. 102. PARITY IN TREATMENT FOR OUTPATIENT MEN18 TAL HEALTH SERVICES. 

19 (a) IN GENERAL.—Section 1833 of the Social Secu20 rity Act (42 U.S.C. 1395l) is amended by striking sub21 section (c). 

22 (b) EFFECTIVE DATE.—The amendment made by 

23 subsection (a) shall apply to items and services furnished 

24 on or after January 1, 2006. 

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1 TITLE II—EXPANDING COV2 ERAGE OF COMMUNITY3 BASED MENTAL HEALTH 

4 SERVICES 

5 SEC. 201. COVERAGE OF INTENSIVE RESIDENTIAL SERV6 ICES. 

7 (a) COVERAGE UNDER PART A.—Section 1812(a) of 

8 the Social Security Act (42 U.S.C. 1395d(a)) is amend9 ed— 

10 (1) in paragraph (4), by striking ‘‘and’’ at the 

11 end; 

12 (2) in paragraph (5), by striking the period at 

13 the end and inserting ‘‘; and’’; and 

14 (3) by adding at the end the following new 

15 paragraph: 

16 ‘‘(6) intensive residential services (as defined in 

17 section 1861(bbb)) furnished to an individual for up 

18 to 120 days during any calendar year, except that 

19 such services may be furnished to the individual for 

20 additional days (not to exceed 20 days) during the 

21 year if necessary for the individual to complete a 

22 course of treatment.’’. 

23 (b) SERVICES DESCRIBED.—Section 1861 of the So24 cial Security Act (42 U.S.C. 1395x) is amended by adding 

25 at the end the following new subsection: 
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1 ‘‘Intensive Residential Services 

2 ‘‘(bbb)(1) Subject to paragraphs (3) and (4), the 

3 term ‘intensive residential services’ means a program of 

4 residential services (described in paragraph (2)) that is— 

5 ‘‘(A) prescribed by a physician for an individual 

6 entitled to, or enrolled for, benefits under part A 

7 who is under the care of the physician; and 

8 ‘‘(B) furnished under the supervision of a phy9 sician pursuant to an individualized, written plan of 

10 treatment established and periodically reviewed by a 

11 physician (in consultation with appropriate staff par12 ticipating in such services), which plan sets forth— 

13 ‘‘(i) the individual’s diagnosis, 

14 ‘‘(ii) the type, amount, frequency, and du15 ration of the items and services provided under 

16 the plan, and 

17 ‘‘(iii) the goals for treatment under the 

18 plan. 

19 In the case of such an individual who is receiving qualified 

20 psychologist services (as defined in subsection (ii)), the in21 dividual may be under the care of the clinical psychologist 

22 with respect to such services under this subsection to the 

23 extent permitted under State law. 

24 ‘‘(2) The program of residential services described in 

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1 tial program that furnishes acute mental health services 

2 or substance abuse services, or both, on a 24-hour basis. 

3 Such services shall include treatment planning and devel4 opment, medication management, case management, crisis 

5 intervention, individual therapy, group therapy, and de6 toxification services. Such services shall be furnished in 

7 any of the following facilities: 

8 ‘‘(A) Crisis residential programs or mental ill9 ness residential treatment programs. 

10 ‘‘(B) Therapeutic family or group treatment 

11 homes. 

12 ‘‘(C) Residential detoxification centers. 

13 ‘‘(D) Residential centers for substance abuse 

14 treatment. 

15 ‘‘(3) No service may be treated as an intensive resi16 dential service under paragraph (1) unless the facility at 

17 which the service is provided— 

18 ‘‘(A) is legally authorized to provide such serv19 ice under the law of the State (or under a State reg20 ulatory mechanism provided by State law) in which 

21 the facility is located or meets such certification re22 quirements that the Secretary may impose; and 

23 ‘‘(B) meets such other requirements as the Sec24 retary may impose to assure the quality of the inten25 sive residential services provided. 

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1 ‘‘(4) No service may be treated as an intensive resi2 dential service under paragraph (1) unless the service is 

3 furnished in accordance with standards established by the 

4 Secretary for the management of such services.’’. 

5 (c) AMOUNT OF PAYMENT.—Section 1814 of the So6 cial Security Act (42 U.S.C. 1395f) is amended— 

7 (1) in subsection (b), in the matter preceding 

8 paragraph (1), by inserting ‘‘other than intensive 

9 residential services,’’ after ‘‘hospice care,’’; and 

10 (2) by adding at the end the following new sub11 section: 

12 ‘‘Payment for Intensive Residential Services 

13 ‘‘(m)(1) The amount of payment under this part for 

14 intensive residential services under section 1812(a)(6) 

15 shall be equal to an amount specified under a prospective 

16 payment system established by the Secretary, taking into 

17 account the prospective payment system established for 

18 psychiatric hospitals pursuant to section 124 of the Medi19 care, Medicaid, and SCHIP Balanced Budget Refinement 

20 Act of 1999 (113 Stat. 1501A–332), as enacted into law 

21 by section 1000(a)(6) of Public Law 106–113. 

22 ‘‘(2) Prior to the date on which the Secretary imple23 ments the prospective payment system established under 

24 paragraph (1), the amount of payment under this part for 

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1 such intensive residential services is the reasonable costs 

2 of providing such services.’’. 

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

4 this section shall apply to items and services furnished on 

5 or after January 1, 2006. 

6 SEC. 202. COVERAGE OF INTENSIVE OUTPATIENT SERV7 ICES. 

8 (a) COVERAGE.—Section 1832(a)(2) of the Social Se9 curity Act (42 U.S.C. 1395k(a)(2)) is amended— 

10 (1) in subparagraph (I), by striking ‘‘and’’ at 

11 the end; 

12 (2) in subparagraph (J), by striking the period 

13 at the end and inserting ‘‘; and’’; and 

14 (3) by adding at the end the following new sub15 paragraph: 

16 ‘‘(K) intensive outpatient services (as de17 scribed in section 1861(ccc)).’’. 

18 (b) SERVICES DESCRIBED.—Section 1861 of the So19 cial Security Act (42 U.S.C. 1395x), as amended by sec20 tion 201(b), is amended by adding at the end the following 

21 new subsection: 

22 ‘‘Intensive Outpatient Services 

23 ‘‘(ccc)(1) The term ‘intensive outpatient services’ 

24 means the items and services described in paragraph (2) 

25 prescribed by a physician and provided within the context 

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1 described in paragraph (3) under the supervision of a phy2 sician (or, to the extent permitted under the law of the 

3 State in which the services are furnished, a non-physician 

4 mental health professional) pursuant to an individualized, 

5 written plan of treatment that is established by a physi6 cian and periodically reviewed by a physician or, to the 

7 extent permitted under the laws of the State in which the 

8 services are furnished, a non-physician mental health pro9 fessional (in consultation with appropriate staff partici10 pating in such services), which plan sets forth the patient’s 

11 diagnosis, the type, amount, frequency, and duration of 

12 the items and services provided under the plan, and the 

13 goals for treatment under the plan. 

14 ‘‘(2)(A) The items and services described in this 

15 paragraph are the items and services described in sub16 paragraph (B) that are reasonable and necessary for the 

17 diagnosis or treatment of the individual’s condition, rea18 sonably expected to improve or maintain the individual’s 

19 condition and functional level and to prevent relapse or 

20 hospitalization, and furnished pursuant to such guidelines 

21 relating to frequency and duration of services as the Sec22 retary shall by regulation establish (taking into account 

23 accepted norms of clinical practice). 

24 ‘‘(B) For purposes of subparagraph (A), the items 

25 and services described in this paragraph are as follows: 

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1 ‘‘(i) Psychiatric rehabilitation. 

2 ‘‘(ii) Assertive community treatment. 

3 ‘‘(iii) Intensive case management. 

4 ‘‘(iv) Day treatment for individuals under 21 

5 years of age. 

6 ‘‘(v) Ambulatory detoxification. 

7 ‘‘(vi) Such other items and services as the Sec8 retary may provide (but in no event to include meals 

9 and transportation). 

10 ‘‘(3) The context described in this paragraph for the 

11 provision of intensive outpatient services is as follows: 

12 ‘‘(A) Such services are furnished in a facility, 

13 home, or community setting. 

14 ‘‘(B) Such services are furnished— 

15 ‘‘(i) to assist the individual to compensate 

16 for, or eliminate, functional deficits and inter17 personal and environmental barriers created by 

18 the disability; and 

19 ‘‘(ii) to restore skills to the individual for 

20 independent living, socialization, and effective 

21 life management. 

22 ‘‘(C) Such services are furnished by an indi23 vidual or entity that— 

24 ‘‘(i) is legally authorized to furnish such 

25 services under State law (or the State reguVerDate Aug 04 2004 00:12 May 03, 2005 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1946.IH H1946
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1 latory mechanism provided by State law) or 

2 meets such certification requirements that the 

3 Secretary may impose; and 

4 ‘‘(ii) meets such other requirements as the 

5 Secretary may impose to assure the quality of 

6 the intensive outpatient services provided.’’. 

7 (c) PAYMENT.— 

8 (1) IN GENERAL.—With respect to intensive 

9 outpatient services (as defined in section 

10 1861(ccc)(1) of the Social Security Act (as added by 

11 subsection (b)) furnished under the medicare pro12 gram, the amount of payment under such Act for 

13 such services shall be 80 percent of— 

14 (A) during 2006 and 2007, the reasonable 

15 costs of furnishing such services; and 

16 (B) on or after January 1, 2008, the 

17 amount of payment established for such serv18 ices under the prospective payment system es19 tablished by the Secretary under paragraph (2) 

20 for such services. 

21 (2) ESTABLISHMENT OF PPS.— 

22 (A) IN GENERAL.—With respect to inten23 sive outpatient services (as defined in section 

24 1861(ccc)(1)) of the Social Security Act (as 

25 added by subsection (b)) furnished under the 

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1 medicare program on or after January 1, 2008, 

2 the Secretary of Health and Human Services 

3 (in this paragraph referred to as the ‘‘Sec4 retary’’) shall establish a prospective payment 

5 system for payment for such services. Such sys6 tem shall include an adequate patient classifica7 tion system that reflects the differences in pa8 tient resource use and costs and shall provide 

9 for an annual update to the rates of payment 

10 established under the system. 

11 (B) ADJUSTMENTS.—In establishing the 

12 system under subparagraph (A), the Secretary 

13 shall provide for adjustments in the prospective 

14 payment amount for variations in wage and 

15 wage-related costs, case mix, and such other 

16 factors as the Secretary determines appropriate. 

17 (C) COLLECTION OF DATA AND EVALUA18 TION.—In developing the system described in 

19 subparagraph (A), the Secretary may require 

20 providers of services under the medicare pro21 gram to submit such information to the Sec22 retary as the Secretary may require to develop 

23 the system, including the most recently avail24 able data. 

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1 (D) REPORTS TO CONGRESS.—Not later 

2 than October 1 of each of 2006 and 2007, the 

3 Secretary shall submit to Congress a report on 

4 the progress of the Secretary in establishing the 

5 prospective payment system under this para6 graph. 

7 (d) CONFORMING AMENDMENTS.—(1) Section 

8 1835(a)(2) of the Social Security Act (42 U.S.C. 

9 1395n(a)(2)) is amended— 

10 (A) in subparagraph (E), by striking ‘‘and’’ at 

11 the end; 

12 (B) in subparagraph (F), by striking the period 

13 at the end and inserting ‘‘; and’’; and 

14 (C) by inserting after subparagraph (F) the fol15 lowing new subparagraph: 

16 ‘‘(G) in the case of intensive outpatient 

17 services, (i) that those services are reasonably 

18 expected to improve or maintain the individual’s 

19 condition and functional level and to prevent re20 lapse or hospitalization, (ii) an individualized, 

21 written plan for furnishing such services has 

22 been established by a physician and is reviewed 

23 periodically by a physician or, to the extent per24 mitted under the laws of the State in which the 

25 services are furnished, a non-physician mental 

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1 health professional, and (iii) such services are 

2 or were furnished while the individual is or was 

3 under the care of a physician or, to the extent 

4 permitted under the law of the State in which 

5 the services are furnished, a non-physician men6 tal health professional.’’. 

7 (2) Section 1861(s)(2)(B) of the Social Security Act 

8 (42 U.S.C. 1395x(s)(2)(B)) is amended by inserting ‘‘and 

9 intensive outpatient services’’ after ‘‘partial hospitalization 

10 services’’. 

11 (3) Section 1861(ff)(1) of the Social Security Act (42 

12 U.S.C. 1395x(ff)(1)) is amended— 

13 (A) by inserting ‘‘or, to the extent permitted 

14 under the law of the State in which the services are 

15 furnished, a non-physician mental health profes16 sional,’’ after ‘‘under the supervision of a physician’’ 

17 and after ‘‘periodically reviewed by a physician’’; and 

18 (B) by striking ‘‘physician’s’’ and inserting ‘‘pa19 tient’s’’. 

20 (4) Section 1861(cc) of the Social Security Act (42 

21 U.S.C. 1395x(cc)) is amended— 

22 (A) in paragraph (1), in the matter preceding 

23 subparagraph (A), by striking ‘‘physician—’’ and in24 serting ‘‘physician or, to the extent permitted under 

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1 nished, a non-physician mental health professional— 

2 ’’; and 

3 (B) in paragraph (2)(E), by inserting before 

4 the semicolon at the end the following: ‘‘, except that 

5 a patient receiving social and psychological services 

6 under paragraph (1)(D) may be under the care of 

7 a non-physician mental health professional with re8 spect to such services to the extent permitted under 

9 the law of the State in which the services are fur10 nished’’. 

11 (e) EFFECTIVE DATE.—The amendments made by 

12 this section shall apply to items and services furnished on 

13 or after January 1, 2006. 

14 TITLE III—IMPROVING BENE15 FICIARY ACCESS TO MEDI16 CARE-COVERED SERVICES 

17 SEC. 301. EXCLUDING CLINICAL SOCIAL WORKER SERVICES 

18 FROM COVERAGE UNDER THE MEDICARE 

19 SKILLED NURSING FACILITY PROSPECTIVE 

20 PAYMENT SYSTEM AND CONSOLIDATED PAY21 MENT. 

22 (a) IN GENERAL.—Section 1888(e)(2)(A)(ii) of the 

23 Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is 

24 amended by inserting ‘‘clinical social worker services,’’ 

25 after ‘‘qualified psychologist services,’’. 

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1 (b) CONFORMING AMENDMENT.—Section 

2 1861(hh)(2) of the Social Security Act (42 U.S.C. 

3 1395x(hh)(2)) is amended by striking ‘‘and other than 

4 services furnished to an inpatient of a skilled nursing facil5 ity which the facility is required to provide as a require6 ment for participation’’. 

7 (c) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply to items and services furnished on 

9 or after January 1, 2006. 

10 SEC. 302. COVERAGE OF MARRIAGE AND FAMILY THERA11 PIST SERVICES. 

12 (a) COVERAGE OF SERVICES.—Section 1861(s)(2) of 

13 the Social Security Act (42 U.S.C. 1395x(s)(2)) is amend14 ed— 

15 (1) in subparagraph (Y), by striking ‘‘and’’ at 

16 the end; 

17 (2) in subparagraph (Z), by adding ‘‘and’’ at 

18 the end; and 

19 (3) by adding at the end the following new sub20 paragraph: 

21 ‘‘(AA) marriage and family therapist services 

22 (as defined in subsection (ddd));’’. 

23 (b) DEFINITION.—Section 1861 of the Social Secu24 rity Act (42 U.S.C. 1395x), as amended by sections 

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1 201(b) and 202(b), is amended by adding at the end the 

2 following new subsection: 

3 ‘‘Marriage and Family Therapist Services 

4 ‘‘(ddd)(1) The term ‘marriage and family therapist 

5 services’ means services performed by a marriage and 

6 family therapist (as defined in paragraph (2)) for the diag7 nosis and treatment of mental illnesses, which the mar8 riage and family therapist is legally authorized to perform 

9 under State law (or the State regulatory mechanism pro10 vided by State law) of the State in which such services 

11 are performed, provided such services are covered under 

12 this title, as would otherwise be covered if furnished by 

13 a physician or as incident to a physician’s professional 

14 service, but only if no facility or other provider charges 

15 or is paid any amounts with respect to the furnishing of 

16 such services. 

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

18 an individual who— 

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

20 which qualifies for licensure or certification as a 

21 marriage and family therapist pursuant to State 

22 law; 

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

24 at least 2 years of clinical supervised experience in 

25 marriage and family therapy; and 

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1 ‘‘(C) is licensed or certified as a marriage and 

2 family therapist in the State in which marriage and 

3 family therapist services are performed.’’. 

4 (c) PROVISION FOR PAYMENT UNDER PART B.—Sec5 tion 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 

6 1395k(a)(2)(B)) is amended by adding at the end the fol7 lowing new clause: 

8 ‘‘(v) marriage and family therapist 

9 services;’’. 

10 (d) AMOUNT OF PAYMENT.— 

11 (1) IN GENERAL.—Section 1833(a)(1) of the 

12 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

13 amended— 

14 (A) by striking ‘‘and’’ before ‘‘(V)’’; and 

15 (B) by inserting before the semicolon at 

16 the end the following: ‘‘, and (W) with respect 

17 to marriage and family therapist services under 

18 section 1861(s)(2)(AA), the amounts paid shall 

19 be 80 percent of the lesser of (i) the actual 

20 charge for the services or (ii) 75 percent of the 

21 amount determined for payment of a psycholo22 gist under subparagraph (L)’’. 

23 (2) DEVELOPMENT OF CRITERIA WITH RE24 SPECT TO CONSULTATION WITH A PHYSICIAN.—The 

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1 ing into consideration concerns for patient confiden2 tiality, develop criteria with respect to payment for 

3 marriage and family therapist services for which 

4 payment may be made directly to the marriage and 

5 family therapist under part B of title XVIII of the 

6 Social Security Act (42 U.S.C. 1395j et seq.) under 

7 which such a therapist must agree to consult with a 

8 patient’s attending or primary care physician in ac9 cordance with such criteria. 

10 (e) EXCLUSION OF MARRIAGE AND FAMILY THERA11 PIST SERVICES FROM SKILLED NURSING FACILITY PRO12 SPECTIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) 

13 of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)), 

14 as amended in section 301(a), is amended by inserting 

15 ‘‘marriage and family therapist services (as defined in sub16 section (ddd)(1)),’’ after ‘‘clinical social worker services,’’. 

17 (f) COVERAGE OF MARRIAGE AND FAMILY THERA18 PIST SERVICES PROVIDED IN RURAL HEALTH CLINICS

19 AND FEDERALLY QUALIFIED HEALTH CENTERS.—Sec20 tion 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 

21 1395x(aa)(1)(B)) is amended by striking ‘‘or by a clinical 

22 social worker (as defined in subsection (hh)(1)),,’’ and in23 serting ‘‘, by a clinical social worker (as defined in sub24 section (hh)(1)), or by a marriage and family therapist 

25 (as defined in subsection (ddd)(2)),’’. 

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1 (g) INCLUSION OF MARRIAGE AND FAMILY THERA2 PISTS AS PRACTITIONERS FOR ASSIGNMENT OF

3 CLAIMS.—Section 1842(b)(18)(C) of the Social Security 

4 Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding 

5 at the end the following new clause: 

6 ‘‘(vii) A marriage and family therapist (as de7 fined in section 1861(ddd)(2)).’’. 

8 (h) EFFECTIVE DATE.—The amendments made by 

9 this section shall apply to items and services furnished on 

10 or after January 1, 2006. 

11 SEC. 303. COVERAGE OF MENTAL HEALTH COUNSELOR 

12 SERVICES. 

13 (a) COVERAGE OF SERVICES.—Section 1861(s)(2) of 

14 the Social Security Act (42 U.S.C. 1395x(s)(2)), as 

15 amended in section 302(a), is amended— 

16 (1) in subparagraph (Z), by striking ‘‘and’’ at 

17 the end; 

18 (2) in subparagraph (AA), by inserting ‘‘and’’ 

19 at the end; and 

20 (3) by adding at the end the following new sub21 paragraph: 

22 ‘‘(BB) mental health counselor services (as 

23 defined in subsection (eee)(2));’’. 

24 (b) DEFINITION.—Section 1861 of the Social Secu25 rity Act (42 U.S.C. 1395x), as amended by sections 

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1 201(b), 202(b), and 302(b), is amended by adding at the 

2 end the following new subsection: 

3 ‘‘Mental Health Counselor; Mental Health Counselor 

4 Services 

5 ‘‘(eee)(1) The term ‘mental health counselor’ means 

6 an individual who— 

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

8 mental health counseling or a related field; 

9 ‘‘(B) after obtaining such a degree has per10 formed at least 2 years of supervised mental health 

11 counselor practice; and 

12 ‘‘(C) is licensed or certified as a mental health 

13 counselor or professional counselor by the State in 

14 which the services are performed. 

15 ‘‘(2) The term ‘mental health counselor services’ 

16 means services performed by a mental health counselor (as 

17 defined in paragraph (1)) for the diagnosis and treatment 

18 of mental illnesses which the mental health counselor is 

19 legally authorized to perform under State law (or the 

20 State regulatory mechanism provided by the State law) of 

21 the State in which such services are performed, provided 

22 such services are covered under this title, as would other23 wise be covered if furnished by a physician or as incident 

24 to a physician’s professional service, but only if no facility 

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1 or other provider charges or is paid any amounts with re2 spect to the furnishing of such services.’’. 

3 (c) PAYMENT.— 

4 (1) IN GENERAL.—Section 1833(a)(1) of the 

5 Social Security Act (42 U.S.C. 1395l(a)(1)), as 

6 amended by section 302(d), is amended— 

7 (A) by striking ‘‘and’’ before ‘‘(W)’’; and 

8 (B) by inserting before the semicolon at 

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

10 to mental health counselor services under sec11 tion 1861(s)(2)(BB), the amounts paid shall be 

12 80 percent of the lesser of (i) the actual charge 

13 for the services or (ii) 75 percent of the amount 

14 determined for payment of a psychologist under 

15 subparagraph (L)’’. 

16 (2) DEVELOPMENT OF CRITERIA WITH RE17 SPECT TO CONSULTATION WITH A PHYSICIAN.—The 

18 Secretary of Health and Human Services shall, tak19 ing into consideration concerns for patient confiden20 tiality, develop criteria with respect to payment for 

21 mental health counselor services for which payment 

22 may be made directly to the mental health counselor 

23 under part B of title XVIII of the Social Security 

24 Act (42 U.S.C. 1395j et seq.) under which such a 

25 counselor must agree to consult with a patient’s atVerDate Aug 04 2004 00:12 May 03, 2005 Jkt 039200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H1946.IH H1946
25 

•HR 1946 IH 

1 tending or primary care physician in accordance 

2 with such criteria. 

3 (d) EXCLUSION OF MENTAL HEALTH COUNSELOR

4 SERVICES FROM SKILLED NURSING FACILITY PROSPEC5 TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) of 

6 the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)), 

7 as amended by sections 301(a) and 302(e), is amended 

8 by inserting ‘‘mental health counselor services (as defined 

9 in section 1861(eee)(2)),’’ after ‘‘marriage and family 

10 therapist services (as defined in subsection (ddd)(1)),’’. 

11 (e) COVERAGE OF MENTAL HEALTH COUNSELOR

12 SERVICES PROVIDED IN RURAL HEALTH CLINICS AND

13 FEDERALLY QUALIFIED HEALTH CENTERS.—Section 

14 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 

15 1395x(aa)(1)(B)), as amended by section 302(f), is 

16 amended— 

17 (1) by striking ‘‘or by a marriage’’ and insert18 ing ‘‘by a marriage’’; and 

19 (2) by inserting ‘‘or a mental health counselor 

20 (as defined in subsection (eee)(1)),’’ after ‘‘marriage 

21 and family therapist (as defined in subsection 

22 (ddd)(2)),’’. 

23 (f) INCLUSION OF MENTAL HEALTH COUNSELORS AS

24 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Section 

25 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 

26 

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1 1395u(b)(18)(C)), as amended by section 302(g), is 

2 amended by adding at the end the following new clause: 

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

4 section 1861(eee)(1)).’’. 

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

6 this section shall apply to items and services furnished on 

7 or after January 1, 2006. 

8 SEC. 304. STUDY OF COVERAGE CRITERIA FOR ALZ9 HEIMER’S DISEASE AND RELATED MENTAL 

10 ILLNESSES. 

11 (a) STUDY.— 

12 (1) IN GENERAL.—The Secretary of Health and 

13 Human Services (in this section referred to as the 

14 ‘‘Secretary’’) shall conduct a study to determine 

15 whether the criteria for coverage of any therapy 

16 service (including occupational therapy services and 

17 physical therapy services) or any outpatient mental 

18 health care service under the medicare program 

19 under title XVIII of the Social Security Act (42 

20 U.S.C. 1395 et seq.) unduly restricts the access of 

21 any medicare beneficiary who has been diagnosed 

22 with Alzheimer’s disease or a related mental illness 

23 to such a service because the coverage criteria re24 quires the medicare beneficiary to display continuing 

27 

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1 clinical improvement to continue to receive the serv2 ice. 

3 (2) DETERMINATION OF NEW COVERAGE CRI4 TERIA.—If the Secretary determines that the cov5 erage criteria described in paragraph (1) unduly re6 stricts the access of any medicare beneficiary to the 

7 services described in such paragraph, the Secretary 

8 shall identify alternative coverage criteria that would 

9 permit a medicare beneficiary who has been diag10 nosed with Alzheimer’s disease or a related mental 

11 illness to receive coverage for health care services 

12 under the medicare program that are designed to 

13 control symptoms, maintain functional capabilities, 

14 reduce or deter deterioration, and prevent or reduce 

15 hospitalization of the beneficiary. 

16 (b) REPORT.—Not later than 1 year after the date 

17 of enactment of this Act, the Secretary shall submit to 

18 the committees of jurisdiction of Congress a report on the 

19 study conducted under subsection (a) together with such 

20 recommendations for legislative and administrative action 

21 as the Secretary determines appropriate. 

Æ