I

107TH CONGRESS

1ST SESSION H. R. 1522

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 4, 2001

Mr. STARK (for himself, Mr. MATSUI, Mr. FARR of California, Mr. GUTIERREZ, Mr. FRANK, Mr. BLAGOJEVICH, Ms. SCHAKOWSKY, Ms. DELAURO,

Mr. FROST, Mr. MCNULTY, Mr. KENNEDY of Rhode Island, Ms. KAPTUR, Mr. WAXMAN, Mr. STRICKLAND, and Mr. BALDACCI) 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 2001’’.
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1 (b) TABLE OF CONTENTS.—The table of contents of

2 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings.

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.

3 SEC. 2. FINDINGS.

4 The Congress finds the following:

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

6 of any population in the United States, and the sui7 cide rate of that population increases with age, with

8 individuals 65 and older accounting for 20 percent

9 of all suicide deaths in the United States, while com10 prising only 13 percent of the population of the

11 United States.

12 (2) Disability due to mental illness in individ13 uals over 65 years old will become a major public

14 health problem in the near future because of demo-
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1 graphic changes. In particular, dementia, depression,

2 schizophrenia, among other conditions, will all

3 present special problems for this age group.

4 (3) Major depression is strikingly prevalent

5 among older people, with between 8 and 20 percent

6 of older people in community studies and up to 37

7 percent of those seen in primary care settings expe8 riencing symptoms of depression.

9 (4) 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 (5) 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 (6) 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 (7) The disabled are another population receiv4 ing inadequate mental health care through medicare.

5 According to the Health Care Financing Administra6 tion, medicare is the primary health care coverage

7 for the 5,000,000 non-elderly, disabled people on So8 cial Security Disability Insurance. Up to 40 percent

9 of these individuals have a diagnosis of mental ill10 ness.

11 (8) 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) by adding ‘‘and’’ at the end of para9 graph (1);

10 (B) by striking ‘‘; and’’ at the end of para11 graph (2); 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, 2002.

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, 2002.
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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

9 amended—

10 (1) by striking ‘‘and’’ at the end of paragraph

11 (3);

12 (2) by striking the period at the end of para13 graph (4) and inserting ‘‘; and’’; and

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

15 paragraph:

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

17 section 1861(ww)) 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), as amended by sec25 tions 102(b) and 105(b) of the Medicare, Medicaid, and
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1 SCHIP Benefits Improvement and Protection Act of

2 2000, as enacted into law by section 1(a)(6) of Public Law

3 106–554, is amended by adding at the end the following

4 new subsection:

5 ‘‘Intensive Residential Services

6 ‘‘(ww)(1) Subject to paragraphs (3) and (4), the term

7 ‘intensive residential services’ means a program of residen8 tial services (described in paragraph (2)) that is—

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

10 entitled to benefits under part A who is under the

11 care of the physician; and

12 ‘‘(B) furnished under the supervision of a phy13 sician pursuant to an individualized, written plan of

14 treatment established and periodically reviewed by a

15 physician (in consultation with appropriate staff par16 ticipating in such services), which plan sets forth—

17 ‘‘(i) the individual’s diagnosis,

18 ‘‘(ii) the type, amount, frequency, and du19 ration of the items and services provided under

20 the plan, and

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

22 plan.

23 In the case of such an individual who is receiving

24 qualified psychologist services (as defined in sub25 section (ii)), the individual may be under the care of
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1 the clinical psychologist with respect to such services

2 under this subsection to the extent permitted under

3 State law.

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

5 this paragraph is a nonhospital-based community residen6 tial program that furnishes acute mental health services

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

8 Such services shall include treatment planning and devel9 opment, medication management, case management, crisis

10 intervention, individual therapy, group therapy, and de11 toxification services. Such services shall be furnished in

12 any of the following facilities:

13 ‘‘(A) Crisis residential programs or mental ill14 ness residential treatment programs.

15 ‘‘(B) Therapeutic family or group treatment

16 homes.

17 ‘‘(C) Residential detoxification centers.

18 ‘‘(D) Residential centers for substance abuse

19 treatment.

20 ‘‘(3) No service may be treated as an intensive resi21 dential service under paragraph (1) unless the facility at

22 which the service is provided—

23 ‘‘(A) is legally authorized to provide such serv24 ice under the law of the State (or under a State reg25 ulatory mechanism provided by State law) in which
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1 the facility is located or meets such certification re2 quirements that the Secretary may impose; and

3 ‘‘(B) meets such other requirements as the Sec4 retary may impose to assure the quality of the inten5 sive residential services provided.

6 ‘‘(4) No service may be treated as an intensive resi7 dential service under paragraph (1) unless the service is

8 furnished in accordance with standards established by the

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

10 (c) AMOUNT OF PAYMENT.—Section 1814 of the So11 cial Security Act (42 U.S.C. 1395f) is amended—

12 (1) in subsection (b) in the matter preceding

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

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

15 (2) by adding at the end the following new sub16 section:

17 ‘‘Payment for Intensive Residential Services

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

19 intensive residential services under section 1812(a)(5)

20 shall be equal to an amount specified under a prospective

21 payment system established by the Secretary, taking into

22 account the prospective payment system to be established

23 for psychiatric hospitals under section 124 of the Medi24 care, Medicaid, and SCHIP Balanced Budget Refinement
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1 Act of 1999 (113 Stat. 1501A–332), as enacted into law

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

3 ‘‘(2) Prior to the date on which the Secretary imple4 ments the prospective payment system established under

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

6 such intensive residential services is the reasonable costs

7 of providing such services.’’.

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

9 this section shall apply to items and services furnished on

10 or after January 1, 2002.

11 SEC. 202. COVERAGE OF INTENSIVE OUTPATIENT SERV12 ICES.

13 (a) COVERAGE.—Section 1832(a)(2) of the Social Se14 curity Act (42 U.S.C. 1395k(a)(2)) is amended—

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

16 the end;

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

18 and inserting ‘‘; and’’; and

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

21 ‘‘(K) intensive outpatient services (as de22 scribed in section 1861(xx)).’’.

23 (b) SERVICES DESCRIBED.—Section 1861 of the So24 cial Security Act (42 U.S.C. 1395x), as amended by sec-
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1 tion 202(b), is further amended by adding at the end the

2 following new subsection:

3 ‘‘Intensive Outpatient Services

4 ‘‘(xx)(1) The term ‘intensive outpatient services’

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

6 prescribed by a physician and provided within the context

7 described in paragraph (3) under the supervision of a phy8 sician (or, to the extent permitted under the law of the

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

10 mental health professional) pursuant to an individualized,

11 written plan of treatment established by a physician and

12 is reviewed periodically by a physician or, to the extent

13 permitted under the laws of the State in which the services

14 are furnished, a non-physician mental health professional

15 (in consultation with appropriate staff participating in

16 such services), which plan sets forth the patient’s diag17 nosis, the type, amount, frequency, and duration of the

18 items and services provided under the plan, and the goals

19 for treatment under the plan.

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

21 paragraph the items and services described in subpara22 graph (B) that are reasonable and necessary for the diag23 nosis or treatment of the individual’s condition, reasonably

24 expected to improve or maintain the individual’s condition

25 and functional level and to prevent relapse or hospitaliza-
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1 tion, and furnished pursuant to such guidelines relating

2 to frequency and duration of services as the Secretary

3 shall by regulation establish (taking into account accepted

4 norms of clinical practice).

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

6 and services described in this paragraph are as follows:

7 ‘‘(i) Psychiatric rehabilitation.

8 ‘‘(ii) Assertive community treatment.

9 ‘‘(iii) Intensive case management.

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

11 years of age.

12 ‘‘(v) Ambulatory detoxification.

13 ‘‘(vi) Such other items and services as the Sec14 retary may provide (but in no event to include meals

15 and transportation).

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

17 provision of intensive outpatient services is as follows:

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

19 home, or community setting.

20 ‘‘(B) Such services are furnished—

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

22 for, or eliminate, functional deficits and inter23 personal and environmental barriers created by

24 the disability; and
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1 ‘‘(ii) to restore skills to the individual for

2 independent living, socialization, and effective

3 life management.

4 ‘‘(C) Such services are furnished by an indi5 vidual or entity that—

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

7 services under State law (or the State regu8 latory mechanism provided by State law) or

9 meets such certification requirements that the

10 Secretary may impose; and

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

12 Secretary may impose to assure the quality of

13 the intensive outpatient services provided.’’.

14 (c) PAYMENT.—

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

16 outpatient services (as defined in section

17 1861(xx)(1) of the Social Security Act (as added by

18 subsection (b)) furnished under the medicare pro19 gram, the amount of payment under such Act for

20 such services shall be 80 percent of—

21 (A) during 2002 and 2003, the reasonable

22 costs of furnishing such services; and

23 (B) on or after January 1, 2004, the

24 amount of payment established for such serv25 ices under the prospective payment system es-
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1 tablished by the Secretary under paragraph (2)

2 for such services.

3 (2) ESTABLISHMENT OF PPS.—

4 (A) IN GENERAL.—With respect to inten5 sive outpatient services (as defined in section

6 1861(xx)(1) of the Social Security Act (as

7 added by subsection (b)) furnished under the

8 medicare program on or after January 1, 2004,

9 the Secretary of Health and Human Services

10 shall establish a prospective payment system for

11 payment for such services. Such system shall

12 include an adequate patient classification sys13 tem that reflects the differences in patient re14 source use and costs, shall provide for an an15 nual update to the rates of payment established

16 under the system.

17 (B) ADJUSTMENTS.—In establishing the

18 system under subparagraph (A), the Secretary

19 shall provide for adjustments in the prospective

20 payment amount for variations in wage and

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

22 factors as the Secretary determines appropriate.

23 (C) COLLECTION OF DATA AND EVALUA24 TION.—In developing the system described in

25 subparagraph (A), the Secretary may require
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1 providers of services under the medicare pro2 gram to submit such information to the Sec3 retary as the Secretary may require to develop

4 the system, including the most recently avail5 able data.

6 (D) REPORTS TO CONGRESS.—Not later

7 than October 1 of each of 2002 and 2003, the

8 Secretary shall submit to Congress a report on

9 the progress of the Secretary in establishing the

10 prospective payment system under this para11 graph.

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

13 1835(a)(2) of the Social Security Act (42 U.S.C.

14 1395n(a)(2)) is amended—

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

16 the end;

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

18 and inserting ‘‘; and

19 (C) by inserting after subparagraph (F) the fol20 lowing new subparagraph:

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

22 services, (i) that those services are reasonably

23 expected to improve or maintain the individual’s

24 condition and functional level and to prevent re25 lapse or hospitalization, (ii) an individualized,
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1 written plan for furnishing such services has

2 been established by a physician and is reviewed

3 periodically by a physician or, to the extent per4 mitted under the laws of the State in which the

5 services are furnished, a non-physician mental

6 health professional, and (iii) such services are

7 or were furnished while the individual is or was

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

9 permitted under the law of the State in which

10 the services are furnished, a non-physician men11 tal health professional.’’.

12 (2) Section 1861(s)(2)(B) of such Act (42 U.S.C.

13 1395x(s)(2)(B)) is amended by inserting ‘‘and intensive

14 outpatient services’’ after ‘‘partial hospitalization serv15 ices’’.

16 (3) Section 1861(ff)(1) of such Act (42 U.S.C.

17 1395x(ff)(1)) is amended—

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

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

20 furnished, a non-physician mental health profes21 sional,’’ after ‘‘under the supervision of a physician’’

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

23 (B) by striking ‘‘physician’s’’ and inserting ‘‘pa24 tient’s’’.
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1 (4) Section 1861(cc) of such Act (42 U.S.C.

2 1395x(cc)) is amended—

3 (A) in paragraph (1), by striking ‘‘physician—

4 ’’ and inserting ‘‘physician or, to the extent per5 mitted under the law of the State in which the serv6 ices are furnished, a non-physician mental health

7 professional—’’ and

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

9 the semicolon the following: ‘‘, except that a patient

10 receiving social and psychological services under

11 paragraph (1)(D) may be under the care of a non12 physician mental health professional with respect to

13 such services to the extent permitted under the law

14 of the State in which the services are furnished’’.

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

16 this section shall apply to items and services furnished on

17 or after January 1, 2002.
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1 TITLE III—IMPROVING BENE2 FICIARY ACCESS TO MEDI3 CARE-COVERED SERVICES

4 SEC. 301. EXCLUDING CLINICAL SOCIAL WORKER SERVICES

5 FROM COVERAGE UNDER THE MEDICARE

6 SKILLED NURSING FACILITY PROSPECTIVE

7 PAYMENT SYSTEM AND CONSOLIDATED PAY8 MENT.

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

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

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

12 after ‘‘qualified psychologist services,’’.

13 (b) CONFORMING AMENDMENT.—Section

14 1861(hh)(2) of the Social Security Act (42 U.S.C.

15 1395x(hh)(2)) is amended by striking ‘‘and other than

16 services furnished to an inpatient of a skilled nursing facil17 ity which the facility is required to provide as a require18 ment for participation’’.

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

20 this section shall apply to items and services furnished on

21 or after January 1, 2002.

22 SEC. 302. COVERAGE OF MARRIAGE AND FAMILY THERA23 PIST SERVICES.

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

25 the Social Security Act (42 U.S.C. 1395x(s)(2)), as
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1 amended by sections 102(a) and 105(a) of the Medicare,

2 Medicaid, and SCHIP Benefits Improvement and Protec3 tion Act of 2000, as enacted into law by section 1(a)(6)

4 of Public Law 106–554, is amended—

5 (1) by striking ‘‘and’’ at the end of subpara6 graph (U);

7 (2) by inserting ‘‘and’’ at the end of subpara8 graph (V); and

9 (3) by adding at the end the following new sub10 paragraph:

11 ‘‘(W) marriage and family therapist services (as

12 defined in subsection (yy));’’.

13 (b) DEFINITION.—Section 1861 of the Social Secu14 rity Act (42 U.S.C. 1395x), as amended by sections

15 201(b) and 202(b), is further amended by adding at the

16 end the following new subsection:

17 ‘‘Marriage and Family Therapist Services

18 ‘‘(yy)(1) The term ‘marriage and family therapist

19 services’ means services performed by a marriage and

20 family therapist (as defined in paragraph (2)) for the diag21 nosis and treatment of mental illnesses, which the mar22 riage and family therapist is legally authorized to perform

23 under State law (or the State regulatory mechanism pro24 vided by State law) of the State in which such services

25 are performed provided such services are covered under
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1 this title, as would otherwise be covered if furnished by

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

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

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

5 such services.

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

7 an individual who—

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

9 which qualifies for licensure or certification as a

10 marriage and family therapist pursuant to State

11 law;

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

13 at least two years of clinical supervised experience in

14 marriage and family therapy; and

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

16 family therapist in the State in which marriage and

17 family therapist services are performed.’’.

18 (c) PROVISION FOR PAYMENT UNDER PART B.—Sec19 tion 1832(a)(2)(B) of the Social Security Act (42 U.S.C.

20 1395k(a)(2)(B)) is amended by adding at the end the fol21 lowing new clause:

22 ‘‘(v) marriage and family therapist

23 services;’’.

24 (d) AMOUNT OF PAYMENT.—
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1 (1) IN GENERAL.—Section 1833(a)(1) of the

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

3 amended by sections 105(c) and 223(c) of the Medi4 care, Medicaid, and SCHIP Benefits Improvement

5 and Protection Act of 2000, as enacted into law by

6 section 1(a)(6) of Public Law 106–554, is

7 amended—

8 (A) by striking ‘‘and’’ before ‘‘(U)’’; and

9 (B) by inserting before the semicolon at

10 the end the following: ‘‘, and (V) with respect

11 to marriage and family therapist services under

12 section 1861(s)(2)(W), the amounts paid shall

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

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

15 amount determined for payment of a psycholo16 gist under clause (L)’’.

17 (2) DEVELOPMENT OF CRITERIA WITH RE18 SPECT TO CONSULTATION WITH A PHYSICIAN.—The

19 Secretary of Health and Human Services shall, tak20 ing into consideration concerns for patient confiden21 tiality, develop criteria with respect to payment for

22 marriage and family therapist services for which

23 payment may be made directly to the marriage and

24 family therapist under part B of title XVIII of the

25 Social Security Act under which such a therapist
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1 must agree to consult with a patient’s attending or

2 primary care physician in accordance with such cri3 teria.

4 (e) EXCLUSION OF MARRIAGE AND FAMILY THERA5 PIST SERVICES FROM SKILLED NURSING FACILITY PRO6 SPECTIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii)

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

8 as amended in section 301(a), is further amended by in9 serting ‘‘marriage and family therapist services (as de10 fined in subsection (yy)(1)),’’ after ‘‘clinical social worker

11 services,’’.

12 (f) COVERAGE OF MARRIAGE AND FAMILY THERA13 PIST SERVICES PROVIDED IN RURAL HEALTH CLINICS

14 AND FEDERALLY QUALIFIED HEALTH CENTERS.—Sec15 tion 1861(aa)(1)(B) of the Social Security Act (42 U.S.C.

16 1395x(aa)(1)(B)) is amended by striking ‘‘or by a clinical

17 social worker (as defined in subsection (hh)(1)),,’’ and in18 serting ‘‘, by a clinical social worker (as defined in sub19 section (hh)(1)), or by a marriage and family therapist

20 (as defined in subsection (yy)(2)),’’.

21 (g) INCLUSION OF MARRIAGE AND FAMILY THERA22 PISTS AS PRACTITIONERS FOR ASSIGNMENT OF

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

24 Act (42 U.S.C. 1395u(b)(18)(C)), as amended by section

25 105(d) of the Medicare, Medicaid, and SCHIP Benefits
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1 Improvement and Protection Act of 2000, as enacted into

2 law by section 1(a)(6) of Public Law 106–554, is amended

3 by adding at the end the following new clause:

4 ‘‘(vii) A marriage and family therapist (as de5 fined in section 1861(yy)(2)).’’.

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

7 this section shall apply to items and services furnished on

8 or after January 1, 2002.

9 SEC. 303. COVERAGE OF MENTAL HEALTH COUNSELOR

10 SERVICES.

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

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

13 amended in section 302(a), is further amended—

14 (1) by striking ‘‘and’’ at the end of subpara15 graph (V);

16 (2) by inserting ‘‘and’’ at the end of subpara17 graph (W); and

18 (3) by adding at the end the following new sub19 paragraph:

20 ‘‘(X) mental health counselor services (as

21 defined in subsection (zz)(2));’’.

22 (b) DEFINITION.—Section 1861 of the Social Secu23 rity Act (42 U.S.C. 1395x), as amended by sections

24 201(b), 202(b), and 302(b), is further amended by adding

25 at the end the following new subsection:
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1 ‘‘Mental Health Counselor; Mental Health Counselor

2 Services

3 ‘‘(zz)(1) The term ‘mental health counselor’ means

4 an individual who—

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

6 mental health counseling or a related field;

7 ‘‘(B) after obtaining such a degree has per8 formed at least 2 years of supervised mental health

9 counselor practice; and

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

11 counselor or professional counselor by the State in

12 which the services are performed.

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

14 means services performed by a mental health counselor (as

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

16 of mental illnesses which the mental health counselor is

17 legally authorized to perform under State law (or the

18 State regulatory mechanism provided by the State law) of

19 the State in which such services are performed provided

20 such services are covered under this title as would other21 wise be covered if furnished by a physician or as incident

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

23 or other provider charges or is paid any amounts with re24 spect to the furnishing of such services.’’.

25 (c) PAYMENT.—
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1 (1) IN GENERAL.—Section 1833(a)(1) of the

2 Social Security Act (42 U.S.C. 13951(a)(1)), as

3 amended by section 302(d), is further amended—

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

5 (B) by inserting before the semicolon at

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

7 to mental health counselor services under sec8 tion 1861(s)(2)(X), the amounts paid shall be

9 80 percent of the lesser of (i) the actual charge

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

11 determined for payment of a psychologist under

12 clause (L)’’.

13 (2) DEVELOPMENT OF CRITERIA WITH RE14 SPECT TO CONSULTATION WITH A PHYSICIAN.—The

15 Secretary of Health and Human Services shall, tak16 ing into consideration concerns for patient confiden17 tiality, develop criteria with respect to payment for

18 mental health counselor services for which payment

19 may be made directly to the mental health counselor

20 under part B of title XVIII of the Social Security

21 Act under which such a counselor must agree to con22 sult with a patient’s attending or primary care phy23 sician in accordance with such criteria.

24 (d) EXCLUSION OF MENTAL HEALTH COUNSELOR

25 SERVICES FROM SKILLED NURSING FACILITY PROSPEC-
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1 TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) of

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

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

4 amended by inserting ‘‘mental health counselor services

5 (as defined in section 1861(zz)(2)),’’ after ‘‘marriage and

6 family therapist services (as defined in subsection

7 (yy)(1)),’’.

8 (e) COVERAGE OF MENTAL HEALTH COUNSELOR

9 SERVICES PROVIDED IN RURAL HEALTH CLINICS AND

10 FEDERALLY QUALIFIED HEALTH CENTERS.—Section

11 1861(aa)(1)(B) of the Social Security Act (42 U.S.C.

12 1395x(aa)(1)(B)), as amended by section 302(f), is fur13 ther amended—

14 (1) by striking ‘‘or’’ before ‘‘marriage and fam15 ily therapist services’’; and

16 (2) by inserting ‘‘or mental health counselor

17 services (as defined in section 1861(zz)(2)),’’ after

18 ‘‘marriage and family therapist services (as defined

19 in subsection (yy)(1)),’’.

20 (f) INCLUSION OF MENTAL HEALTH COUNSELORS AS

21 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Section

22 1842(b)(18)(C) of the Social Security Act (42 U.S.C.

23 1395u(b)(18)(C)), as amended by section 302(g), is fur24 ther amended by adding at the end the following new

25 clause:
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1 ‘‘(viii) A mental health counselor (as defined in

2 section 1861(zz)(1)).’’.

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

4 this section shall apply to items and services furnished on

5 or after January 1, 2002.

6 SEC. 304. STUDY OF COVERAGE CRITERIA FOR ALZ7 HEIMER’S DISEASE AND RELATED MENTAL

8 ILLNESSES.

9 (a) STUDY.—

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

11 Human Services (in this section referred to as the

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

13 whether the criteria for coverage of any therapy

14 service (including occupational therapy services and

15 physical therapy services) or any outpatient mental

16 health care service under the medicare program

17 under title XVIII of the Social Security Act unduly

18 restricts the access of any medicare beneficiary who

19 has been diagnosed with Alzheimer’s disease or a re20 lated mental illness to such a service because the

21 coverage criteria requires the medicare beneficiary to

22 display continuing clinical improvement to continue

23 to receive the service.

24 (2) DETERMINATION OF NEW COVERAGE CRI25 TERIA.—If the Secretary determines that the cov-
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1 erage criteria described in paragraph (1) unduly re2 stricts the access of any medicare beneficiary to the

3 services described in such paragraph, the Secretary

4 shall identify alternative coverage criteria that would

5 permit a medicare beneficiary who has been diag6 nosed with Alzheimer’s disease or a related mental

7 illness to receive coverage for health care services

8 under the medicare program that are designed to

9 control symptoms, maintain functional capabilities,

10 reduce or deter deterioration, and prevent or reduce

11 hospitalization of the beneficiary.

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

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

14 the committees of jurisdiction of Congress a report on the

15 study conducted under subsection (a) together with such

16 recommendations for legislative and administrative action

17 as the Secretary determines appropriate.

Æ