I 

110TH CONGRESS 

1ST SESSION H. R. 1663 

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 

MARCH 23, 2007 

Mr. STARK (for himself, Mr. RAMSTAD, and Mr. KENNEDY) 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 2007’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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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 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, 2008. 


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1 SEC. 102. PARITY IN TREATMENT FOR OUTPATIENT MEN2 TAL HEALTH SERVICES. 

3 (a) IN GENERAL.—Section 1833 of the Social Secu4 rity Act (42 U.S.C. 1395l) is amended by striking sub5 section (c). 

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

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

8 on or after January 1, 2008. 

9 TITLE II—EXPANDING COV10 ERAGE OF COMMUNITY11 BASED MENTAL HEALTH 

12 SERVICES 

13 SEC. 201. COVERAGE OF INTENSIVE RESIDENTIAL SERV14 ICES. 

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

16 the Social Security Act (42 U.S.C. 1395d(a)) is amend17 ed— 

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

19 end; 

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

21 the end and inserting ‘‘; and’’; and 

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

23 paragraph: 

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

25 section 1861(ccc)) furnished to an individual for up 

26 to 120 days during any calendar year, except that 


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1 such services may be furnished to the individual for 

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

3 year if necessary for the individual to complete a 

4 course of treatment.’’. 

5 (b) SERVICES DESCRIBED.—Section 1861 of the So6 cial Security Act (42 U.S.C. 1395x) is amended by adding 

7 at the end the following new subsection: 

8 ‘‘(ccc) INTENSIVE RESIDENTIAL SERVICES.—(1) 

9 Subject to paragraphs (3) and (4), the term ‘intensive res10 idential services’ means a program of residential services 

11 (described in paragraph (2)) that is— 

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

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

14 who is under the care of the physician; and 

15 ‘‘(B) furnished under the supervision of a phy16 sician pursuant to an individualized, written plan of 

17 treatment established and periodically reviewed by a 

18 physician (in consultation with appropriate staff par19 ticipating in such services), which plan sets forth— 

20 ‘‘(i) the individual’s diagnosis, 

21 ‘‘(ii) the type, amount, frequency, and du22 ration of the items and services provided under 

23 the plan, and 

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

25 plan. 


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

2 psychologist services (as defined in subsection (ii)), the in3 dividual may be under the care of the clinical psychologist 

4 with respect to such services under this subsection to the 

5 extent permitted under State law. 

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

7 this paragraph is a nonhospital-based community residen8 tial program that furnishes acute mental health services 

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

10 Such services shall include treatment planning and devel11 opment, medication management, case management, crisis 

12 intervention, individual therapy, group therapy, and de13 toxification services. Such services shall be furnished in 

14 any of the following facilities: 

15 ‘‘(A) Crisis residential programs or mental ill16 ness residential treatment programs. 

17 ‘‘(B) Therapeutic family or group treatment 

18 homes. 

19 ‘‘(C) Residential detoxification centers. 

20 ‘‘(D) Residential centers for substance abuse 

21 treatment. 

22 ‘‘(3) No service may be treated as an intensive resi23 dential service under paragraph (1) unless the facility at 

24 which the service is provided— 


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1 ‘‘(A) is legally authorized to provide such serv2 ice under the law of the State (or under a State reg3 ulatory mechanism provided by State law) in which 

4 the facility is located or meets such certification re5 quirements that the Secretary may impose; and 

6 ‘‘(B) meets such other requirements as the Sec7 retary may impose to assure the quality of the inten8 sive residential services provided. 

9 ‘‘(4) No service may be treated as an intensive resi10 dential service under paragraph (1) unless the service is 

11 furnished in accordance with standards established by the 

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

13 (c) AMOUNT OF PAYMENT.—Section 1814 of the So14 cial Security Act (42 U.S.C. 1395f) is amended— 

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

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

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

18 (2) by adding at the end the following new sub19 section: 

20 ‘‘(m) PAYMENT FOR INTENSIVE RESIDENTIAL SERV21 ICES.—(1) The amount of payment under this part for 

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

23 shall be equal to an amount specified under a prospective 

24 payment system established by the Secretary, taking into 

25 account the prospective payment system established for 


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1 psychiatric hospitals pursuant to section 124 of the Medi2 care, Medicaid, and SCHIP Balanced Budget Refinement 

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

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

5 ‘‘(2) Prior to the date on which the Secretary imple6 ments the prospective payment system established under 

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

8 such intensive residential services is the reasonable costs 

9 of providing such services.’’. 

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

11 this section shall apply to items and services furnished on 

12 or after January 1, 2008. 

13 SEC. 202. COVERAGE OF INTENSIVE OUTPATIENT SERV14 ICES. 

15 (a) COVERAGE.—Section 1832(a)(2) of the Social Se16 curity Act (42 U.S.C. 1395k(a)(2)) is amended— 

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

18 the end; 

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

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

21 (3) by adding at the end the following new sub22 paragraph: 

23 ‘‘(K) intensive outpatient services (as de24 scribed in section 1861(ddd)).’’. 


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1 (b) SERVICES DESCRIBED.—Section 1861 of the So2 cial Security Act (42 U.S.C. 1395x), as amended by sec3 tion 201(b), is amended by adding at the end the following 

4 new subsection: 

5 ‘‘(ddd) INTENSIVE OUTPATIENT SERVICES.—(1) The 

6 term ‘intensive outpatient services’ means the items and 

7 services described in paragraph (2) prescribed by a physi8 cian and provided within the context described in para9 graph (3) under the supervision of a physician (or, to the 

10 extent permitted under the law of the State in which the 

11 services are furnished, a non-physician mental health pro12 fessional) pursuant to an individualized, written plan of 

13 treatment that is established by a physician and periodi14 cally reviewed by a physician or, to the extent permitted 

15 under the laws of the State in which the services are fur16 nished, a non-physician mental health professional (in con17 sultation with appropriate staff participating in such serv18 ices), which plan sets forth the patient’s diagnosis, the 

19 type, amount, frequency, and duration of the items and 

20 services provided under the plan, and the goals for treat21 ment under the plan. 

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

23 paragraph are the items and services described in sub24 paragraph (B) that are reasonable and necessary for the 

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1 sonably expected to improve or maintain the individual’s 

2 condition and functional level and to prevent relapse or 

3 hospitalization, and furnished pursuant to such guidelines 

4 relating to frequency and duration of services as the Sec5 retary shall by regulation establish (taking into account 

6 accepted norms of clinical practice). 

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

8 and services described in this paragraph are as follows: 

9 ‘‘(i) Psychiatric rehabilitation. 

10 ‘‘(ii) Assertive community treatment. 

11 ‘‘(iii) Intensive case management. 

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

13 years of age. 

14 ‘‘(v) Ambulatory detoxification. 

15 ‘‘(vi) Such other items and services as the Sec16 retary may provide (but in no event to include meals 

17 and transportation). 

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

19 provision of intensive outpatient services is as follows: 

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

21 home, or community setting. 

22 ‘‘(B) Such services are furnished— 

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

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1 personal and environmental barriers created by 

2 the disability; and 

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

4 independent living, socialization, and effective 

5 life management. 

6 ‘‘(C) Such services are furnished by an indi7 vidual or entity that— 

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

9 services under State law (or the State regu10 latory mechanism provided by State law) or 

11 meets such certification requirements that the 

12 Secretary may impose; and 

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

14 Secretary may impose to assure the quality of 

15 the intensive outpatient services provided.’’. 

16 (c) PAYMENT.— 

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

18 outpatient services (as defined in section 

19 1861(ddd)(1) of the Social Security Act (as added 

20 by subsection (b)) furnished under the medicare pro21 gram, the amount of payment under such Act for 

22 such services shall be 80 percent of— 

23 (A) during 2008 and 2009, the reasonable 

24 costs of furnishing such services; and 


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1 (B) on or after January 1, 2010, the 

2 amount of payment established for such serv3 ices under the prospective payment system es4 tablished by the Secretary under paragraph (2) 

5 for such services. 

6 (2) ESTABLISHMENT OF PPS.— 

7 (A) IN GENERAL.—With respect to inten8 sive outpatient services (as defined in section 

9 1861(ddd)(1)) of the Social Security Act (as 

10 added by subsection (b)) furnished under the 

11 medicare program on or after January 1, 2010, 

12 the Secretary of Health and Human Services 

13 (in this paragraph referred to as the ‘‘Sec14 retary’’) shall establish a prospective payment 

15 system for payment for such services. Such sys16 tem shall include an adequate patient classifica17 tion system that reflects the differences in pa18 tient resource use and costs and shall provide 

19 for an annual update to the rates of payment 

20 established under the system. 

21 (B) ADJUSTMENTS.—In establishing the 

22 system under subparagraph (A), the Secretary 

23 shall provide for adjustments in the prospective 

24 payment amount for variations in wage and 


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

2 factors as the Secretary determines appropriate. 

3 (C) COLLECTION OF DATA AND EVALUA4 TION.—In developing the system described in 

5 subparagraph (A), the Secretary may require 

6 providers of services under the medicare pro7 gram to submit such information to the Sec8 retary as the Secretary may require to develop 

9 the system, including the most recently avail10 able data. 

11 (D) REPORTS TO CONGRESS.—Not later 

12 than October 1 of each of 2008 and 2009, the 

13 Secretary shall submit to Congress a report on 

14 the progress of the Secretary in establishing the 

15 prospective payment system under this para16 graph. 

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

18 1835(a)(2) of the Social Security Act (42 U.S.C. 

19 1395n(a)(2)) is amended— 

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

21 the end; 

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

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

24 (C) by inserting after subparagraph (F) the fol25 lowing new subparagraph: 


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

2 services, (i) that those services are reasonably 

3 expected to improve or maintain the individual’s 

4 condition and functional level and to prevent re5 lapse or hospitalization, (ii) an individualized, 

6 written plan for furnishing such services has 

7 been established by a physician and is reviewed 

8 periodically by a physician or, to the extent per9 mitted under the laws of the State in which the 

10 services are furnished, a non-physician mental 

11 health professional, and (iii) such services are 

12 or were furnished while the individual is or was 

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

14 permitted under the law of the State in which 

15 the services are furnished, a non-physician men16 tal health professional.’’. 

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

18 (42 U.S.C. 1395x(s)(2)(B)) is amended by inserting ‘‘and 

19 intensive outpatient services’’ after ‘‘partial hospitalization 

20 services’’. 

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

22 U.S.C. 1395x(ff)(1)) is amended— 

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

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

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1 sional,’’ after ‘‘under the supervision of a physician’’ 

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

3 (B) by striking ‘‘physician’s’’ and inserting ‘‘pa4 tient’s’’. 

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

6 U.S.C. 1395x(cc)) is amended— 

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

8 subparagraph (A), by striking ‘‘physician—’’ and in9 serting ‘‘physician or, to the extent permitted under 

10 the law of the State in which the services are fur11 nished, a non-physician mental health professional— 

12 ’’; and 

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

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

15 a patient receiving social and psychological services 

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

17 a non-physician mental health professional with re18 spect to such services to the extent permitted under 

19 the law of the State in which the services are fur20 nished’’. 

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

22 this section shall apply to items and services furnished on 

23 or after January 1, 2008. 


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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, 2008. 


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1 SEC. 302. COVERAGE OF MARRIAGE AND FAMILY THERA2 PIST SERVICES. 

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

4 the Social Security Act (42 U.S.C. 1395x(s)(2)) is amend5 ed— 

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

7 the end; 

8 (2) in subparagraph (AA), by adding ‘‘and’’ at 

9 the end; and 

10 (3) by adding at the end the following new sub11 paragraph: 

12 ‘‘(BB) marriage and family therapist services 

13 (as defined in subsection (eee));’’. 

14 (b) DEFINITION.—Section 1861 of the Social Secu15 rity Act (42 U.S.C. 1395x), as amended by sections 

16 201(b) and 202(b), is amended by adding at the end the 

17 following new subsection: 

18 ‘‘(eee) MARRIAGE AND FAMILY THERAPIST SERV19 ICES.—(1) The term ‘marriage and family therapist serv20 ices’ means services performed by a marriage and family 

21 therapist (as defined in paragraph (2)) for the diagnosis 

22 and treatment of mental illnesses, which the marriage and 

23 family therapist is legally authorized to perform under 

24 State law (or the State regulatory mechanism provided by 

25 State law) of the State in which such services are per26 formed, provided such services are covered under this title, 


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1 as would otherwise be covered if furnished by a physician 

2 or as incident to a physician’s professional service, but 

3 only if no facility or other provider charges or is paid any 

4 amounts with respect to the furnishing of such services. 

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

6 an individual who— 

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

8 which qualifies for licensure or certification as a 

9 marriage and family therapist pursuant to State 

10 law; 

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

12 at least 2 years of clinical supervised experience in 

13 marriage and family therapy; and 

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

15 family therapist in the State in which marriage and 

16 family therapist services are performed.’’. 

17 (c) PROVISION FOR PAYMENT UNDER PART B.—Sec18 tion 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 

19 1395k(a)(2)(B)) is amended by adding at the end the fol20 lowing new clause: 

21 ‘‘(v) marriage and family therapist 

22 services;’’. 

23 (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)) is 

3 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 marriage and family therapist services under 

8 section 1861(s)(2)(BB), the amounts paid shall 

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

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

11 amount determined for payment of a psycholo12 gist under subparagraph (L)’’. 

13 (2) DEVELOPMENT OF CRITERIAWITH 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 marriage and family therapist services for which 

19 payment may be made directly to the marriage and 

20 family therapist under part B of title XVIII of the 

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

22 which such a therapist must agree to consult with a 

23 patient’s attending or primary care physician in ac24 cordance with such criteria. 


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1 (e) EXCLUSION OF MARRIAGE AND FAMILY THERA2 PIST SERVICES FROM SKILLED NURSING FACILITY PRO3 SPECTIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) 

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

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

6 ‘‘marriage and family therapist services (as defined in sub7 section (eee)(1)),’’ after ‘‘clinical social worker services,’’. 

8 (f) COVERAGE OF MARRIAGE AND FAMILY THERA9 PIST SERVICES PROVIDED IN RURAL HEALTH CLINICS

10 AND FEDERALLY QUALIFIED HEALTH CENTERS.—Sec11 tion 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 

12 1395x(aa)(1)(B)) is amended by striking ‘‘or by a clinical 

13 social worker (as defined in subsection (hh)(1)),’’ and in14 serting ‘‘, by a clinical social worker (as defined in sub15 section (hh)(1)), or by a marriage and family therapist 

16 (as defined in subsection (eee)(2)),’’. 

17 (g) INCLUSION OF MARRIAGE AND FAMILY THERA18 PISTS AS PRACTITIONERS FOR ASSIGNMENT OF

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

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

21 at the end the following new clause: 

22 ‘‘(vii) A marriage and family therapist (as de23 fined in section 1861(eee)(2)).’’. 


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

2 this section shall apply to items and services furnished on 

3 or after January 1, 2008. 

4 SEC. 303. COVERAGE OF MENTAL HEALTH COUNSELOR 

5 SERVICES. 

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

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

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

9 (1) in subparagraph (AA), by striking ‘‘and’’ at 

10 the end; 

11 (2) in subparagraph (BB), by inserting ‘‘and’’ 

12 at the end; and 

13 (3) by adding at the end the following new sub14 paragraph: 

15 ‘‘(CC) mental health counselor services (as 

16 defined in subsection (fff)(2));’’. 

17 (b) DEFINITION.—Section 1861 of the Social Secu18 rity Act (42 U.S.C. 1395x), as amended by sections 

19 201(b), 202(b), and 302(b), is amended by adding at the 

20 end the following new subsection: 

21 ‘‘(fff) MENTAL HEALTH COUNSELOR; MENTAL

22 HEALTH COUNSELOR SERVICES.—(1) The term ‘mental 

23 health counselor’ means an individual who— 

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

25 mental health counseling or a related field; 


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1 ‘‘(B) after obtaining such a degree has per2 formed at least 2 years of supervised mental health 

3 counselor practice; and 

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

5 counselor or professional counselor by the State in 

6 which the services are performed. 

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

8 means services performed by a mental health counselor (as 

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

10 of mental illnesses which the mental health counselor is 

11 legally authorized to perform under State law (or the 

12 State regulatory mechanism provided by the State law) of 

13 the State in which such services are performed, provided 

14 such services are covered under this title, as would other15 wise be covered if furnished by a physician or as incident 

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

17 or other provider charges or is paid any amounts with re18 spect to the furnishing of such services.’’. 

19 (c) PAYMENT.— 

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

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

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

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

24 (B) by inserting before the semicolon at 

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


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1 to mental health counselor services under sec2 tion 1861(s)(2)(CC), the amounts paid shall be 

3 80 percent of the lesser of (i) the actual charge 

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

5 determined for payment of a psychologist under 

6 subparagraph (L)’’. 

7 (2) DEVELOPMENT OF CRITERIAWITH RE8 SPECT TO CONSULTATION WITH A PHYSICIAN.—The 

9 Secretary of Health and Human Services shall, tak10 ing into consideration concerns for patient confiden11 tiality, develop criteria with respect to payment for 

12 mental health counselor services for which payment 

13 may be made directly to the mental health counselor 

14 under part B of title XVIII of the Social Security 

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

16 counselor must agree to consult with a patient’s at17 tending or primary care physician in accordance 

18 with such criteria. 

19 (d) EXCLUSION OF MENTAL HEALTH COUNSELOR

20 SERVICES FROM SKILLED NURSING FACILITY PROSPEC21 TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) of 

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

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

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


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1 in section 1861(fff)(2)),’’ after ‘‘marriage and family ther2 apist services (as defined in subsection (eee)(1)),’’. 

3 (e) COVERAGE OF MENTAL HEALTH COUNSELOR

4 SERVICES PROVIDED IN RURAL HEALTH CLINICS AND

5 FEDERALLY QUALIFIED HEALTH CENTERS.—Section 

6 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 

7 1395x(aa)(1)(B)), as amended by section 302(f), is 

8 amended— 

9 (1) by striking ‘‘or by a marriage’’ and insert10 ing ‘‘by a marriage’’; and 

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

12 (as defined in subsection (fff)(1)),’’ after ‘‘marriage 

13 and family therapist (as defined in subsection 

14 (eee)(2)),’’. 

15 (f) INCLUSION OF MENTAL HEALTH COUNSELORS AS

16 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Section 

17 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 

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

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

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

21 section 1861(fff)(1)).’’. 

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

23 this section shall apply to items and services furnished on 

24 or after January 1, 2008. 


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•HR 1663 IH

1 SEC. 304. STUDY OF COVERAGE CRITERIA FOR ALZ2 HEIMER’S DISEASE AND RELATED MENTAL 

3 ILLNESSES. 

4 (a) STUDY.— 

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

6 Human Services (in this section referred to as the 

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

8 whether the criteria for coverage of any therapy 

9 service (including occupational therapy services and 

10 physical therapy services) or any outpatient mental 

11 health care service under the medicare program 

12 under title XVIII of the Social Security Act (42 

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

14 any medicare beneficiary who has been diagnosed 

15 with Alzheimer’s disease or a related mental illness 

16 to such a service because the coverage criteria re17 quires the medicare beneficiary to display continuing 

18 clinical improvement to continue to receive the serv19 ice. 

20 (2) DETERMINATION OF NEW COVERAGE CRI21 TERIA.—If the Secretary determines that the cov22 erage criteria described in paragraph (1) unduly re23 stricts the access of any medicare beneficiary to the 

24 services described in such paragraph, the Secretary 

25 shall identify alternative coverage criteria that would 

26 permit a medicare beneficiary who has been diagVerDate Aug 31 2005 03:13 Mar 28, 2007 Jkt 059200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H1663.IH H1663

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•HR 1663 IH

1 nosed with Alzheimer’s disease or a related mental 

2 illness to receive coverage for health care services 

3 under the medicare program that are designed to 

4 control symptoms, maintain functional capabilities, 

5 reduce or deter deterioration, and prevent or reduce 

6 hospitalization of the beneficiary. 

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

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

9 the committees of jurisdiction of Congress a report on the 

10 study conducted under subsection (a) together with such 

11 recommendations for legislative and administrative action 

12 as the Secretary determines appropriate. 

Æ 


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