II 

109TH CONGRESS 

1ST SESSION S. 927 

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

coverage of mental health services under the medicare program. 

IN THE SENATE OF THE UNITED STATES 

APRIL 27, 2005 

Mr. CORZINE (for himself, Mr. LAUTENBERG, Mr. SARBANES, Mr. JOHNSON, 

Ms. LANDRIEU, and Mr. KENNEDY) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to 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 

20 qualified psychologist services (as defined in sub21 section (ii)), the individual may be under the care of 

22 the clinical psychologist with respect to such services 

23 under this subsection to the extent permitted under 

24 State law. 
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1 ‘‘(2) The program of residential services described in 

2 this paragraph is a nonhospital-based community residen3 tial program that furnishes acute mental health services 

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

5 Such services shall include treatment planning and devel6 opment, medication management, case management, crisis 

7 intervention, individual therapy, group therapy, and de8 toxification services. Such services shall be furnished in 

9 any of the following facilities: 

10 ‘‘(A) Crisis residential programs or mental ill11 ness residential treatment programs. 

12 ‘‘(B) Therapeutic family or group treatment 

13 homes. 

14 ‘‘(C) Residential detoxification centers. 

15 ‘‘(D) Residential centers for substance abuse 

16 treatment. 

17 ‘‘(3) No service may be treated as an intensive resi18 dential service under paragraph (1) unless the facility at 

19 which the service is provided— 

20 ‘‘(A) is legally authorized to provide such serv21 ice under the law of the State (or under a State reg22 ulatory mechanism provided by State law) in which 

23 the facility is located or meets such certification re24 quirements that the Secretary may impose; and 
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1 ‘‘(B) meets such other requirements as the Sec2 retary may impose to assure the quality of the inten3 sive residential services provided. 

4 ‘‘(4) No service may be treated as an intensive resi5 dential service under paragraph (1) unless the service is 

6 furnished in accordance with standards established by the 

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

8 (c) AMOUNT OF PAYMENT.—Section 1814 of the So9 cial Security Act (42 U.S.C. 1395f) is amended— 

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

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

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

13 (2) by adding at the end the following new sub14 section: 

15 ‘‘Payment for Intensive Residential Services 

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

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

18 shall be equal to an amount specified under a prospective 

19 payment system established by the Secretary, taking into 

20 account the prospective payment system established for 

21 psychiatric hospitals pursuant to section 124 of the Medi22 care, Medicaid, and SCHIP Balanced Budget Refinement 

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

24 by section 1000(a)(6) of Public Law 106–113. 
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1 ‘‘(2) Prior to the date on which the Secretary imple2 ments the prospective payment system established under 

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

4 such intensive residential services is the reasonable costs 

5 of providing such services.’’. 

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

7 this section shall apply to items and services furnished on 

8 or after January 1, 2006. 

9 SEC. 202. COVERAGE OF INTENSIVE OUTPATIENT SERV10 ICES. 

11 (a) COVERAGE.—Section 1832(a)(2) of the Social Se12 curity Act (42 U.S.C. 1395k(a)(2)) is amended— 

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

14 the end; 

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

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

17 (3) by adding at the end the following new sub18 paragraph: 

19 ‘‘(K) intensive outpatient services (as de20 scribed in section 1861(ccc)).’’. 

21 (b) SERVICES DESCRIBED.—Section 1861 of the So22 cial Security Act (42 U.S.C. 1395x), as amended by sec23 tion 201(b), is amended by adding at the end the following 

24 new subsection: 
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1 ‘‘Intensive Outpatient Services 

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

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

4 prescribed by a physician and provided within the context 

5 described in paragraph (3) under the supervision of a phy6 sician (or, to the extent permitted under the law of the 

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

8 mental health professional) pursuant to an individualized, 

9 written plan of treatment that is established by a physi10 cian and periodically reviewed by a physician or, to the 

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

12 services are furnished, a non-physician mental health pro13 fessional (in consultation with appropriate staff partici14 pating in such services), which plan sets forth the patient’s 

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

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

17 goals for treatment under the plan. 

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

19 paragraph are the items and services described in sub20 paragraph (B) that are reasonable and necessary for the 

21 diagnosis or treatment of the individual’s condition, rea22 sonably expected to improve or maintain the individual’s 

23 condition and functional level and to prevent relapse or 

24 hospitalization, and furnished pursuant to such guidelines 

25 relating to frequency and duration of services as the Sec-
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1 retary shall by regulation establish (taking into account 

2 accepted norms of clinical practice). 

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

4 and services described in this paragraph are as follows: 

5 ‘‘(i) Psychiatric rehabilitation. 

6 ‘‘(ii) Assertive community treatment. 

7 ‘‘(iii) Intensive case management. 

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

9 years of age. 

10 ‘‘(v) Ambulatory detoxification. 

11 ‘‘(vi) Such other items and services as the Sec12 retary may provide (but in no event to include meals 

13 and transportation). 

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

15 provision of intensive outpatient services is as follows: 

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

17 home, or community setting. 

18 ‘‘(B) Such services are furnished— 

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

20 for, or eliminate, functional deficits and inter21 personal and environmental barriers created by 

22 the disability; and 

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

24 independent living, socialization, and effective 

25 life management. 
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1 ‘‘(C) Such services are furnished by an indi2 vidual or entity that— 

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

4 services under State law (or the State regu5 latory mechanism provided by State law) or 

6 meets such certification requirements that the 

7 Secretary may impose; and 

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

9 Secretary may impose to assure the quality of 

10 the intensive outpatient services provided.’’. 

11 (c) PAYMENT.— 

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

13 outpatient services (as defined in section 

14 1861(ccc)(1) of the Social Security Act (as added by 

15 subsection (b)) furnished under the medicare pro16 gram, the amount of payment under such Act for 

17 such services shall be 80 percent of— 

18 (A) during 2006 and 2007, the reasonable 

19 costs of furnishing such services; and 

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

21 amount of payment established for such serv22 ices under the prospective payment system es23 tablished by the Secretary under paragraph (2) 

24 for such services. 

25 (2) ESTABLISHMENT OF PPS.— 
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1 (A) IN GENERAL.—With respect to inten2 sive outpatient services (as defined in section 

3 1861(ccc)(1)) of the Social Security Act (as 

4 added by subsection (b)) furnished under the 

5 medicare program on or after January 1, 2008, 

6 the Secretary of Health and Human Services 

7 (in this paragraph referred to as the ‘‘Sec8 retary’’) shall establish a prospective payment 

9 system for payment for such services. Such sys10 tem shall include an adequate patient classifica11 tion system that reflects the differences in pa12 tient resource use and costs and shall provide 

13 for an annual update to the rates of payment 

14 established under the system. 

15 (B) ADJUSTMENTS.—In establishing the 

16 system under subparagraph (A), the Secretary 

17 shall provide for adjustments in the prospective 

18 payment amount for variations in wage and 

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

20 factors as the Secretary determines appropriate. 

21 (C) COLLECTION OF DATA AND EVALUA22 TION.—In developing the system described in 

23 subparagraph (A), the Secretary may require 

24 providers of services under the medicare pro25 gram to submit such information to the Sec-
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1 retary as the Secretary may require to develop 

2 the system, including the most recently avail3 able data. 

4 (D) REPORTS TO CONGRESS.—Not later 

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

6 Secretary shall submit to Congress a report on 

7 the progress of the Secretary in establishing the 

8 prospective payment system under this para9 graph. 

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

11 1835(a)(2) of the Social Security Act (42 U.S.C. 

12 1395n(a)(2)) is amended— 

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

14 the end; 

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

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

17 (C) by inserting after subparagraph (F) the fol18 lowing new subparagraph: 

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

20 services, (i) that those services are reasonably 

21 expected to improve or maintain the individual’s 

22 condition and functional level and to prevent re23 lapse or hospitalization, (ii) an individualized, 

24 written plan for furnishing such services has 

25 been established by a physician and is reviewed 
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1 periodically by a physician or, to the extent per2 mitted under the laws of the State in which the 

3 services are furnished, a non-physician mental 

4 health professional, and (iii) such services are 

5 or were furnished while the individual is or was 

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

7 permitted under the law of the State in which 

8 the services are furnished, a non-physician men9 tal health professional.’’. 

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

11 (42 U.S.C. 1395x(s)(2)(B)) is amended by inserting ‘‘and 

12 intensive outpatient services’’ after ‘‘partial hospitalization 

13 services’’. 

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

15 U.S.C. 1395x(ff)(1)) is amended— 

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

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

18 furnished, a non-physician mental health profes19 sional,’’ after ‘‘under the supervision of a physician’’ 

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

21 (B) by striking ‘‘physician’s’’ and inserting ‘‘pa22 tient’s’’. 

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

24 U.S.C. 1395x(cc)) is amended— 
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1 (A) in paragraph (1), in the matter preceding 

2 subparagraph (A), by striking ‘‘physician—’’ and in3 serting ‘‘physician or, to the extent permitted under 

4 the law of the State in which the services are fur5 nished, a non-physician mental health professional— 

6 ’’; and 

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

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

9 a patient receiving social and psychological services 

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

11 a non-physician mental health professional with re12 spect to such services to the extent permitted under 

13 the law of the State in which the services are fur14 nished’’. 

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

16 this section shall apply to items and services furnished on 

17 or after January 1, 2006. 
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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, 2006. 
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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 (Y), by striking ‘‘and’’ at 

7 the end; 

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

9 the end; and 

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

12 ‘‘(AA) marriage and family therapist services 

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

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 ‘‘Marriage and Family Therapist Services 

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

20 services’ means services performed by a marriage and 

21 family therapist (as defined in paragraph (2)) for the diag22 nosis and treatment of mental illnesses, which the mar23 riage and family therapist is legally authorized to perform 

24 under State law (or the State regulatory mechanism pro25 vided by State law) of the State in which such services 

26 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 2 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)) 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)(AA), 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 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 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 (ddd)(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 (ddd)(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(ddd)(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, 2006. 

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 (Z), by striking ‘‘and’’ at 

10 the end; 

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

12 at the end; and 

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

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

16 defined in subsection (eee)(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 ‘‘Mental Health Counselor; Mental Health Counselor 

22 Services 

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

24 an individual who— 
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1 ‘‘(A) possesses a master’s or doctor’s degree in 

2 mental health counseling or a related field; 

3 ‘‘(B) after obtaining such a degree has per4 formed at least 2 years of supervised mental health 

5 counselor practice; and 

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

7 counselor or professional counselor by the State in 

8 which the services are performed. 

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

10 means services performed by a mental health counselor (as 

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

12 of mental illnesses which the mental health counselor is 

13 legally authorized to perform under State law (or the 

14 State regulatory mechanism provided by the State law) of 

15 the State in which such services are performed, provided 

16 such services are covered under this title, as would other17 wise be covered if furnished by a physician or as incident 

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

19 or other provider charges or is paid any amounts with re20 spect to the furnishing of such services.’’. 

21 (c) PAYMENT.— 

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

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

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

25 (A) by striking ‘‘and’’ before ‘‘(W)’’; and 
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1 (B) by inserting before the semicolon at 

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

3 to mental health counselor services under sec4 tion 1861(s)(2)(BB), the amounts paid shall be 

5 80 percent of the lesser of (i) the actual charge 

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

7 determined for payment of a psychologist under 

8 subparagraph (L)’’. 

9 (2) DEVELOPMENT OF CRITERIA WITH RE10 SPECT TO CONSULTATION WITH A PHYSICIAN.—The 

11 Secretary of Health and Human Services shall, tak12 ing into consideration concerns for patient confiden13 tiality, develop criteria with respect to payment for 

14 mental health counselor services for which payment 

15 may be made directly to the mental health counselor 

16 under part B of title XVIII of the Social Security 

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

18 counselor must agree to consult with a patient’s at19 tending or primary care physician in accordance 

20 with such criteria. 

21 (d) EXCLUSION OF MENTAL HEALTH COUNSELOR

22 SERVICES FROM SKILLED NURSING FACILITY PROSPEC23 TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) of 

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

25 as amended by sections 301(a) and 302(e), is amended 
26 

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

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

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

4 (e) COVERAGE OF MENTAL HEALTH COUNSELOR

5 SERVICES PROVIDED IN RURAL HEALTH CLINICS AND

6 FEDERALLY QUALIFIED HEALTH CENTERS.—Section 

7 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 

8 1395x(aa)(1)(B)), as amended by section 302(f), is 

9 amended— 

10 (1) by striking ‘‘or by a marriage’’ and insert11 ing ‘‘by a marriage’’; and 

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

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

14 and family therapist (as defined in subsection 

15 (ddd)(2)),’’. 

16 (f) INCLUSION OF MENTAL HEALTH COUNSELORS AS

17 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Section 

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

19 1395u(b)(18)(C)), as amended by section 302(g), is 

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

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

22 section 1861(eee)(1)).’’. 

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

24 this section shall apply to items and services furnished on 

25 or after January 1, 2006. 
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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 diag-
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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