To amend title XVIII of the Social Security Act to ensure adequate coverage of outpatient mental health services under the Medicare program.

To amend title XVIII of the Social Security Act to ensure adequate coverage of outpatient mental health services under the Medicare program. 1. Ensuring adequate coverage of outpatient mental health services under the Medicare program (a) Modification of definition of partial hospitalization services Section 1861(ff)(1) of the Social Security Act ( 42 U.S.C. 1395x(ff)(1) for an individual determined (not less frequently than monthly) by a physician to have a need for such services for a minimum of 20 hours per week prescribed by a physician (b) Coverage of intensive outpatient services (1) Scope of benefits (A) Community mental health centers Section 1832(a)(2)(J) of the Social Security Act ( 42 U.S.C. 1395k(a)(2)(J) and intensive outpatient services partial hospitalization services (B) Incident-to services Section 1861(s)(2)(B) is amended by inserting or intensive outpatient services partial hospitalization services (2) Definition Section 1861(ff) of the Social Security Act ( 42 U.S.C. 1395x(ff) (A) in the header, by inserting ; Intensive Outpatient Services Partial Hospitalization Services (B) by adding at the end the following new paragraph: (4) The term intensive outpatient services partial hospitalization services (A) section 1835(a)(2)(F)(i) shall not apply; (B) the reference in such paragraph to an individual determined (not less frequently than monthly) by a physician to have a need for such services for a minimum of 20 hours per week determined (not less frequently than once every other month) by a physician to have a need for such services for a minimum of 9 hours per week (C) the reference to a community mental health center (as defined in subparagraph (B)) a community mental health center (as defined in subparagraph (B)), a Federally qualified health center, or a rural health clinic . (3) Exclusion from calculation of certain treatment costs Section 1833(c)(2) of the Social Security Act ( 42 U.S.C. 1395l(c)(2) or intensive outpatient services partial hospitalization services (4) Conforming amendments (A) Intensive outpatient services Section 1861(aa) of the Social Security Act ( 42 U.S.C. 1395x(aa) (i) in paragraph (1)— (I) in subparagraph (B), by striking and (II) in subparagraph (C), by adding and (III) by inserting after subparagraph (C) the following new subparagraph: (D) intensive outpatient services (as defined in section 1861(ff)(4)), ; and (ii) in paragraph (3), by striking through (C) through (D) (B) Provider of services Section 1866(e)(2) of the Social Security Act ( 42 U.S.C. 1395cc(e)(2) , or intensive outpatient services (as described in section 1861(ff)(4)) partial hospitalization services (as described in section 1861(ff)(1)) (c) Special payment rule for FQHCs and RHCs Section 1834 of the Social Security Act ( 42 U.S.C. 1395m (1) in subsection (o), by adding at the end the following new paragraph: (5) Special payment rule for intensive outpatient services (A) In general In the case of intensive outpatient services furnished by a Federally qualified health center, the payment amount for such services shall be equal to the amount that would have been paid under this title for such services had such services been covered OPD services furnished by a hospital. (B) Exclusion Costs associated with intensive outpatient services shall not be used to determine the amount of payment for Federally qualified health center services under the prospective payment system under this subsection. ; and (2) in subsection (y)— (A) in the header, by striking to hospice patients (B) by adding at the end the following new paragraph: (3) Special payment rule for intensive outpatient services (A) In general In the case of intensive outpatient services furnished by a rural health clinic, the payment amount for such services shall be equal to the amount that would have been paid under this title for such services had such services been covered OPD services furnished by a hospital. (B) Exclusion Costs associated with intensive outpatient services shall not be used to determine the amount of payment for rural health clinic services under the methodology for all-inclusive rates (established by the Secretary) under section 1833(a)(3). . (d) Effective date The amendments made by this section shall apply with respect to items and services furnished on or after January 1, 2024.

Summary: This bill provides for Medicare coverage of intensive outpatient services that are provided by community mental health centers, rural health clinics, or federally qualified health centers.