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. GUTIER-
REZ, Mr. FRANK, Mr. BLAGOJEVICH, Ms. SCHAKOWSKY, Ms. DELAURO,
Mr. FROST, Mr. MCNULTY, Mr. KENNEDY of Rhode Island, Ms. KAP-
TUR, 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 consider-
ation 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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) IN GENERAL.—This Act may be cited as the
‘‘Medicare Mental Health Modernization Act of 2001’’.
(b) TABLE OF CONTENTS.—The table of contents of
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 MEDICARE-
COVERED 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.
SEC. 2. FINDINGS.
The Congress finds the following:
(1) Older people have the highest rate of suicide
of any population in the United States, and the sui-
cide rate of that population increases with age, with
individuals 65 and older accounting for 20 percent
of all suicide deaths in the United States, while com-
prising only 13 percent of the population of the
United States.
(2) Disability due to mental illness in individ-
uals over 65 years old will become a major public
health problem in the near future because of demo-
graphic changes. In particular, dementia, depression,
schizophrenia, among other conditions, will all
present special problems for this age group.
(3) Major depression is strikingly prevalent
among older people, with between 8 and 20 percent
of older people in community studies and up to 37
percent of those seen in primary care settings expe-
riencing symptoms of depression.
(4) Almost 20 percent of the population of indi-
viduals age 55 and older, experience specific mental
disorders that are not part of normal aging.
(5) Unrecognized and untreated depression,
Alzheimer’s disease, anxiety, late-life schizophrenia,
and other mental conditions can be severely impair-
ing and may even be fatal.
(6) Substance abuse, particularly the abuse of
alcohol and prescription drugs, among adults 65 and
older is one of the fastest growing health problems
in the United States, with 17 percent of this age
group suffering from addiction or substance abuse.
While addiction often goes undetected and untreated
among older adults, aging and disability makes the
body more vulnerable to the effects of alcohol and
drugs, further exacerbating other age-related health
problems. Medicare coverage for addiction treatment
of the elderly needs to recognize these special
vulnerabilities.
(7) The disabled are another population receiv-
ing inadequate mental health care through medicare.
According to the Health Care Financing Administra-
tion, medicare is the primary health care coverage
for the 5,000,000 non-elderly, disabled people on So-
cial Security Disability Insurance. Up to 40 percent
of these individuals have a diagnosis of mental ill-
ness.
(8) The current medicare benefit structure dis-
criminates against the millions of Americans who
suffer from mental illness and maintains an out-
dated bias toward institutionally based service deliv-
ery. According to the report of the Surgeon General
on mental health for 1999, intensive outpatient serv-
ices, such as psychiatric rehabilitation and assertive
community treatment, represent state-of-the-art
mental health services. These evidence-based com-
munity support services help people with psychiatric
disabilities improve their ability to function in the
community and reduce hospitalization rates by 30 to
60 percent, even for people with the most severe
mental illnesses.
TITLE I—ESTABLISHING PARITY
FOR MENTAL HEALTH SERVICES
SEC. 101. ELIMINATION OF LIFETIME LIMIT ON INPATIENT
MENTAL HEALTH SERVICES.
(a) IN GENERAL.—Section 1812 of the Social Secu-
rity Act (42 U.S.C. 1395d) is amended—
(1) in subsection (b)—
(A) by adding ‘‘and’’ at the end of para-
graph (1);
(B) by striking ‘‘; and’’ at the end of para-
graph (2); and
(C) by striking paragraph (3); and
(2) by striking subsection (c).
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to items and services furnished
on or after January 1, 2002.
SEC. 102. PARITY IN TREATMENT FOR OUTPATIENT MEN-
TAL HEALTH SERVICES.
(a) IN GENERAL.—Section 1833 of the Social Secu-
rity Act (42 U.S.C. 1395l) is amended by striking sub-
section (c).
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to items and services furnished
on or after January 1, 2002.
TITLE 
II—EXPANDING 
COV-
ERAGE 
OF 
COMMUNITY-
BASED 
MENTAL 
HEALTH
SERVICES
SEC. 201. COVERAGE OF INTENSIVE RESIDENTIAL SERV-
ICES.
(a) COVERAGE UNDER PART A.—Section 1812(a) of
the Social Security Act (42 U.S.C. 1395d(a)) is
amended—
(1) by striking ‘‘and’’ at the end of paragraph
(3);
(2) by striking the period at the end of para-
graph (4) and inserting ‘‘; and’’; and
(3) by adding at the end the following new
paragraph:
‘‘(5) intensive residential services (as defined in
section 1861(ww)) furnished to an individual for up
to 120 days during any calendar year, except that
such services may be furnished to the individual for
additional days (not to exceed 20 days) during the
year if necessary for the individual to complete a
course of treatment.’’.
(b) SERVICES DESCRIBED.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x), as amended by sec-
tions 102(b) and 105(b) of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of
2000, as enacted into law by section 1(a)(6) of Public Law
106–554, is amended by adding at the end the following
new subsection:
‘‘Intensive Residential Services
‘‘(ww)(1) Subject to paragraphs (3) and (4), the term
‘intensive residential services’ means a program of residen-
tial services (described in paragraph (2)) that is—
‘‘(A) prescribed by a physician for an individual
entitled to benefits under part A who is under the
care of the physician; and
‘‘(B) furnished under the supervision of a phy-
sician pursuant to an individualized, written plan of
treatment established and periodically reviewed by a
physician (in consultation with appropriate staff par-
ticipating in such services), which plan sets forth—
‘‘(i) the individual’s diagnosis,
‘‘(ii) the type, amount, frequency, and du-
ration of the items and services provided under
the plan, and
‘‘(iii) the goals for treatment under the
plan.
In the case of such an individual who is receiving
qualified psychologist services (as defined in sub-
section (ii)), the individual may be under the care of
the clinical psychologist with respect to such services
under this subsection to the extent permitted under
State law.
‘‘(2) The program of residential services described in
this paragraph is a nonhospital-based community residen-
tial program that furnishes acute mental health services
or substance abuse services, or both, on a 24-hour basis.
Such services shall include treatment planning and devel-
opment, medication management, case management, crisis
intervention, individual therapy, group therapy, and de-
toxification services. Such services shall be furnished in
any of the following facilities:
‘‘(A) Crisis residential programs or mental ill-
ness residential treatment programs.
‘‘(B) Therapeutic family or group treatment
homes.
‘‘(C) Residential detoxification centers.
‘‘(D) Residential centers for substance abuse
treatment.
‘‘(3) No service may be treated as an intensive resi-
dential service under paragraph (1) unless the facility at
which the service is provided—
‘‘(A) is legally authorized to provide such serv-
ice under the law of the State (or under a State reg-
ulatory mechanism provided by State law) in which
the facility is located or meets such certification re-
quirements that the Secretary may impose; and
‘‘(B) meets such other requirements as the Sec-
retary may impose to assure the quality of the inten-
sive residential services provided.
‘‘(4) No service may be treated as an intensive resi-
dential service under paragraph (1) unless the service is
furnished in accordance with standards established by the
Secretary for the management of such services.’’.
(c) AMOUNT OF PAYMENT.—Section 1814 of the So-
cial Security Act (42 U.S.C. 1395f) is amended—
(1) in subsection (b) in the matter preceding
paragraph (1), by inserting ‘‘other than intensive
residential services,’’ after ‘‘hospice care,’’; and
(2) by adding at the end the following new sub-
section:
‘‘Payment for Intensive Residential Services
‘‘(m)(1) The amount of payment under this part for
intensive residential services under section 1812(a)(5)
shall be equal to an amount specified under a prospective
payment system established by the Secretary, taking into
account the prospective payment system to be established
for psychiatric hospitals under section 124 of the Medi-
care, Medicaid, and SCHIP Balanced Budget Refinement
Act of 1999 (113 Stat. 1501A–332), as enacted into law
by section 1000(a)(6) of Public Law 106–113.
‘‘(2) Prior to the date on which the Secretary imple-
ments the prospective payment system established under
paragraph (1), the amount of payment under this part for
such intensive residential services is the reasonable costs
of providing such services.’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished on
or after January 1, 2002.
SEC. 202. COVERAGE OF INTENSIVE OUTPATIENT SERV-
ICES.
(a) COVERAGE.—Section 1832(a)(2) of the Social Se-
curity Act (42 U.S.C. 1395k(a)(2)) is amended—
(1) in subparagraph (I), by striking ‘‘and’’ at
the end;
(2) in subparagraph (J), by striking the period
and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(K) intensive outpatient services (as de-
scribed in section 1861(xx)).’’.
(b) SERVICES DESCRIBED.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x), as amended by sec-
tion 202(b), is further amended by adding at the end the
following new subsection:
‘‘Intensive Outpatient Services
‘‘(xx)(1) The term ‘intensive outpatient services’
means the items and services described in paragraph (2)
prescribed by a physician and provided within the context
described in paragraph (3) under the supervision of a phy-
sician (or, to the extent permitted under the law of the
State in which the services are furnished, a non-physician
mental health professional) pursuant to an individualized,
written plan of treatment established by a physician and
is reviewed periodically by a physician or, to the extent
permitted under the laws of the State in which the services
are furnished, a non-physician mental health professional
(in consultation with appropriate staff participating in
such services), which plan sets forth the patient’s diag-
nosis, the type, amount, frequency, and duration of the
items and services provided under the plan, and the goals
for treatment under the plan.
‘‘(2)(A) The items and services described in this
paragraph the items and services described in subpara-
graph (B) that are reasonable and necessary for the diag-
nosis or treatment of the individual’s condition, reasonably
expected to improve or maintain the individual’s condition
and functional level and to prevent relapse or hospitaliza-
tion, and furnished pursuant to such guidelines relating
to frequency and duration of services as the Secretary
shall by regulation establish (taking into account accepted
norms of clinical practice).
‘‘(B) For purposes of subparagraph (A), the items
and services described in this paragraph are as follows:
‘‘(i) Psychiatric rehabilitation.
‘‘(ii) Assertive community treatment.
‘‘(iii) Intensive case management.
‘‘(iv) Day treatment for individuals under 21
years of age.
‘‘(v) Ambulatory detoxification.
‘‘(vi) Such other items and services as the Sec-
retary may provide (but in no event to include meals
and transportation).
‘‘(3) The context described in this paragraph for the
provision of intensive outpatient services is as follows:
‘‘(A) Such services are furnished in a facility,
home, or community setting.
‘‘(B) Such services are furnished—
‘‘(i) to assist the individual to compensate
for, or eliminate, functional deficits and inter-
personal and environmental barriers created by
the disability; and
‘‘(ii) to restore skills to the individual for
independent living, socialization, and effective
life management.
‘‘(C) Such services are furnished by an indi-
vidual or entity that—
‘‘(i) is legally authorized to furnish such
services under State law (or the State regu-
latory mechanism provided by State law) or
meets such certification requirements that the
Secretary may impose; and
‘‘(ii) meets such other requirements as the
Secretary may impose to assure the quality of
the intensive outpatient services provided.’’.
(c) PAYMENT.—
(1) IN
GENERAL.—With respect to intensive
outpatient 
services 
(as 
defined 
in 
section
1861(xx)(1) of the Social Security Act (as added by
subsection (b)) furnished under the medicare pro-
gram, the amount of payment under such Act for
such services shall be 80 percent of—
(A) during 2002 and 2003, the reasonable
costs of furnishing such services; and
(B) on or after January 1, 2004, the
amount of payment established for such serv-
ices under the prospective payment system es-
tablished by the Secretary under paragraph (2)
for such services.
(2) ESTABLISHMENT OF PPS.—
(A) IN GENERAL.—With respect to inten-
sive outpatient services (as defined in section
1861(xx)(1) of the Social Security Act (as
added by subsection (b)) furnished under the
medicare program on or after January 1, 2004,
the Secretary of Health and Human Services
shall establish a prospective payment system for
payment for such services. Such system shall
include an adequate patient classification sys-
tem that reflects the differences in patient re-
source use and costs, shall provide for an an-
nual update to the rates of payment established
under the system.
(B) ADJUSTMENTS.—In establishing the
system under subparagraph (A), the Secretary
shall provide for adjustments in the prospective
payment amount for variations in wage and
wage-related costs, case mix, and such other
factors as the Secretary determines appropriate.
(C) COLLECTION OF DATA AND EVALUA-
TION.—In developing the system described in
subparagraph (A), the Secretary may require
providers of services under the medicare pro-
gram to submit such information to the Sec-
retary as the Secretary may require to develop
the system, including the most recently avail-
able data.
(D) REPORTS
TO
CONGRESS.—Not later
than October 1 of each of 2002 and 2003, the
Secretary shall submit to Congress a report on
the progress of the Secretary in establishing the
prospective payment system under this para-
graph.
(d) 
CONFORMING
AMENDMENTS.—(1) 
Section
1835(a)(2) of the Social Security Act (42 U.S.C.
1395n(a)(2)) is amended—
(A) in subparagraph (E), by striking ‘‘and’’ at
the end;
(B) in subparagraph (F), by striking the period
and inserting ‘‘; and
(C) by inserting after subparagraph (F) the fol-
lowing new subparagraph:
‘‘(G) in the case of intensive outpatient
services, (i) that those services are reasonably
expected to improve or maintain the individual’s
condition and functional level and to prevent re-
lapse or hospitalization, (ii) an individualized,
written plan for furnishing such services has
been established by a physician and is reviewed
periodically by a physician or, to the extent per-
mitted under the laws of the State in which the
services are furnished, a non-physician mental
health professional, and (iii) such services are
or were furnished while the individual is or was
under the care of a physician or, to the extent
permitted under the law of the State in which
the services are furnished, a non-physician men-
tal health professional.’’.
(2) Section 1861(s)(2)(B) of such Act (42 U.S.C.
1395x(s)(2)(B)) is amended by inserting ‘‘and intensive
outpatient services’’ after ‘‘partial hospitalization serv-
ices’’.
(3) Section 1861(ff)(1) of such Act (42 U.S.C.
1395x(ff)(1)) is amended—
(A) by inserting ‘‘or, to the extent permitted
under the law of the State in which the services are
furnished, a non-physician mental health profes-
sional,’’ after ‘‘under the supervision of a physician’’
and after ‘‘periodically reviewed by a physician’’; and
(B) by striking ‘‘physician’s’’ and inserting ‘‘pa-
tient’s’’.
(4) Section 1861(cc) of such Act (42 U.S.C.
1395x(cc)) is amended—
(A) in paragraph (1), by striking ‘‘physician—
’’ and inserting ‘‘physician or, to the extent per-
mitted under the law of the State in which the serv-
ices are furnished, a non-physician mental health
professional—’’ and
(B) in paragraph (2)(E), by inserting before
the semicolon the following: ‘‘, except that a patient
receiving social and psychological services under
paragraph (1)(D) may be under the care of a non-
physician mental health professional with respect to
such services to the extent permitted under the law
of the State in which the services are furnished’’.
(e) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished on
or after January 1, 2002.
TITLE 
III—IMPROVING 
BENE-
FICIARY ACCESS TO MEDI-
CARE-COVERED SERVICES
SEC. 301. EXCLUDING CLINICAL SOCIAL WORKER SERVICES
FROM COVERAGE UNDER THE MEDICARE
SKILLED NURSING FACILITY PROSPECTIVE
PAYMENT SYSTEM AND CONSOLIDATED PAY-
MENT.
(a) IN GENERAL.—Section 1888(e)(2)(A)(ii) of the
Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is
amended by inserting ‘‘clinical social worker services,’’
after ‘‘qualified psychologist services,’’.
(b) 
CONFORMING
AMENDMENT.—Section
1861(hh)(2) of the Social Security Act (42 U.S.C.
1395x(hh)(2)) is amended by striking ‘‘and other than
services furnished to an inpatient of a skilled nursing facil-
ity which the facility is required to provide as a require-
ment for participation’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished on
or after January 1, 2002.
SEC. 302. COVERAGE OF MARRIAGE AND FAMILY THERA-
PIST SERVICES.
(a) COVERAGE OF SERVICES.—Section 1861(s)(2) of
the Social Security Act (42 U.S.C. 1395x(s)(2)), as
amended by sections 102(a) and 105(a) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protec-
tion Act of 2000, as enacted into law by section 1(a)(6)
of Public Law 106–554, is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (U);
(2) by inserting ‘‘and’’ at the end of subpara-
graph (V); and
(3) by adding at the end the following new sub-
paragraph:
‘‘(W) marriage and family therapist services (as
defined in subsection (yy));’’.
(b) DEFINITION.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x), as amended by sections
201(b) and 202(b), is further amended by adding at the
end the following new subsection:
‘‘Marriage and Family Therapist Services
‘‘(yy)(1) The term ‘marriage and family therapist
services’ means services performed by a marriage and
family therapist (as defined in paragraph (2)) for the diag-
nosis and treatment of mental illnesses, which the mar-
riage and family therapist is legally authorized to perform
under State law (or the State regulatory mechanism pro-
vided by State law) of the State in which such services
are performed provided such services are covered under
this title, as would otherwise be covered if furnished by
a physician or as incident to a physician’s professional
service, but only if no facility or other provider charges
or is paid any amounts with respect to the furnishing of
such services.
‘‘(2) The term ‘marriage and family therapist’ means
an individual who—
‘‘(A) possesses a master’s or doctoral degree
which qualifies for licensure or certification as a
marriage and family therapist pursuant to State
law;
‘‘(B) after obtaining such degree has performed
at least two years of clinical supervised experience in
marriage and family therapy; and
‘‘(C) is licensed or certified as a marriage and
family therapist in the State in which marriage and
family therapist services are performed.’’.
(c) PROVISION FOR PAYMENT UNDER PART B.—Sec-
tion 1832(a)(2)(B) of the Social Security Act (42 U.S.C.
1395k(a)(2)(B)) is amended by adding at the end the fol-
lowing new clause:
‘‘(v) marriage and family therapist
services;’’.
(d) AMOUNT OF PAYMENT.—
(1) IN GENERAL.—Section 1833(a)(1) of the
Social Security Act (42 U.S.C. 1395l(a)(1)), as
amended by sections 105(c) and 223(c) of the Medi-
care, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000, as enacted into law by
section 
1(a)(6) 
of 
Public 
Law 
106–554, 
is
amended—
(A) by striking ‘‘and’’ before ‘‘(U)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (V) with respect
to marriage and family therapist services under
section 1861(s)(2)(W), the amounts paid shall
be 80 percent of the lesser of (i) the actual
charge for the services or (ii) 75 percent of the
amount determined for payment of a psycholo-
gist under clause (L)’’.
(2) DEVELOPMENT
OF
CRITERIA
WITH
RE-
SPECT TO CONSULTATION WITH A PHYSICIAN.—The
Secretary of Health and Human Services shall, tak-
ing into consideration concerns for patient confiden-
tiality, develop criteria with respect to payment for
marriage and family therapist services for which
payment may be made directly to the marriage and
family therapist under part B of title XVIII of the
Social Security Act under which such a therapist
must agree to consult with a patient’s attending or
primary care physician in accordance with such cri-
teria.
(e) EXCLUSION OF MARRIAGE AND FAMILY THERA-
PIST SERVICES FROM SKILLED NURSING FACILITY PRO-
SPECTIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii)
of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)),
as amended in section 301(a), is further amended by in-
serting ‘‘marriage and family therapist services (as de-
fined in subsection (yy)(1)),’’ after ‘‘clinical social worker
services,’’.
(f) COVERAGE OF MARRIAGE AND FAMILY THERA-
PIST SERVICES PROVIDED IN RURAL HEALTH CLINICS
AND FEDERALLY QUALIFIED HEALTH CENTERS.—Sec-
tion 1861(aa)(1)(B) of the Social Security Act (42 U.S.C.
1395x(aa)(1)(B)) is amended by striking ‘‘or by a clinical
social worker (as defined in subsection (hh)(1)),,’’ and in-
serting ‘‘, by a clinical social worker (as defined in sub-
section (hh)(1)), or by a marriage and family therapist
(as defined in subsection (yy)(2)),’’.
(g) INCLUSION OF MARRIAGE AND FAMILY THERA-
PISTS
AS
PRACTITIONERS
FOR
ASSIGNMENT
OF
CLAIMS.—Section 1842(b)(18(C) of the Social Security
Act (42 U.S.C. 1395u(b)(18)(C)), as amended by section
105(d) of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000, as enacted into
law by section 1(a)(6) of Public Law 106–554, is amended
by adding at the end the following new clause:
‘‘(vii) A marriage and family therapist (as de-
fined in section 1861(yy)(2)).’’.
(h) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished on
or after January 1, 2002.
SEC. 303. COVERAGE OF MENTAL HEALTH COUNSELOR
SERVICES.
(a) COVERAGE OF SERVICES.—Section 1861(s)(2) of
the Social Security Act (42 U.S.C. 1395x(s)(2)), as
amended in section 302(a), is further amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (V);
(2) by inserting ‘‘and’’ at the end of subpara-
graph (W); and
(3) by adding at the end the following new sub-
paragraph:
‘‘(X) mental health counselor services (as
defined in subsection (zz)(2));’’.
(b) DEFINITION.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x), as amended by sections
201(b), 202(b), and 302(b), is further amended by adding
at the end the following new subsection:
‘‘Mental Health Counselor; Mental Health Counselor
Services
‘‘(zz)(1) The term ‘mental health counselor’ means
an individual who—
‘‘(A) possesses a master’s or doctor’s degree in
mental health counseling or a related field;
‘‘(B) after obtaining such a degree has per-
formed at least 2 years of supervised mental health
counselor practice; and
‘‘(C) is licensed or certified as a mental health
counselor or professional counselor by the State in
which the services are performed.
‘‘(2) The term ‘mental health counselor services’
means services performed by a mental health counselor (as
defined in paragraph (1)) for the diagnosis and treatment
of mental illnesses which the mental health counselor is
legally authorized to perform under State law (or the
State regulatory mechanism provided by the State law) of
the State in which such services are performed provided
such services are covered under this title as would other-
wise be covered if furnished by a physician or as incident
to a physician’s professional service, but only if no facility
or other provider charges or is paid any amounts with re-
spect to the furnishing of such services.’’.
(c) PAYMENT.—
(1) IN GENERAL.—Section 1833(a)(1) of the
Social Security Act (42 U.S.C. 13951(a)(1)), as
amended by section 302(d), is further amended—
(A) by striking ‘‘and’’ before ‘‘(V)’’; and
(B) by inserting before the semicolon at
the end the following: ‘‘, and (W) with respect
to mental health counselor services under sec-
tion 1861(s)(2)(X), the amounts paid shall be
80 percent of the lesser of (i) the actual charge
for the services or (ii) 75 percent of the amount
determined for payment of a psychologist under
clause (L)’’.
(2) DEVELOPMENT
OF
CRITERIA
WITH
RE-
SPECT TO CONSULTATION WITH A PHYSICIAN.—The
Secretary of Health and Human Services shall, tak-
ing into consideration concerns for patient confiden-
tiality, develop criteria with respect to payment for
mental health counselor services for which payment
may be made directly to the mental health counselor
under part B of title XVIII of the Social Security
Act under which such a counselor must agree to con-
sult with a patient’s attending or primary care phy-
sician in accordance with such criteria.
(d) EXCLUSION OF MENTAL HEALTH COUNSELOR
SERVICES FROM SKILLED NURSING FACILITY PROSPEC-
TIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) of
the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)),
as amended by sections 301(a) and 302(e), is further
amended by inserting ‘‘mental health counselor services
(as defined in section 1861(zz)(2)),’’ after ‘‘marriage and
family therapist services (as defined in subsection
(yy)(1)),’’.
(e) COVERAGE
OF MENTAL HEALTH COUNSELOR
SERVICES PROVIDED IN RURAL HEALTH CLINICS AND
FEDERALLY
QUALIFIED
HEALTH
CENTERS.—Section
1861(aa)(1)(B) of the Social Security Act (42 U.S.C.
1395x(aa)(1)(B)), as amended by section 302(f), is fur-
ther amended—
(1) by striking ‘‘or’’ before ‘‘marriage and fam-
ily therapist services’’; and
(2) by inserting ‘‘or mental health counselor
services (as defined in section 1861(zz)(2)),’’ after
‘‘marriage and family therapist services (as defined
in subsection (yy)(1)),’’.
(f) INCLUSION OF MENTAL HEALTH COUNSELORS AS
PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Section
1842(b)(18)(C) of the Social Security Act (42 U.S.C.
1395u(b)(18)(C)), as amended by section 302(g), is fur-
ther amended by adding at the end the following new
clause:
‘‘(viii) A mental health counselor (as defined in
section 1861(zz)(1)).’’.
(g) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished on
or after January 1, 2002.
SEC. 304. STUDY OF COVERAGE CRITERIA FOR ALZ-
HEIMER’S DISEASE AND RELATED MENTAL
ILLNESSES.
(a) STUDY.—
(1) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the
‘‘Secretary’’) shall conduct a study to determine
whether the criteria for coverage of any therapy
service (including occupational therapy services and
physical therapy services) or any outpatient mental
health care service under the medicare program
under title XVIII of the Social Security Act unduly
restricts the access of any medicare beneficiary who
has been diagnosed with Alzheimer’s disease or a re-
lated mental illness to such a service because the
coverage criteria requires the medicare beneficiary to
display continuing clinical improvement to continue
to receive the service.
(2) DETERMINATION OF NEW COVERAGE CRI-
TERIA.—If the Secretary determines that the cov-
erage criteria described in paragraph (1) unduly re-
stricts the access of any medicare beneficiary to the
services described in such paragraph, the Secretary
shall identify alternative coverage criteria that would
permit a medicare beneficiary who has been diag-
nosed with Alzheimer’s disease or a related mental
illness to receive coverage for health care services
under the medicare program that are designed to
control symptoms, maintain functional capabilities,
reduce or deter deterioration, and prevent or reduce
hospitalization of the beneficiary.
(b) REPORT.—Not later than 1 year after the date
of enactment of this Act, the Secretary shall submit to
the committees of jurisdiction of Congress a report on the
study conducted under subsection (a) together with such
recommendations for legislative and administrative action
as the Secretary determines appropriate.
Æ