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 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 2007’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
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 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. 
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) in paragraph (1), by adding ‘‘or’’ at 
the end; 
(B) in paragraph (2), by striking ‘‘; or’’ at 
the end and inserting a period; 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, 2008. 
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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, 2008. 
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 amend-
ed— 
(1) in paragraph (4), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (5), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(6) intensive residential services (as defined in 
section 1861(ccc)) furnished to an individual for up 
to 120 days during any calendar year, except that 
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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) is amended by adding 
at the end the following new subsection: 
‘‘(ccc) INTENSIVE
RESIDENTIAL
SERVICES.—(1) 
Subject to paragraphs (3) and (4), the term ‘intensive res-
idential services’ means a program of residential services 
(described in paragraph (2)) that is— 
‘‘(A) prescribed by a physician for an individual 
entitled to, or enrolled for, 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. 
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In the case of such an individual who is receiving qualified 
psychologist services (as defined in subsection (ii)), the in-
dividual 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— 
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‘‘(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: 
‘‘(m) PAYMENT FOR INTENSIVE RESIDENTIAL SERV-
ICES.—(1) The amount of payment under this part for 
intensive residential services under section 1812(a)(6) 
shall be equal to an amount specified under a prospective 
payment system established by the Secretary, taking into 
account the prospective payment system established for 
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psychiatric hospitals pursuant to 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, 2008. 
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 
at the end 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(ddd)).’’. 
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(b) SERVICES DESCRIBED.—Section 1861 of the So-
cial Security Act (42 U.S.C. 1395x), as amended by sec-
tion 201(b), is amended by adding at the end the following 
new subsection: 
‘‘(ddd) INTENSIVE OUTPATIENT SERVICES.—(1) The 
term ‘intensive outpatient services’ means the items and 
services described in paragraph (2) prescribed by a physi-
cian and provided within the context described in para-
graph (3) under the supervision of a physician (or, to the 
extent permitted under the law of the State in which the 
services are furnished, a non-physician mental health pro-
fessional) pursuant to an individualized, written plan of 
treatment that is established by a physician and periodi-
cally reviewed by a physician or, to the extent permitted 
under the laws of the State in which the services are fur-
nished, a non-physician mental health professional (in con-
sultation with appropriate staff participating in such serv-
ices), which plan sets forth the patient’s diagnosis, the 
type, amount, frequency, and duration of the items and 
services provided under the plan, and the goals for treat-
ment under the plan. 
‘‘(2)(A) The items and services described in this 
paragraph are the items and services described in sub-
paragraph (B) that are reasonable and necessary for the 
diagnosis or treatment of the individual’s condition, rea-
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sonably expected to improve or maintain the individual’s 
condition and functional level and to prevent relapse or 
hospitalization, and furnished pursuant to such guidelines 
relating to frequency and duration of services as the Sec-
retary 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-
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