I 
111TH CONGRESS 
1ST SESSION H. R. 1693 
To amend title XVIII of the Social Security Act to provide for the coverage 
of marriage and family therapist services and mental health counselor 
services under part B of the Medicare Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 24, 2009 
Mr. GORDON of Tennessee (for himself, Mrs. NAPOLITANO, and Mr. LEWIS 
of Georgia) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, 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 provide 
for the coverage of marriage and family therapist services 
and mental health counselor services under part B of 
the Medicare Program, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Seniors Mental Health 
Access Improvement Act of 2009’’. 
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SEC. 2. COVERAGE OF MARRIAGE AND FAMILY THERAPIST 
SERVICES AND MENTAL HEALTH COUNSELOR 
SERVICES UNDER PART B OF THE MEDICARE 
PROGRAM. 
(a) COVERAGE OF SERVICES.— 
(1) IN
GENERAL.—Section 1861(s)(2) of the 
Social Security Act (42 U.S.C. 1395x(s)(2)) is 
amended— 
(A) in subparagraph (DD), by striking 
‘‘and’’ after the semicolon at the end; 
(B) in subparagraph (EE), by inserting 
‘‘and’’ after the semicolon at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(FF) marriage and family therapist serv-
ices (as defined in subsection (hhh)(1)) and 
mental health counselor services (as defined in 
subsection (hhh)(3));’’. 
(2) DEFINITIONS.—Section 1861 of such Act 
(42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection: 
‘‘Marriage and Family Therapist Services 
‘‘(hhh)(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-
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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, as would otherwise be covered if furnished 
by a physician or as an incident to a physician’s profes-
sional service, but only if no facility or other provider 
charges or is paid any amounts with respect to the fur-
nishing 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 2 years of clinical supervised experience in 
marriage and family therapy; and 
‘‘(C) in the case of an individual performing 
services in a State that provides for licensure or cer-
tification of marriage and family therapists, is li-
censed or certified as a marriage and family thera-
pist in such State. 
‘‘(3) The term ‘mental health counselor services’ 
means services performed by a mental health counselor (as 
defined in paragraph (4)) for the diagnosis and treatment 
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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, as would 
otherwise be covered if furnished by a physician or as inci-
dent 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. 
‘‘(4) 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) in the case of an individual performing 
services in a State that provides for licensure or cer-
tification of mental health counselors or professional 
counselors, is licensed or certified as a mental health 
counselor or professional counselor in such State.’’. 
(3) PROVISION
FOR
PAYMENT
UNDER
PART 
B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 
1395k(a)(2)(B)) is amended by adding at the end 
the following new clause: 
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‘‘(v) marriage and family therapist 
services 
(as 
defined 
in 
section 
1861(hhh)(1)) and mental health counselor 
services 
(as 
defined 
in 
section 
1861(hhh)(3));’’. 
(4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 
of such Act (42 U.S.C. 1395l(a)(1)) is amended— 
(A) by striking ‘‘and (W)’’ and inserting 
‘‘(W)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (X) with respect 
to marriage and family therapist services and 
mental health counselor services under section 
1861(s)(2)(FF), the amounts paid shall be 80 
percent of the lesser of the actual charge for 
the services or 75 percent of the amount deter-
mined for payment of a psychologist under sub-
paragraph (L)’’. 
(5) EXCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPIST SERVICES AND MENTAL HEALTH COUN-
SELOR SERVICES FROM SKILLED NURSING FACILITY 
PROSPECTIVE
PAYMENT
SYSTEM.—Section 
1888(e)(2)(A)(ii) 
of 
such 
Act 
(42 
U.S.C. 
1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar-
riage and family therapist services, mental health 
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counselor services,’’ after ‘‘qualified psychologist 
services,’’. 
(6) INCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPISTS AND MENTAL HEALTH COUNSELORS AS 
PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec-
tion 1842(b)(18)(C) of such Act (42 U.S.C. 
1395u(b)(18)(C)) is amended by adding at the end 
the following new clauses: 
‘‘(vii) A marriage and family therapist 
(as defined in section 1861(hhh)(2)). 
‘‘(viii) A mental health counselor (as 
defined in section 1861(hhh)(4)).’’. 
(b) COVERAGE OF CERTAIN MENTAL HEALTH SERV-
ICES PROVIDED IN CERTAIN SETTINGS.— 
(1) RURAL HEALTH CLINICS AND FEDERALLY 
QUALIFIED
HEALTH
CENTERS.—Section 
1861(aa)(1)(B) 
of 
such 
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 inserting ‘‘by a clinical social worker 
(as defined in subsection (hh)(1)), by a marriage 
and family therapist (as defined in subsection 
(hhh)(2)), or by a mental health counselor (as de-
fined in subsection (hhh)(4))’’. 
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(2) 
HOSPICE
PROGRAMS.—Section 
1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 
1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 
one marriage and family therapist or mental health 
counselor’’ after ‘‘social worker’’. 
(c) AUTHORIZATION
OF MARRIAGE
AND FAMILY 
THERAPISTS
AND MENTAL HEALTH COUNSELORS TO 
DEVELOP DISCHARGE PLANS FOR POST-HOSPITAL SERV-
ICES.—Section 1861(ee)(2)(G) of such Act (42 U.S.C. 
1395x(ee)(2)(G)) is amended by inserting ‘‘including 
those marriage and family therapists and mental health 
counselors meeting appropriate qualification standards as 
issued by the Secretary’’ after ‘‘social worker, qualified 
personnel’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to services furnished 
on or after January 1, 2010. 
Æ 
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