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 the Social Security Act 
(42 U.S.C. 1395x(s)(2)(B)) is amended by inserting ‘‘and 
intensive outpatient services’’ after ‘‘partial hospitalization 
services’’. 
(3) Section 1861(ff)(1) of the Social Security 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 the Social Security Act (42 
U.S.C. 1395x(cc)) is amended—
(A) in paragraph (1), in the matter preceding 
subparagraph 
(A), 
by 
striking
‘‘physician—’’ and inserting ‘‘physician or, to the ex-
tent permitted under the law of the State in which 
the services are furnished, a non-physician mental 
health professional—’’; and 
(B) in paragraph (2)(E), by inserting before 
the semicolon at the end 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 re-
spect to such services to the extent permitted under 
the law of the State in which the services are fur-
nished’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2004.
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, 2004.
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)) is amend-
ed—
(1) in subparagraph (U), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (V), by adding ‘‘and’’ at 
the end; 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 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 2 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)) 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 subparagraph (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.
(h) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2004. 
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 amended—
(1) in subparagraph (V), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (W), by inserting ‘‘and’’ at 
the end; 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 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. 1395l(a)(1)), as 
amended by section 302(d), is 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 
subparagraph (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 amended 
by inserting ‘‘mental health counselor services (as defined
in section 1861(zz)(2)),’’ after ‘‘marriage and family ther-
apist 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 
amended—
(1) by striking ‘‘or by a marriage’’ and insert-
ing ‘‘by a marriage’’; and 
(2) by inserting ‘‘or a mental health counselor 
(as defined in subsection (zz)(1)),’’ after ‘‘marriage 
and family therapist (as defined in subsection 
(yy)(2)),’’. 
(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 
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, 2004.
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.
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