‘‘(B) a licensed psychologist (as defined by 
the Secretary for purposes of section 1861(ii) of 
such Act (42 U.S.C. 1395x(ii))); 
‘‘(C) a clinical social worker (as defined in 
section 1861(hh)(1) of such Act (42 U.S.C. 
1395x(hh)(1)); or
‘‘(D) a clinical nurse specialist (as defined 
in section 1861(aa)(5)(B) of such Act (42 
U.S.C. 1395x(aa)(5)(B))). 
‘‘(3) PRIMARY HEALTH CARE PROVIDER.—The 
term ‘primary health care provider’ includes family 
practice, internal medicine, pediatrics, obstetrics and 
gynecology, geriatrics, and emergency medicine phy-
sicians as well as physician assistants and nurse 
practitioners. 
‘‘(4) RURAL
AREA.—The term ‘rural area’ 
means 
a 
rural 
area 
as 
defined 
in 
section 
1886(d)(2)(D) of the Social Security Act, or such an 
area in a rural census tract of a metropolitan statis-
tical area (as determined under the most recent 
modification of the Goldsmith Modification, origi-
nally published in the Federal Register on February 
27, 1992 (57 Fed. Reg. 6725)), or any other geo-
graphical area that the Director designates as a 
rural area.
‘‘(c) DURATION.—Grants awarded under subsection 
(a) shall be awarded for a period of 5 years. 
‘‘(d) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (a) shall use funds received 
through such grant to administer an interdisciplinary, 
side-by-side training program for mental health care pro-
viders and primary health care providers, that includes 
providing, under appropriate supervision, health care serv-
ices to patients in underserved, rural areas without regard 
to patients’ ability to pay for such services. 
‘‘(e) APPLICATION.—An eligible entity desiring a 
grant under subsection (a) shall submit an application to 
the Director at such time, in such manner, and containing 
such information as the Director may reasonably require, 
including—
‘‘(1) a description of the activities which the eli-
gible entity intends to carry out using amounts pro-
vided under the grant; 
‘‘(2) a description of the manner in which the 
activities funded under the grant will meet the men-
tal health care needs of underserved rural popu-
lations within the State; and 
‘‘(3) a description of the network agreement 
with partnering facilities.
‘‘(f) EVALUATIONS; REPORT.—Each eligible entity 
that receives a grant under this section shall submit to 
the Director of the Office of Rural Health Policy (of the 
Health Resources and Services Administration) an evalua-
tion describing the programs authorized under this section 
and any other information that the Director deems appro-
priate. After receiving such evaluations, the Director shall 
submit to the appropriate committees of Congress a report 
describing such evaluations. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
$100,000,000 for fiscal year 2004 and such sums as may 
be necessary for each of the fiscal years 2005 through 
2008.’’. 
(b) COVERAGE OF MARRIAGE AND FAMILY THERA-
PIST SERVICES AND MENTAL HEALTH COUNSELOR SERV-
ICES UNDER PART B OF THE MEDICARE PROGRAM.—
(1) COVERAGE OF SERVICES.—
(A) IN GENERAL.—Section 1861(s)(2) (42 
U.S.C. 1395x(s)(2)) is amended—
(i) in subparagraph (U), by striking 
‘‘and’’ after the semicolon at the end; 
(ii) in subparagraph (V)(iii), by in-
serting ‘‘and’’ after the semicolon at the 
end; and
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(W) marriage and family therapist services (as 
defined in subsection (ww)(1)) and mental health 
counselor 
services 
(as 
defined 
in 
subsection 
(ww)(3));’’. 
(B) 
DEFINITIONS.—Section 
1861 
(42 
U.S.C. 1395x) is amended by adding at the end 
the following new subsection: 
‘‘Marriage and Family Therapist Services; Marriage and 
Family Therapist; Mental Health Counselor Serv-
ices; Mental Health Counselor 
‘‘(ww)(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, 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 
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.’’. 
(C) PROVISION
FOR
PAYMENT
UNDER 
PART
B.—Section 1832(a)(2)(B) (42 U.S.C. 
1395k(a)(2)(B)) is amended by adding at the 
end the following new clause: 
‘‘(v) marriage and family therapist 
services and mental health counselor serv-
ices;’’. 
(D) 
AMOUNT
OF
PAYMENT.—Section 
1833(a)(1) (42 U.S.C. 1395l(a)(1)) is amend-
ed—
(i) by striking ‘‘and (U)’’ and insert-
ing ‘‘(U)’’; and
(ii) by inserting before the semicolon 
at the end the following: ‘‘, and (V) with 
respect to marriage and family therapist 
services and mental health counselor serv-
ices under section 1861(s)(2)(W), the 
amounts paid shall be 80 percent of the 
lesser of the actual charge for the services 
or 75 percent of the amount determined 
for payment of a psychologist under sub-
paragraph (L)’’. 
(E) EXCLUSION OF MARRIAGE AND FAM-
ILY
THERAPIST
SERVICES
AND
MENTAL 
HEALTH COUNSELOR SERVICES FROM SKILLED 
NURSING
FACILITY
PROSPECTIVE
PAYMENT 
SYSTEM.—Section 1888(e)(2)(A) (42 U.S.C. 
1395yy(e)(2)(A)), 
as 
amended 
by 
section 
4(b)(1)(B), is amended—
(i) in clause (i)(II), by striking 
‘‘clauses (ii), (iii), and (iv)’’ and inserting 
‘‘clauses (ii), (iii), (iv), and (v)’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(v) EXCLUSION OF MARRIAGE AND 
FAMILY
THERAPIST
SERVICES
AND
MEN-
TAL
HEALTH
COUNSELOR
SERVICES.—
Services described in this clause are mar-
riage and family therapist services (as de-
fined in subsection (ww)(1)) and mental 
health counselor services (as defined in 
section 1861(ww)(3)).’’. 
(F) INCLUSION OF MARRIAGE AND FAMILY 
THERAPISTS
AND
MENTAL
HEALTH
COUN-
SELORS AS PRACTITIONERS FOR ASSIGNMENT 
OF
CLAIMS.—Section 
1842(b)(18)(C) 
(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 de-
fined in section 1861(ww)(2)). 
‘‘(viii) A mental health counselor (as defined in 
section 1861(ww)(4)).’’. 
(c) 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) (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 de-
fined in subsection (ww)(2)), or by a mental health 
counselor (as defined in subsection (ww)(4)),’’. 
(2) 
HOSPICE
PROGRAMS.—Section 
1861(dd)(2)(B)(i)(III) 
(42 
U.S.C. 
1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 
a marriage and family therapist (as defined in sub-
section (ww)(2))’’ after ‘‘social worker’’. 
(d) AUTHORIZATION
OF MARRIAGE
AND FAMILY 
THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST-
HOSPITAL
SERVICES.—Section 
1861(ee)(2)(G) 
(42 
U.S.C. 1395x(ee)(2)(G)) is amended by inserting ‘‘mar-
riage and family therapist (as defined in subsection 
(ww)(2)),’’ after ‘‘social worker,’’. 
(e) EFFECTIVE DATE.—The amendments made by 
subsections (b), (c), and (d) shall apply with respect to 
services furnished on or after January 1, 2004. 
SEC. 9. RURAL HEALTH SERVICES RESEARCH IMPROVE-
MENTS. 
(a) IN
GENERAL.—Section 711(b) (42 U.S.C. 
912(b)) is amended—
(1) in paragraph (3), by striking ‘‘and’’ after 
the comma at the end; 
(2) in paragraph (4), by striking the period at 
the end and inserting ‘‘, and’’; and
(3) by adding at the end the following new 
paragraph: 
‘‘(5) have the authority to administer grants to 
support rural health services research.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect on January 1, 2004. 
SEC. 10. EXCLUSION FOR LOAN PAYMENTS UNDER NA-
TIONAL HEALTH SERVICE CORPS LOAN RE-
PAYMENT PROGRAM. 
(a) IN GENERAL.—Section 117 of the Internal Rev-
enue Code of 1986 is amended by adding at the end the 
following new subsection: 
‘‘(e) LOAN PAYMENTS UNDER NATIONAL HEALTH 
SERVICE CORPS LOAN REPAYMENT PROGRAM.—Gross in-
come shall not include any amount received under section 
338B(g) of the Public Health Service Act.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to amounts received by an indi-
vidual in taxable years beginning after December 31, 
2002.
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