To amend title XVIII of the Social Security Act to ensure adequate coverage of outpatient mental health services under the Medicare program.
Bill: H.R.8878 | Sponsor: Rep. Chu, Judy (D-CA)
Policy area: Health

Summary:
This bill provides for Medicare coverage of intensive outpatient services that are provided by community mental health centers, rural health clinics, or federally qualified health centers.

To amend title XVIII of the Social Security Act to ensure adequate 
   coverage of outpatient mental health services under the Medicare 
                                program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. ENSURING ADEQUATE COVERAGE OF OUTPATIENT MENTAL HEALTH 
              SERVICES UNDER THE MEDICARE PROGRAM.

    (a) Modification of Definition of Partial Hospitalization 
Services.--Section 1861(ff)(1) of the Social Security Act (42 U.S.C. 
1395x(ff)(1)) is amended by inserting ``for an individual determined 
(not less frequently than monthly) by a physician to have a need for 
such services for a minimum of 20 hours per week'' after ``prescribed 
by a physician''.
    (b) Coverage of Intensive Outpatient Services.--
            (1) Scope of benefits.--
                    (A) Community mental health centers.--Section 
                1832(a)(2)(J) of the Social Security Act (42 U.S.C. 
                1395k(a)(2)(J)) is amended by inserting ``and intensive 
                outpatient services'' after ``partial hospitalization 
                services''.
                    (B) Incident-to services.--Section 1861(s)(2)(B) is 
                amended by inserting ``or intensive outpatient 
                services'' after ``partial hospitalization services''.
            (2) Definition.--Section 1861(ff) of the Social Security 
        Act (42 U.S.C. 1395x(ff)) is amended--
                    (A) in the header, by inserting ``; Intensive 
                Outpatient Services'' after ``Partial Hospitalization 
                Services''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(4) The term `intensive outpatient services' has the meaning 
given the term `partial hospitalization services' in paragraph (1), 
except that--
            ``(A) section 1835(a)(2)(F)(i) shall not apply;
            ``(B) the reference in such paragraph to an individual 
        `determined (not less frequently than monthly) by a physician 
        to have a need for such services for a minimum of 20 hours per 
        week' shall be treated as a reference to an individual 
        `determined (not less frequently than once every other month) 
        by a physician to have a need for such services for a minimum 
        of 9 hours per week'; and
            ``(C) the reference to `a community mental health center 
        (as defined in subparagraph (B))' in paragraph (3) shall be 
        treated as a reference to `a community mental health center (as 
        defined in subparagraph (B)), a Federally qualified health 
        center, or a rural health clinic'.''.
            (3) Exclusion from calculation of certain treatment 
        costs.--Section 1833(c)(2) of the Social Security Act (42 
        U.S.C. 1395l(c)(2)) is amended by inserting ``or intensive 
        outpatient services'' after ``partial hospitalization 
        services''.
            (4) Conforming amendments.--
                    (A) Intensive outpatient services.--Section 
                1861(aa) of the Social Security Act (42 U.S.C. 
                1395x(aa)) is amended--
                            (i) in paragraph (1)--
                                    (I) in subparagraph (B), by 
                                striking ``and'' at the end;
                                    (II) in subparagraph (C), by adding 
                                ``and'' at the end; and
                                    (III) by inserting after 
                                subparagraph (C) the following new 
                                subparagraph:
            ``(D) intensive outpatient services (as defined in section 
        1861(ff)(4)),''; and
                            (ii) in paragraph (3), by striking 
                        ``through (C)'' and inserting ``through (D)''.
                    (B) Provider of services.--Section 1866(e)(2) of 
                the Social Security Act (42 U.S.C. 1395cc(e)(2)) is 
                amended by inserting ``, or intensive outpatient 
                services (as described in section 1861(ff)(4))'' after 
                ``partial hospitalization services (as described in 
                section 1861(ff)(1))''.
    (c) Special Payment Rule for FQHCs and RHCs.--Section 1834 of the 
Social Security Act (42 U.S.C. 1395m) is amended--
            (1) in subsection (o), by adding at the end the following 
        new paragraph:
            ``(5) Special payment rule for intensive outpatient 
        services.--
                    ``(A) In general.--In the case of intensive 
                outpatient services furnished by a Federally qualified 
                health center, the payment amount for such services 
                shall be equal to the amount that would have been paid 
                under this title for such services had such services 
                been covered OPD services furnished by a hospital.
                    ``(B) Exclusion.--Costs associated with intensive 
                outpatient services shall not be used to determine the 
                amount of payment for Federally qualified health center 
                services under the prospective payment system under 
                this subsection.''; and
            (2) in subsection (y)--
                    (A) in the header, by striking ``to Hospice 
                Patients''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(3) Special payment rule for intensive outpatient 
        services.--
                    ``(A) In general.--In the case of intensive 
                outpatient services furnished by a rural health clinic, 
                the payment amount for such services shall be equal to 
                the amount that would have been paid under this title 
                for such services had such services been covered OPD 
                services furnished by a hospital.
                    ``(B) Exclusion.--Costs associated with intensive 
                outpatient services shall not be used to determine the 
                amount of payment for rural health clinic services 
                under the methodology for all-inclusive rates 
                (established by the Secretary) under section 
                1833(a)(3).''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to items and services furnished on or after January 
1, 2024.
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