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Q: SECTION 1. SHORT TITLE.

This Act may be cited as the ''Partial Hospitalization Services
Integrity Act of 1999''.

SEC. 2. LIMITATION ON LOCATION OF PROVISION OF SERVICES.

(a) In General.--Section 1861(ff)(2) of the Social Security Act (42
U.S.C. 1395x(ff)(2)) is amended in the matter following subparagraph
(I)--
(1) by striking ''and furnished'' and inserting
''furnished''; and
(2) by inserting before the period the following: '', and
furnished other than in a skilled nursing facility, residential
treatment facility or other residential setting (as determined
by the Secretary)''.
(b) Effective Date.--The amendments made by subsection (a) apply
with respect to partial hospitalization services furnished on or after
the first day of the third month beginning after the date of the
enactment of this Act.

SEC. 3. QUALIFICATIONS FOR COMMUNITY MENTAL HEALTH CENTERS.

(a) In General.--Section 1861(ff)(3)(B) of the Social Security Act
(42 U.S.C. 1395x(ff)(3)(B)) is amended by striking ''entity'' and all
that follows and inserting the following: ''entity that--
''(i)(I) provides the mental health services described in
section 1913(c)(1) of the Public Health Service Act; or
''(II) in the case of an entity operating in a State that
by law precludes the entity from providing a service described
in such section itself, provides for such service by contract
with an approved organization or entity (as determined by the
Secretary);
''(ii) meets applicable licensing or certification
requirements for community mental health centers in the State
in which it is located; and
''(iii) meets such additional conditions as the Secretary
shall specify to ensure (I) the health and safety of
individuals being furnished such services, (II) the effective
and efficient furnishing of such services, and (III) the
compliance of such entity with the criteria described in such
section.''.
(b) Clarification of Criteria for Community Mental Health
Centers.--Section 1913(c)(1)(E) of the Public Health Service Act (42
U.S.C. 300x-3(c)(1)(E)) is amended to read as follows:
''(E) Determining the clinical appropriateness of
admissions to any inpatient psychiatric hospitals by
engaging a full-time mental health professional who is
licensed or certified to make such a determination by
the State involved.''.
(c) Effective Date.--The amendments made by this section apply with
respect to community mental health centers furnishing services under
the medicare program on or after the first day of the third month
beginning after the date of the enactment of this Act.

SEC. 4. GUIDELINES FOR ITEMS AND SERVICES COMPRISING PARTIAL
HOSPITALIZATION SERVICES.

Not later than 180 days after the date of the enactment of this
Act, the Secretary shall first adopt national coverage and
administrative policies for partial hospitalization services furnished
under title XVIII of the Social Security Act, using a negotiated
rulemaking process under subchapter III of chapter 5 of title 5, United
States Code.

SEC. 5. REFINEMENT OF PERIODICITY OF REVIEW OF PLAN FOR PARTIAL
HOSPITALIZATION SERVICES.

(a) In General.--Section 1835(a)(2)(F)(ii) of the Social Security
Act (42 U.S.C. 1395n(a)(2)(F)(ii)) is amended by inserting ''at a
reasonable rate (as determined by the Secretary)'' after ''is reviewed
periodically''.
(b) Effective Date.--The amendment made by subsection (a) applies
with respect to plans for furnishing partial hospitalization services
established on or after the first day of the third month beginning
after the date of the enactment of this Act.

SEC. 6. RECERTIFICATION OF PROVIDERS OF PARTIAL HOSPITALIZATION
SERVICES.

(a) In General.--With respect to each community mental health
center that furnishes partial hospitalization services for which
payment is made under title XVIII of the Social Security Act, the
Secretary of Health and Human Services shall provide for periodic
recertification to ensure that the provision of such services complies
with applicable requirements of such title.
(b) Deadline for First Recertification.--The first recertification
under subsection (a) shall be completed not later than one year after
the date of the enactment of this Act.

SEC. 7. CIVIL MONETARY PENALTIES FOR FALSE CERTIFICATION OF ELIGIBILITY
FOR HOSPICE CARE OR PARTIAL HOSPITALIZATION SERVICES.

(a) In General.--Section 1128A(b)(3) of the Social Security Act (42
U.S.C. 1320a-7a(b)(3)) is amended--
(1) in subparagraph (A)(ii), by inserting '', hospice care,
or partial hospitalization services'' after ''home health
services''; and
(2) in subparagraph (B), by inserting '', section
1814(a)(7) in the case of hospice care, or section
1835(a)(2)(F) in the case of partial hospitalization services''
after ''in the case of home health services''.
(b) Effective Date.--The amendments made by subsection (a) apply
with respect to certifications of eligibility for hospice care or
partial hospitalization services under the medicare program made on or
after the first day of the third month beginning after the date of the
enactment of this Act.

SEC. 8. DEMONSTRATION FOR COST EFFECTIVE WRAP AROUND MENTAL HEALTH
SERVICES.

(a) Establishment.--
(1) In general.--The Secretary of Health and Human Services
shall implement a demonstration project (in this section
referred to as the ''project'') under part B of title XVIII of
the Social Security Act under which community mental health
centers may offer wrap around mental health services (as
defined in paragraph (2)(A)) for purposes of providing for a
full continuum of ambulatory behavioral health care services.
(2) Definitions.--
(A) Wrap around mental health services defined.--
The term ''wrap around mental health services'' means
comprehensive outpatient mental health services
furnished to an individual pursuant to an
individualized treatment plan developed by a mental
health professional, in consultation with the family of
the individual (if available). Such services are
furnished to the individual through a comprehensive,
multidisciplinary health and social services delivery
system that provides coordinated therapeutic
interventions, including medical services,
psychotherapy services, occupational therapy services,
and social work services.
(B) Licensed mental health professional.--The term
''mental health professional'' means any of the
following individuals who are licensed by the State in
which the individual furnishes services (as that term
is defined in paragraphs (1), (2)(M), and (2)(N) of
section 1861(s) of the Social Security Act (42 U.S.C.
1395x(s))) to design and execute treatment plans
described in subparagraph (A) without the supervision
of another health care practitioner:
(i) A physician, as defined in section
1861(r)(1) of such Act (42 U.S.C. 1395x(r)(1)).
(ii) A clinical psychologist, as defined by
the Secretary pursuant to section 1861(ii) of
such Act (42 U.S.C. 1395x(ii)).
(iii) A clinical social worker, as defined
in section 1861(hh) of such Act (42 U.S.C.
1395x(hh)).
(b) Selection of Centers.--For purposes of implementing such
project, the Secretary shall select for participation in the project
community mental health centers that serve populations in three
different States, one of which predominantly serves rural populations.
(c) Capitated Payment.--The Secretary shall establish and make
prospective monthly payments of a capitation amount for individuals
receiving wrap around mental health services under this project.
(d) Evaluation and Report.--
(1) Evaluation.--The Secretary shall evaluate the project.
Such evaluation shall include an examination of--
(A) the project's effect on the health, well-being,
condition, and functional level of beneficiaries
receiving wrap around mental health services;
(B) any savings to the medicare program by reason
of capitated payments for wrap around medical services
consisting of partial hospitalization services (as that
term is defined in section 1861(ff) of the Social
Security Act (42 U.S.C. 1395x(ff));
(C) the impact of basing payment for such services
on a capitated basis; and
(D) the project's effect on utilization of
inpatient services (including inpatient mental health
services) and associated costs.
(2) Report.--Not later than four years after the date of
the enactment of this Act, the Secretary shall submit to
Congress a report containing a statement of the findings and
conclusions of the Secretary pursuant to the evaluation
conducted under paragraph (1), together with any
recommendations for legislation the Secretary considers
appropriate with respect to--
(A) the provision of additional mental health
services by community mental health centers under
partial hospitalization services; and
(B) payment for such services on a capitated basis.
(e) Duration.--The project shall be conducted for a three year
period.
(f) Funding.--The Secretary shall provide for the transfer from the
Federal Hospital Insurance Trust Fund, established under section 1817
of the Social Security Act (42 U.S.C. 1395i), of such funds as are
necessary for the costs of carrying out the demonstration project under
this section.
A:
Partial Hospitalization Services Integrity Act of 1999 - Amends title XVIII (Medicare) of the Social Security Act to provide for the following: (1) denial of Medicare coverage for partial hospitalization services (for psychiatric treatment) furnished in a skilled nursing facility, a residential treatment facility, or any other type of residential setting determined by the Secretary of Health and Human Services; (2) new qualifications for community mental health centers (centers) as the Secretary is required to specify to ensure the health and safety of individuals being furnished mental health services and their effective and efficient furnishing; and (3) national coverage and administrative policies for partial hospitalization services under Medicare that the Secretary is to first adopt using negotiated rulemaking.
Directs the Secretary to do the following: (1) provide for periodic recertification to ensure that the provision of such Medicare-reimbursable services by centers complies with applicable Medicare requirements; and (2) implement a specified demonstration project under Medicare part B (Supplementary Medical Insurance) under which centers may offer wrap around mental health services for purposes of providing for a full continuum of ambulatory behavioral health care services. Provides for funding for demonstration project costs.
Makes miscellaneous technical amendments concerning criteria for centers under the Public Health Service Act, and periodic physician review of physician written, individualized plans for partial hospitalization services under Medicare.
Amends SSA title XI to provide for civil monetary penalties for false certification of eligibility for hospice care or partial hospitalization services.