[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 3233 Introduced in Senate (IS)]







106th CONGRESS
  2d Session
                                S. 3233

To amend title XVIII of the Social Security Act to provide for medicare 
 beneficiary copayments for outpatient mental health services that are 
 the same as beneficiary copayments for other part B services, and for 
                            other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

            October 25 (legislative day, September 22), 2000

 Mr. Wellstone introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for medicare 
 beneficiary copayments for outpatient mental health services that are 
 the same as beneficiary copayments for other part B services, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Mental Health Modernization 
Act of 2000''.

SEC. 2. FINDINGS.

    The Senate finds the following:
            (1) Older people have the highest rate of suicide of any 
        population in the United States, and the suicide rate of that 
        population increases with age, with individuals 65 and older 
        accounting for 20 percent of all suicide deaths in the United 
        States, while comprising only 13 percent of the population of 
        the United States.
            (2) Disability due to mental illness in individuals over 65 
        years old will become a major public health problem in the near 
        future because of demographic changes. In particular, dementia, 
        depression, schizophrenia, among other conditions, will all 
        present special problems for this age group.
            (3) Major depression is strikingly prevalent among older 
        people, with between 8 and 20 percent of older people in 
        community studies and up to 37 percent of those seen in primary 
        care settings experiencing symptoms of depression.
            (4) Almost 20 percent of the population of individuals age 
        55 and older, experience specific mental disorders that are not 
        part of normal aging.
            (5) Unrecognized and untreated depression, Alzheimer's 
        disease, anxiety, late-life schizophrenia, and other mental 
        conditions can be severely impairing and may even be fatal.
            (6) Substance abuse, particularly the abuse of alcohol and 
        prescription drugs, among adults 65 and older is one of the 
        fastest growing health problems in the United States, with 17 
        percent of this age group suffering from addiction or substance 
        abuse. While addiction often goes undetected and untreated 
        among older adults, aging and disability makes the body more 
        vulnerable to the effects of alcohol and drugs, further 
        exacerbating other age-related health problems. Medicare 
        coverage for addiction treatment of the elderly needs to 
        recognize these special vulnerabilities.
            (7) The disabled are another population receiving 
        inadequate mental health care through medicare. According to 
        the Health Care Financing Administration, medicare is the 
        primary health care coverage for the 5,000,000 non-elderly, 
        disabled people on Social Security Disability Insurance. Up to 
        40 percent of these individuals have a diagnosis of mental 
        illness, and also face severe discrimination in mental health 
        coverage.

SEC. 3. DECREASE IN MEDICARE BENEFICIARY COPAYMENT FOR OUTPATIENT 
              MENTAL HEALTH SERVICES.

    (a) In General.--Section 1833(c) of the Social Security Act (42 
U.S.C. 1395l(c)) is repealed.
    (b) Conforming Amendment.--Section 1866(a)(2)(A) of such Act (42 
U.S.C. 1395cc(a)(2)(A)) is amended by striking the second sentence.
    (c) Effective Date.--The amendments made by subsections (a) and (b) 
shall apply to items and services furnished on or after the date of 
enactment of this Act.

SEC. 4. INTENSIVE RESIDENTIAL SERVICES.

    (a) Coverage Under Part A.--Section 1812(a) (42 U.S.C. 1395d(a)) is 
amended--
            (1) in paragraph (4), by striking ``and'' at the end;
            (2) in paragraph (5), by striking the period at the end of 
        and inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(5) intensive residential services (as defined in section 
        1861(uu)) furnished to an individual for up to 120 days during 
        any calendar year.''.
    (b) Intensive Residential Services Defined.--Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection:

                    ``Intensive Residential Services

    ``(uu)(1) Subject to paragraphs (2) and (3), the term `intensive 
residential services' means inpatient services provided in any of the 
following facilities:
            ``(A) Residential detoxification centers.
            ``(B) Crisis residential programs or mental illness 
        residential treatment programs.
            ``(C) Therapeutic family or group treatment homes.
            ``(D) Residential centers for substance abuse treatment.
    ``(2) No service may be treated as an intensive residential service 
unless the facility at which the service is provided--
            ``(A) is legally authorized to provide such service under 
        the law of the State (or under a State regulatory mechanism 
        provided by State law) in which the facility is located or is 
        certified to provide such service by an appropriate 
        accreditation entity approved by the State in consultation with 
        the Secretary; and
            ``(B) meets such other requirements as the Secretary may 
        impose to assure the quality of the intensive residential 
        services provided.
    ``(3) No service may be treated as an intensive residential service 
under paragraph (1) unless the service is furnished in accordance with 
standards established by the Secretary for the management of such 
services.''.
    (c) Reduction in Days of Coverage for Inpatient Services.--Section 
1812(b)(3) of the Social Security Act (42 U.S.C. 1395d(b)(3)) is 
amended by striking the period at the end and inserting the following: 
``, reduced by a number of days determined by the Secretary so that the 
actuarial value of providing such number of days of services under this 
paragraph to the individual is equal to the actuarial value of the days 
of inpatient residential services furnished to the individual under 
subsection (a)(5) during the year after such services have been 
furnished to the individual for 120 days during the year (rounded to 
the nearest day).''.
    (d) Amount of Payment.--Section 1814 of the Social Security Act (42 
U.S.C. 1395f) is amended--
            (1) in subsection (b), in the matter preceding paragraph 
        (1), by inserting ``other than a provider of intensive 
        residential services,'' after ``hospice care,''; and
            (2) by adding at the end the following new subsection:

              ``Payment for Intensive Residential Services

    ``(m)(1) Except as provided in paragraphs (2) and (3), the amount 
of payment under this part for intensive residential services under 
section 1812(a)(5) shall be equal to the lesser of--
            ``(A) the reasonable cost of such services, as determined 
        under section 1861(v), or
            ``(B) the customary charges with respect to such services,
less the amount a provider may charge as described in clause (ii) of 
section 1866(a)(2)(A).
    ``(2) If intensive residential services are furnished by a public 
provider of services or by another provider which demonstrates to the 
satisfaction of the Secretary that a significant portion of its 
patients are low-income (and requests that payment be made under this 
clause), free of charge or at nominal charges to the public, the 
Secretary shall determine the amount of payment for such services in 
accordance with subsection (b)(2).
    ``(3) If (and for so long as) the conditions described in 
subsection (b)(3) are met, the Secretary shall determine the amount of 
payment for intensive residential services under the reimbursement 
system described in such subsection.''.

SEC. 5. STUDY OF COVERAGE CRITERIA FOR ALZHEIMER'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 related 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 criteria.--If the 
        Secretary determines that the coverage criteria described in 
        paragraph (1) unduly restricts 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 diagnosed 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.

SEC. 6. MENTAL HEALTH COUNSELING SERVICES.

    (a) Adding Mental Health Counselor Services to the Definition of 
Medical and Other Health Services.--Section 1861(s)(2) of the Social 
Security Act (42 U.S.C. 1395(s)(2)) is amended--
            (1) in subparagraph (S), by striking ``and'' at the end;
            (2) in subparagraph (T)(ii), by adding ``and'' at the end; 
        and
            (3) by adding at the end the following new subparagraph:
                    ``(U) mental health counselor services (as defined 
                in subsection (vv));''.
    (b) Mental Health Counselor; Mental Health Counselor Services 
Defined.--Section 1861 of the Social Security Act (42 U.S.C. 1395x), as 
amended by section 4, is amended by adding at the end the following new 
subsection:

      ``Mental Health Counselor; Mental Health Counselor Services

    ``(vv)(1) The term `mental health counselor' means an individual 
who--
            ``(A) possesses a master's or doctor's degree in counseling 
        or a related field;
            ``(B) after obtaining such a degree has performed at least 
        2 years of supervised mental health counselor practice; and
            ``(C)(i) is licensed or certified as a mental health 
        counselor or professional counselor by the State in which the 
        services are performed; or
            ``(ii) in the case of an individual in a State that does 
        not provide for licensure or certification--
                    ``(I) has completed at least 2 years or 3,000 hours 
                of post-master's degree supervised mental health 
                counselor practice under the supervision of a master's 
                or doctor's level mental health provider in an 
                appropriate setting (as determined by the Secretary); 
                and
                    ``(II) meet such other criteria as the Secretary 
                establishes.
    ``(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 as performed as would otherwise be covered if 
furnished by a physician or as incident to a physician's professional 
service.''.
    (c) Payment.--Section 1833(a)(1) of the Social Security Act (42 
U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and'' before ``(S)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (T) with respect to mental health counselor 
        services under section 1861(s)(2)(U), the amounts paid shall be 
        80 percent of (i) the actual charge for the services or (ii) 75 
        percent of the amount determined for payment of a psychologist 
        under clause (L)''.

SEC. 7. EXCLUDING CLINICAL SOCIAL WORKER SERVICES FROM COVERAGE UNDER 
              THE MEDICARE SKILLED NURSING FACILITY PROSPECTIVE PAYMENT 
              SYSTEM AND CONSOLIDATED PAYMENT.

    (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 such Act (42 
U.S.C. 1395x(hh)(2)) is amended by striking ``and other than services 
furnished to an inpatient of a skilled nursing facility which the 
facility is required to provide as a requirement for participation''.
    (c) Effective Date.--The amendments made by this section apply as 
if included in the enactment of section 4432(a) of the Balanced Budget 
Act of 1997.
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