[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1946 Introduced in House (IH)]






109th CONGRESS
  1st Session
                                H. R. 1946

 To amend title XVIII of the Social Security Act to expand and improve 
     coverage of mental health services under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 27, 2005

  Mr. Stark introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
    and Commerce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to expand and improve 
     coverage of 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. SHORT TITLE; TABLE OF CONTENTS.

    (a) In General.--This Act may be cited as the ``Medicare Mental 
Health Modernization Act of 2005''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
        TITLE I--ESTABLISHING PARITY FOR MENTAL HEALTH SERVICES

Sec. 101. Elimination of lifetime limit on inpatient mental health 
                            services.
Sec. 102. Parity in treatment for outpatient mental health services.
 TITLE II--EXPANDING COVERAGE OF COMMUNITY-BASED MENTAL HEALTH SERVICES

Sec. 201. Coverage of intensive residential services.
Sec. 202. Coverage of intensive outpatient services.
  TITLE III--IMPROVING BENEFICIARY ACCESS TO MEDICARE-COVERED SERVICES

Sec. 301. Excluding clinical social worker services from coverage under 
                            the medicare skilled nursing facility 
                            prospective payment system and consolidated 
                            payment.
Sec. 302. Coverage of marriage and family therapist services.
Sec. 303. Coverage of mental health counselor services.
Sec. 304. Study of coverage criteria for Alzheimer's disease and 
                            related mental illnesses.

SEC. 2. FINDINGS.

    Congress 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, anxiety, 
        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) Anxiety disorders rival depression in their prevalence 
        among older people with a rate of 11.4 percent in persons aged 
        55 and older.
            (5) Almost 20 percent of the population of individuals age 
        55 and older, experience specific mental disorders that are not 
        part of normal aging.
            (6) Unrecognized and untreated depression, Alzheimer's 
        disease, anxiety, late-life schizophrenia, and other mental 
        conditions can be severely impairing and may even be fatal.
            (7) 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.
            (8) The disabled are another population receiving 
        inadequate mental health care through medicare. According to 
        the Centers for Medicare & Medicaid Services, medicare is the 
        primary health care coverage for the 5,000,000 nonelderly, 
        disabled people on Social Security Disability Insurance. Up to 
        40 percent of these individuals have a diagnosis of mental 
        illness.
            (9) The current medicare benefit structure discriminates 
        against the millions of Americans who suffer from mental 
        illness and maintains an outdated bias toward institutionally 
        based service delivery. According to the report of the Surgeon 
        General on mental health for 1999, intensive outpatient 
        services, such as psychiatric rehabilitation and assertive 
        community treatment, represent state-of-the-art mental health 
        services. These evidence-based community support services help 
        people with psychiatric disabilities improve their ability to 
        function in the community and reduce hospitalization rates by 
        30 to 60 percent, even for people with the most severe mental 
        illnesses.

        TITLE I--ESTABLISHING PARITY FOR MENTAL HEALTH SERVICES

SEC. 101. ELIMINATION OF LIFETIME LIMIT ON INPATIENT MENTAL HEALTH 
              SERVICES.

    (a) In General.--Section 1812 of the Social Security Act (42 U.S.C. 
1395d) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (1), by adding ``or'' at the end;
                    (B) in paragraph (2), by striking ``; or'' at the 
                end and inserting a period; and
                    (C) by striking paragraph (3); and
            (2) by striking subsection (c).
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to items and services furnished on or after January 1, 2006.

SEC. 102. PARITY IN TREATMENT FOR OUTPATIENT MENTAL HEALTH SERVICES.

    (a) In General.--Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by striking subsection (c).
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items and services furnished on or after January 1, 2006.

 TITLE II--EXPANDING COVERAGE OF COMMUNITY-BASED MENTAL HEALTH SERVICES

SEC. 201. COVERAGE OF INTENSIVE RESIDENTIAL SERVICES.

    (a) Coverage Under Part A.--Section 1812(a) of the Social Security 
Act (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 and 
        inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(6) intensive residential services (as defined in section 
        1861(bbb)) furnished to an individual for up to 120 days during 
        any calendar year, except that such services may be furnished 
        to the individual for additional days (not to exceed 20 days) 
        during the year if necessary for the individual to complete a 
        course of treatment.''.
    (b) Services Described.--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

    ``(bbb)(1) Subject to paragraphs (3) and (4), the term `intensive 
residential services' means a program of residential services 
(described in paragraph (2)) that is--
            ``(A) prescribed by a physician for an individual entitled 
        to, or enrolled for, benefits under part A who is under the 
        care of the physician; and
            ``(B) furnished under the supervision of a physician 
        pursuant to an individualized, written plan of treatment 
        established and periodically reviewed by a physician (in 
        consultation with appropriate staff participating in such 
        services), which plan sets forth--
                    ``(i) the individual's diagnosis,
                    ``(ii) the type, amount, frequency, and duration of 
                the items and services provided under the plan, and
                    ``(iii) the goals for treatment under the plan.
In the case of such an individual who is receiving qualified 
psychologist services (as defined in subsection (ii)), the individual 
may be under the care of the clinical psychologist with respect to such 
services under this subsection to the extent permitted under State law.
    ``(2) The program of residential services described in this 
paragraph is a nonhospital-based community residential program that 
furnishes acute mental health services or substance abuse services, or 
both, on a 24-hour basis. Such services shall include treatment 
planning and development, medication management, case management, 
crisis intervention, individual therapy, group therapy, and 
detoxification services. Such services shall be furnished in any of the 
following facilities:
            ``(A) Crisis residential programs or mental illness 
        residential treatment programs.
            ``(B) Therapeutic family or group treatment homes.
            ``(C) Residential detoxification centers.
            ``(D) Residential centers for substance abuse treatment.
    ``(3) No service may be treated as an intensive residential service 
under paragraph (1) 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 
        meets such certification requirements that the Secretary may 
        impose; and
            ``(B) meets such other requirements as the Secretary may 
        impose to assure the quality of the intensive residential 
        services provided.
    ``(4) 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) 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 intensive residential 
        services,'' after ``hospice care,''; and
            (2) by adding at the end the following new subsection:

              ``Payment for Intensive Residential Services

    ``(m)(1) The amount of payment under this part for intensive 
residential services under section 1812(a)(6) shall be equal to an 
amount specified under a prospective payment system established by the 
Secretary, taking into account the prospective payment system 
established for psychiatric hospitals pursuant to section 124 of the 
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 
(113 Stat. 1501A-332), as enacted into law by section 1000(a)(6) of 
Public Law 106-113.
    ``(2) Prior to the date on which the Secretary implements the 
prospective payment system established under paragraph (1), the amount 
of payment under this part for such intensive residential services is 
the reasonable costs of providing such services.''.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2006.

SEC. 202. COVERAGE OF INTENSIVE OUTPATIENT SERVICES.

    (a) Coverage.--Section 1832(a)(2) of the Social Security Act (42 
U.S.C. 1395k(a)(2)) is amended--
            (1) in subparagraph (I), by striking ``and'' at the end;
            (2) in subparagraph (J), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(K) intensive outpatient services (as described 
                in section 1861(ccc)).''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x), as amended by section 201(b), is amended by adding 
at the end the following new subsection:

                    ``Intensive Outpatient Services

    ``(ccc)(1) The term `intensive outpatient services' means the items 
and services described in paragraph (2) prescribed by a physician and 
provided within the context described in paragraph (3) under the 
supervision of a physician (or, to the extent permitted under the law 
of the State in which the services are furnished, a non-physician 
mental health professional) pursuant to an individualized, written plan 
of treatment that is established by a physician and periodically 
reviewed by a physician or, to the extent permitted under the laws of 
the State in which the services are furnished, a non-physician mental 
health professional (in consultation with appropriate staff 
participating in such services), which plan sets forth the patient's 
diagnosis, the type, amount, frequency, and duration of the items and 
services provided under the plan, and the goals for treatment under the 
plan.
    ``(2)(A) The items and services described in this paragraph are the 
items and services described in subparagraph (B) that are reasonable 
and necessary for the diagnosis or treatment of the individual's 
condition, reasonably expected to improve or maintain the individual's 
condition and functional level and to prevent relapse or 
hospitalization, and furnished pursuant to such guidelines relating to 
frequency and duration of services as the Secretary shall by regulation 
establish (taking into account accepted norms of clinical practice).
    ``(B) For purposes of subparagraph (A), the items and services 
described in this paragraph are as follows:
            ``(i) Psychiatric rehabilitation.
            ``(ii) Assertive community treatment.
            ``(iii) Intensive case management.
            ``(iv) Day treatment for individuals under 21 years of age.
            ``(v) Ambulatory detoxification.
            ``(vi) Such other items and services as the Secretary may 
        provide (but in no event to include meals and transportation).
    ``(3) The context described in this paragraph for the provision of 
intensive outpatient services is as follows:
            ``(A) Such services are furnished in a facility, home, or 
        community setting.
            ``(B) Such services are furnished--
                    ``(i) to assist the individual to compensate for, 
                or eliminate, functional deficits and interpersonal and 
                environmental barriers created by the disability; and
                    ``(ii) to restore skills to the individual for 
                independent living, socialization, and effective life 
                management.
            ``(C) Such services are furnished by an individual or 
        entity that--
                    ``(i) is legally authorized to furnish such 
                services under State law (or the State regulatory 
                mechanism provided by State law) or meets such 
                certification requirements that the Secretary may 
                impose; and
                    ``(ii) meets such other requirements as the 
                Secretary may impose to assure the quality of the 
                intensive outpatient services provided.''.
    (c) Payment.--
            (1) In general.--With respect to intensive outpatient 
        services (as defined in section 1861(ccc)(1) of the Social 
        Security Act (as added by subsection (b)) furnished under the 
        medicare program, the amount of payment under such Act for such 
        services shall be 80 percent of--
                    (A) during 2006 and 2007, the reasonable costs of 
                furnishing such services; and
                    (B) on or after January 1, 2008, the amount of 
                payment established for such services under the 
                prospective payment system established by the Secretary 
                under paragraph (2) for such services.
            (2) Establishment of pps.--
                    (A) In general.--With respect to intensive 
                outpatient services (as defined in section 
                1861(ccc)(1)) of the Social Security Act (as added by 
                subsection (b)) furnished under the medicare program on 
                or after January 1, 2008, the Secretary of Health and 
                Human Services (in this paragraph referred to as the 
                ``Secretary'') shall establish a prospective payment 
                system for payment for such services. Such system shall 
                include an adequate patient classification system that 
                reflects the differences in patient resource use and 
                costs and shall provide for an annual update to the 
                rates of payment established under the system.
                    (B) Adjustments.--In establishing the system under 
                subparagraph (A), the Secretary shall provide for 
                adjustments in the prospective payment amount for 
                variations in wage and wage-related costs, case mix, 
                and such other factors as the Secretary determines 
                appropriate.
                    (C) Collection of data and evaluation.--In 
                developing the system described in subparagraph (A), 
                the Secretary may require providers of services under 
                the medicare program to submit such information to the 
                Secretary as the Secretary may require to develop the 
                system, including the most recently available data.
                    (D) Reports to congress.--Not later than October 1 
                of each of 2006 and 2007, the Secretary shall submit to 
                Congress a report on the progress of the Secretary in 
                establishing the prospective payment system under this 
                paragraph.
    (d) Conforming Amendments.--(1) Section 1835(a)(2) of the Social 
Security Act (42 U.S.C. 1395n(a)(2)) is amended--
            (A) in subparagraph (E), by striking ``and'' at the end;
            (B) in subparagraph (F), by striking the period at the end 
        and inserting ``; and''; and
            (C) by inserting after subparagraph (F) the following new 
        subparagraph:
                    ``(G) in the case of intensive outpatient services, 
                (i) that those services are reasonably expected to 
                improve or maintain the individual's condition and 
                functional level and to prevent relapse or 
                hospitalization, (ii) an individualized, written plan 
                for furnishing such services has been established by a 
                physician and is reviewed periodically by a physician 
                or, to the extent permitted 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 mental 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 professional,'' after ``under the 
        supervision of a physician'' and after ``periodically reviewed 
        by a physician''; and
            (B) by striking ``physician's'' and inserting 
        ``patient'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 extent 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 respect to such services to the extent permitted under the 
        law of the State in which the services are furnished''.
    (e) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2006.

  TITLE III--IMPROVING BENEFICIARY ACCESS TO MEDICARE-COVERED SERVICES

SEC. 301. 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 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 
facility which the facility is required to provide as a requirement for 
participation''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2006.

SEC. 302. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES.

    (a) Coverage of Services.--Section 1861(s)(2) of the Social 
Security Act (42 U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (Y), by striking ``and'' at the end;
            (2) in subparagraph (Z), by adding ``and'' at the end; and
            (3) by adding at the end the following new subparagraph:
            ``(AA) marriage and family therapist services (as defined 
        in subsection (ddd));''.
    (b) Definition.--Section 1861 of the Social Security 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

    ``(ddd)(1) The term `marriage and family therapist services' means 
services performed by a marriage and family therapist (as defined in 
paragraph (2)) for the diagnosis and treatment of mental illnesses, 
which the marriage and family therapist is legally authorized to 
perform under State law (or the State regulatory mechanism provided 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.--Section 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 following 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 ``(V)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (W) with respect to marriage and 
                family therapist services under section 1861(s)(2)(AA), 
                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 respect to consultation 
        with a physician.--The Secretary of Health and Human Services 
        shall, taking into consideration concerns for patient 
        confidentiality, 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 (42 U.S.C. 1395j et 
        seq.) under which such a therapist must agree to consult with a 
        patient's attending or primary care physician in accordance 
        with such criteria.
    (e) Exclusion of Marriage and Family Therapist Services From 
Skilled Nursing Facility Prospective Payment System.--Section 
1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 
1395yy(e)(2)(A)(ii)), as amended in section 301(a), is amended by 
inserting ``marriage and family therapist services (as defined in 
subsection (ddd)(1)),'' after ``clinical social worker services,''.
    (f) Coverage of Marriage and Family Therapist 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)) 
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)), or by a marriage and family 
therapist (as defined in subsection (ddd)(2)),''.
    (g) Inclusion of Marriage and Family Therapists as Practitioners 
for Assignment of Claims.--Section 1842(b)(18)(C) of the Social 
Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the 
end the following new clause:
            ``(vii) A marriage and family therapist (as defined in 
        section 1861(ddd)(2)).''.
    (h) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2006.

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 (Z), by striking ``and'' at the end;
            (2) in subparagraph (AA), by inserting ``and'' at the end; 
        and
            (3) by adding at the end the following new subparagraph:
                    ``(BB) mental health counselor services (as defined 
                in subsection (eee)(2));''.
    (b) Definition.--Section 1861 of the Social Security 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

    ``(eee)(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 performed 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 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.''.
    (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 ``(W)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (X) with respect to mental 
                health counselor services under section 1861(s)(2)(BB), 
                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 respect to consultation 
        with a physician.--The Secretary of Health and Human Services 
        shall, taking into consideration concerns for patient 
        confidentiality, 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 (42 U.S.C. 1395j et seq.) 
        under which such a counselor must agree to consult with a 
        patient's attending or primary care physician in accordance 
        with such criteria.
    (d) Exclusion of Mental Health Counselor Services From Skilled 
Nursing Facility Prospective 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(eee)(2)),'' after 
``marriage and family therapist services (as defined in subsection 
(ddd)(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 inserting ``by a 
        marriage''; and
            (2) by inserting ``or a mental health counselor (as defined 
        in subsection (eee)(1)),'' after ``marriage and family 
        therapist (as defined in subsection (ddd)(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(eee)(1)).''.
    (g) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2006.

SEC. 304. 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 (42 U.S.C. 1395 et seq.) 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.
                                 <all>