II 109th CONGRESS 2d Session S. 3500 IN THE SENATE OF THE UNITED STATES June 13, 2006 Mr. Thomas (for himself, Mr. Conrad, Mr. Harkin, Mr. Roberts, Ms. Collins, Mr. Dayton, Mr. Salazar, Mr. Domenici, Mr. Burns, Mr. Dorgan, Mr. Thune, Mr. Johnson, Mr. Nelson of Nebraska, Ms. Murkowski, and Ms. Snowe) 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 protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program, and for other purposes.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Rural Hospital and Provider Equity (HoPE) Act of 2006. (b)

Table of Contents

The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals. Sec. 3. Extension and Expansion of Medicare hold harmless provision under the prospective payment system for hospital outpatient department (HOPD) services. Sec. 4. Improvement of definition of low-volume hospital for purposes of the Medicare inpatient hospital payment adjustment. Sec. 5. Extension of Medicare wage index reclassifications for certain hospitals. Sec. 6. Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas. Sec. 7. Critical access hospital improvements. Sec. 8. Capital infrastructure revolving loan program. Sec. 9. Extension of Medicare incentive payment program for physician scarcity areas. Sec. 10. Extension of floor on medicare work geographic adjustment. Sec. 11. Medicare home health care planning improvements. Sec. 12. Rural health clinic improvements. Sec. 13. Community health center collaborative access expansion. Sec. 14. Applying add-on policy for home health services furnished in a rural area for 2007. Sec. 15. Use of medical conditions for coding ambulance services. Sec. 16. Extension of increased Medicare payments for ground ambulance services in rural areas. Sec. 17. Improvement in payments to retain emergency and other capacity for ambulances in rural areas. Sec. 18. Coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program. Sec. 19. Medicare remote monitoring pilot projects. Sec. 20. Facilitating the provision of telehealth services across State lines.

2.

Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals

Section 1886(d)(5)(F)(xiv)(II) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended— (1)by striking or, in the case and all that follows through subparagraph (G)(iv); and (2)by inserting at the end the following new sentence: The preceding sentence shall not apply to any hospital with respect to discharges occurring on or after October 1, 2006..

3.

Extension and Expansion of Medicare hold harmless provision under the prospective payment system for hospital outpatient department (HOPD) services

(a)

Extension

(1)

In general

Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)), as amended by section 5105 of the Deficit Reduction Act of 2005 (Public Law 109–171), is amended— (A)in subclause (I)— (i)by striking (I); (ii)by striking (iii)) located in a rural area and inserting (iii)); and (iii)by striking before January 1, 2006 and inserting before January 1, 2009; and (B)by striking subclause (II). (2)

Effective date

The amendments made by paragraph (1) shall apply to covered OPD services furnished on or after January 1, 2006. (b)

Study and Report

(1)

Study

The Secretary of Health and Human Services shall conduct a study to determine if, under the prospective payment system for hospital outpatient department services under section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)), costs incurred by sole community hospitals (as defined in section 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 1395ww(d)(5)(D)(iii))) located in urban areas by ambulatory payment classification groups (APCs) exceed those costs incurred by other hospitals located in urban areas. (2)

Report

Not later than January 1, 2008, the Secretary of Health and Human Services shall submit to Congress a report on the study conducted under paragraph (1) together with recommendations for such legislation and administrative action as the Secretary determines to be appropriate.

4.

Improvement of definition of low-volume hospital for purposes of the Medicare inpatient hospital payment adjustment

Section 1886(d)(12)(C)(i) of the Social Security Act (42 U.S.C. 1395ww(d)(12)(C)(i)) is amended by inserting (or, beginning with fiscal year 2007, 2,000 discharges) after 800 discharges.

5.

Extension of Medicare wage index reclassifications for certain hospitals

(a)

MMA Provision

Section 508 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395ww note) is amended by adding at the end the following new subsection: (g)

Three-year Extension for Certain Hospitals

(1)

In general

In the case of a hospital described in paragraph (2)— (A)subsections (a)(3) and (b) shall be applied by substituting 6-year period for 3-year period; and (B)the limitation under subsection (e) shall not apply after March 31, 2007. (2)

Hospital described

A hospital described in this paragraph is a hospital— (A)that is reclassified to an area under this section as of the day before the date of enactment of this subsection; and (B)(i)that is located in a State with less than 10 people per square mile; or (ii)(I)that is located in a rural area; and (II)for which the Secretary has determined the extension under this subsection to be appropriate. . (b)

Additional Provision

The Secretary of Health and Human Services shall extend the special exception reclassification of a sole community hospital located in a State with less than 10 people per square mile (made under the authority of section 1886(d)(5)(I)(i) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(I)(i)) and contained in the final rule promulgated by the Secretary in the Federal Register on August 11, 2004 (69 Fed. Reg. 49107)) for 3 years through fiscal year 2010.

6.

Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas

Section 416(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 2282; 42 U.S.C. 1395l–4(b)) is amended by striking 2-year and inserting 4-year.

7.

Critical access hospital improvements

(a)

Clarification of payment for clinical laboratory tests furnished by critical access hospitals

(1)

In general

Section 1834(g)(4) of the Social Security Act (42 U.S.C. 1395m(g)(4)) is amended— (A)in the heading, by striking no beneficiary cost-sharing and inserting treatment of; and (B)by adding at the end the following new sentence: “For purposes of the preceding sentence and section 1861(mm)(3), clinical diagnostic laboratory services furnished by a critical access hospital shall be treated as being furnished as part of outpatient critical access services without regard to whether— (A)the individual with respect to whom such services are furnished is physically present in the critical access hospital at the time the specimen is collected; (B)such individual is registered as an outpatient on the records of, and receives such services directly from, the critical access hospital; or (C)payment is (or, but for this subsection, would be) available for such services under the fee schedule established under section 1833(h). . (2)

Effective date

The amendments made by paragraph (1) shall apply to cost reporting periods beginning on or after October 1, 2003. (b)

Elimination of Isolation Test for cost-based ambulance reimbursement

(1)

In general

Section 1834(l)(8) of the Social Security Act (42 U.S.C. 1395m(l)(8)) is amended— (A)in subparagraph (B)— (i)by striking owned and; and (ii)by inserting (including when such services are provided by the entity under an arrangement with the hospital) after hospital; and (B)by striking the comma at the end of subparagraph (B) and all that follows and inserting a period. (2)

Effective date

The amendments made by this subsection shall apply to services furnished on or after January 1, 2007.

8.

Capital infrastructure revolving loan program

(a)

In General

Part A of title XVI of the Public Health Service Act (42 U.S.C. 300q et seq.) is amended by adding at the end the following new section:

1603.

Capital infrastructure revolving loan program

(a)

Authority To Make and Guarantee Loans

(1)

Authority to make loans

The Secretary may make loans from the fund established under section 1602(d) to any rural entity for projects for capital improvements, including— (A)the acquisition of land necessary for the capital improvements; (B)the renovation or modernization of any building; (C)the acquisition or repair of fixed or major movable equipment; and (D)such other project expenses as the Secretary determines appropriate. (2)

Authority to guarantee loans

(A)

In general

The Secretary may guarantee the payment of principal and interest for loans made to rural entities for projects for any capital improvement described in paragraph (1) to any non-Federal lender. (B)

Interest subsidies

In the case of a guarantee of any loan made to a rural entity under subparagraph (A), the Secretary may pay to the holder of such loan, for and on behalf of the project for which the loan was made, amounts sufficient to reduce (by not more than 3 percent) the net effective interest rate otherwise payable on such loan. (b)

Amount of Loan

The principal amount of a loan directly made or guaranteed under subsection (a) for a project for capital improvement may not exceed $5,000,000. (c)

Funding Limitations

(1)

Government credit subsidy exposure

The total of the Government credit subsidy exposure under the Credit Reform Act of 1990 scoring protocol with respect to the loans outstanding at any time with respect to which guarantees have been issued, or which have been directly made, under subsection (a) may not exceed $50,000,000 per year. (2)

Total amounts

Subject to paragraph (1), the total of the principal amount of all loans directly made or guaranteed under subsection (a) may not exceed $250,000,000 per year. (d)

Capital Assessment and Planning Grants

(1)

Nonrepayable grants

Subject to paragraph (2), the Secretary may make a grant to a rural entity, in an amount not to exceed $50,000, for purposes of capital assessment and business planning. (2)

Limitation

The cumulative total of grants awarded under this subsection may not exceed $2,500,000 per year. (e)

Termination of Authority

The Secretary may not directly make or guarantee any loan under subsection (a) or make a grant under subsection (d) after September 30, 2010.

. (b)

Rural Entity Defined

Section 1624 of the Public Health Service Act (42 U.S.C. 300s–3) is amended by adding at the end the following new paragraph: (15)(A)The term rural entity includes— (i)a rural health clinic, as defined in section 1861(aa)(2) of the Social Security Act; (ii)any medical facility with at least 1 bed, but with less than 50 beds, that is located in— (I)a county that is not part of a metropolitan statistical area; or (II)a rural census tract of a metropolitan statistical area (as determined under the most recent modification of the Goldsmith Modification, originally published in the Federal Register on February 27, 1992 (57 Fed. Reg. 6725)); (iii)a hospital that is classified as a rural, regional, or national referral center under section 1886(d)(5)(C) of the Social Security Act; and (iv)a hospital that is a sole community hospital (as defined in section 1886(d)(5)(D)(iii) of the Social Security Act). (B)For purposes of subparagraph (A), the fact that a clinic, facility, or hospital has been geographically reclassified under the Medicare program under title XVIII of the Social Security Act shall not preclude a hospital from being considered a rural entity under clause (i) or (ii) of subparagraph (A). . (c)

Conforming Amendments

Section 1602 of the Public Health Service Act (42 U.S.C. 300q–2) is amended— (1)in subsection (b)(2)(D), by inserting or 1603(a)(2)(B) after 1601(a)(2)(B); and (2)in subsection (d)— (A)in paragraph (1)(C), by striking section 1601(a)(2)(B) and inserting sections 1601(a)(2)(B) and 1603(a)(2)(B); and (B)in paragraph (2)(A), by inserting or 1603(a)(2)(B) after 1601(a)(2)(B).

9.

Extension of Medicare incentive payment program for physician scarcity areas

Section 1833(u)(1) of the Social Security Act (42 U.S.C. 1395l(u)(1)) is amended by striking before January 1, 2008 and inserting before January 1, 2009.

10.

Extension of floor on medicare work geographic adjustment

Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w–4(e)(1)(E)) is amended by striking before January 1, 2007 and inserting before January 1, 2009.

11.

Medicare home health care planning improvements

(a)

In general

Section 1814(a)(2) of the Social Security Act (42 U.S.C. 1395f(a)(2)), in the matter preceding subparagraph (A), is amended— (1)by striking subparagraph (B) and inserting subparagraphs (B) and (C); (2)by inserting (as those terms are defined in section 1861(aa)(5)) after clinical nurse specialist; (3)by inserting or home health agency (as the case may be) after facility; and (4)by inserting (or in the case of services described in subparagraph (C), a physician assistant (as defined in 1861(aa)(5)) under the supervision of a physician) after collaboration with a physician. (b)

Conforming amendments

(1)Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) is amended— (A)in paragraph (2)(C), by inserting a nurse practitioner, a clinical nurse specialist, or a physician assistant (as the case may be) after physician each place it appears; (B)in the second sentence, by striking or clinical nurse specialist and inserting clinical nurse specialist, or physician assistant; (C)in the third sentence— (i)by striking physician certification and inserting certification; (ii)by inserting (or on January 1, 2007, in the case of regulations to implement the amendments made by section 11 of the Rural Hospital and Provider Equity (HoPE) Act of 2006) after 1981; and (iii)by striking a physician who and inserting a physician, nurse practitioner, clinical nurse specialist, or physician assistant who; and (D)in the fourth sentence, by inserting , nurse practitioner, clinical nurse specialist, or physician assistant after physician. (2)Section 1835(a) of the Social Security Act (42 U.S.C. 1395n(a)) is amended— (A)in paragraph (2)— (i)in the matter preceding subparagraph (A), by inserting or, in the case of services described in subparagraph (A), a physician, or a nurse practitioner or clinical nurse specialist (as those terms are defined in 1861(aa)(5)), who does not have a direct or indirect employment relationship with the home health agency but is working in collaboration with a physician (or a physician assistant (as defined in 1861(aa)(5)) under the supervision of a physician) after a physician; and (ii)in subparagraph (A) by inserting a nurse practitioner, a clinical nurse specialist, or a physician assistant (as the case may be) after physician each place it appears; (B)in the third sentence, by inserting , nurse practitioner, clinical nurse specialist, or physician assistant (as the case may be) after physician; (C)in the fourth sentence— (i)by striking physician certification and inserting certification; (ii)by inserting (or on January 1, 2007, in the case of regulations to implement the amendments made by section 11 of the Rural Hospital and Provider Equity (HoPE) Act of 2006) after 1981; and (iii)by striking a physician who and inserting a physician, nurse practitioner, clinical nurse specialist, or physician assistant who; and (D)in the fifth sentence, by inserting , nurse practitioner, clinical nurse specialist, or physician assistant after physician. (3)Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (A)in subsection (m)— (i)in the matter preceding paragraph (1)— (I)by inserting , or a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in subsection (aa)(5)) after physician the first place it appears; and (II)by inserting or a nurse practitioner, clinical nurse specialist, or physician assistant after physician the second place it appears; and (ii)in paragraph (3), by inserting or a nurse practitioner, clinical nurse specialist, or physician assistant after physician; and (B)in subsection (o)(2)— (i)by inserting , nurse practitioners, clinical nurse specialists, or physician assistants (as those terms are defined in subsection (aa)(5)) after physicians; and (ii)by inserting , nurse practitioner, clinical nurse specialist, physician assistant, after physician (4)Section 1895 of the Social Security Act (42 U.S.C. 1395fff) is amended— (A)in subsection (c)(1), by inserting , or the nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1861(aa)(5)), after physician; and (B)in subsection (e)— (i)in paragraph (1)(A), by inserting , or a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1861(aa)(5)), after physician; and (ii)in paragraph (2)— (I)in the heading, by striking Physician certification and inserting Rule of construction regarding requirement for certification; and (II)by striking physician. (c)

Effective Date

The amendments made by this section shall apply to items and services furnished on or after January 1, 2007.

12.

Rural health clinic improvements

Section 1833(f) of the Social Security Act (42 U.S.C. 1395l(f)) is amended— (1)in paragraph (1), by striking , and at the end and inserting a semicolon; (2)in paragraph (2)— (A)by inserting (before 2007) after in a subsequent year; and (B)by striking the period at the end and inserting a semicolon; and (3)by adding at the end the following new paragraphs: (3)in 2007, at $82 per visit; and (4)in a subsequent year, at the limit established under this subsection for the previous year increased by the percentage increase in the MEI (as so defined) applicable to primary care services (as so defined) furnished as of the first day of that year.

13.

Community health center collaborative access expansion

Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended by adding at the end the following: (s)

Miscellaneous Provisions

(1)

Rule of construction with respect to rural health clinics

(A)

In general

Nothing in this section shall be construed to prevent a community health center from contracting with a federally certified rural health clinic (as defined by section 1861(aa)(2) of the Social Security Act) for the delivery of primary health care services that are available at the rural health clinic to individuals who would otherwise be eligible for free or reduced cost care if that individual were able to obtain that care at the community health center. Such services may be limited in scope to those primary health care services available in that rural health clinic. (B)

Assurances

In order for a rural health clinic to receive funds under this section through a contract with a community health center under paragraph (1), such rural health clinic shall establish policies to ensure— (i)nondiscrimination based upon the ability of a patient to pay; and (ii)the establishment of a sliding fee scale for low-income patients. .

14.

Applying add-on policy for home health services furnished in a rural area for 2007

Section 421 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 2283), as amended by section 5201(b) of the Deficit Reduction Act of 2005 (Public Law 109–171), is amended— (1)in the heading, by striking One-year and inserting Temporary; and (2)in subsection (a), by striking before January 1, 2007 and inserting before January 1, 2008.

15.

Use of medical conditions for coding ambulance services

Section 1834(l)(7) of the Social Security Act (42 U.S.C. 1395m(l)(7)) is amended to read as follows: (7)

Coding system

(A)

In general

The Secretary shall, in accordance with section 1173(c)(1)(B) and not later than January 1, 2007, establish a mandatory system or systems for the coding of claims for ambulance services for which payment is made under this subsection, including a code set specifying the medical condition of the individual who is transported and the level of service that is appropriate for the transportation of an individual with that medical condition. (B)

Medical conditions

The code set established under subparagraph (A) shall take into account the list of medical conditions developed in the course of the negotiated rulemaking process conducted under paragraph (1). .

16.

Extension of increased Medicare payments for ground ambulance services in rural areas

Section 1834(l)(13) of the Social Security Act (42 U.S.C. 1395m(l)(13)) is amended— (1)in subparagraph (A), in the matter preceding clause (i), by striking before January 1, 2007 and inserting before January 1, 2008; (2)in subparagraph (B), in the heading, by striking after 2006 and inserting after 2007.

17.

Improvement in payments to retain emergency and other capacity for ambulances in rural areas

(a)

In General

Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) is amended by adding at the end the following new paragraph: (15)

Additional payments for providers furnishing ambulance services in rural areas

(A)

In general

In the case of ground ambulance services furnished on or after January 1, 2007, for which the transportation originates in a rural area (as determined under subparagraph (B)), the Secretary shall provide for a percent increase in the base rate of the fee schedule for a trip identified under this subsection. (B)

Identification of rural areas

The Secretary, in consultation with the Office of Rural Health Policy, shall use the Rural-Urban Commuting Areas (RUCA) coding system, adopted by that Office, to designate rural areas for the purposes of this paragraph. A rural area is any area in RUCA levels 2 through 10 and any unclassified area. (C)

Tiering of rural areas

The Secretary shall designate 4 tiers of rural areas, using a ZIP Code population-based methodology generated by the RUCA coding system, as follows: (i)

Tier 1

A rural area that is a high metropolitan commuting area, in which 30 percent or more of the commuting flow is to an urban area, as designated by the Bureau of the Census (RUCA level 2). (ii)

Tier 2

A rural area that is a low metropolitan commuting area, in which less than 30 percent of the commuting flow is to an urban area or to a large town, as designated by the Bureau of the Census (RUCA levels 3–6). (iii)

Tier 3

A rural area that is a small town core, as designated by the Bureau of the Census, in which no significant portion of the commuting flow is to an area of population greater than 10,000 people (RUCA levels 7–9). (iv)

Tier 4

A rural area in which there is no dominant commuting flow (RUCA level 10) and any unclassified area. The Secretary shall consult with the Office of Rural Health Policy not less often than every 2 years to update the designation of rural areas in accordance with any changes that are made to the RUCA system.(D)

Payment adjustments for trips in rural areas

The Secretary shall adjust the payment rate under this section for ambulance trips that originate in each of the tiers established in subparagraph (C) according to the national average cost of full-cost providers for providing ambulance services in each such tier. . (b)

Review of Payments for Rural Ambulance Services and Report to Congress

(1)

Review

Not later than July 1, 2009, the Secretary of Health and Human Services shall review the system for adjusting payments for rural ambulance services under section 1834(l)(15) of the Social Security Act, as added by subsection (a), to determine the adequacy and appropriateness of such adjustments. In conducting such review, the Secretary shall consult with providers and suppliers affected by such adjustments and with representatives of the ambulance industry generally to determine— (A)whether such adjustments adequately cover the additional costs incurred in serving areas of low population density; and (B)whether the tiered structure for making such adjustments appropriately reflects the difference in costs of providing services in different types of rural areas. (2)

Report

Not later than January 1, 2010, the Secretary shall submit to Congress a report on the review conducted under paragraph (1) together with any recommendations for revision to the systems for adjusting payments for ambulance services in rural areas that the Secretary of Health and Human Services determines appropriate. (c)

Conforming Amendments

(1)Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)), as amended by subsection (a), is amended by adding at the end the following new paragraph: (16)

Designation of rural areas for mileage payment purposes

In establishing any differential in the amount of payment for mileage between rural and urban areas in the fee schedule established under paragraph (1), the Secretary shall, in the case of ambulance services furnished on or after January 1, 2007, identify rural areas in the same manner as provided in paragraph (15)(B). . (2)Section 1834(l)(12)(A) of the Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended by striking January 1, 2010 and inserting January 1, 2007. (3)Section 1834(l)(13)(A)(i) of the Social Security Act (42 U.S.C. 1395m(l)(13)(A)(i)) is amended— (A)by inserting (or in the case of such services furnished in 2007, in a rural area identified by the Secretary under paragraph (15)(B)) after such paragraph; and (B)by striking paragraphs (11) and (12) and inserting paragraphs (11), (12), and (15).

18.

Coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program

(a)

Coverage of Services

(1)

In general

Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 5112 of the Deficit Reduction Act of 2005 (Public Law 109–171), is amended— (A)in subparagraph (Z), by striking and at the end; (B)in subparagraph (AA), by inserting and at the end; and (C)by adding at the end the following new subparagraph: (BB)marriage and family therapist services (as defined in subsection (ccc)(1)) and mental health counselor services (as defined in subsection (ccc)(3)); . (2)

Definitions

Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 5112 of the Deficit Reduction Act of 2005 (Public Law 109–171), is amended by adding at the end the following new subsection: (ccc)

Marriage and Family Therapist Services; Marriage and Family Therapist; Mental Health Counselor Services; Mental Health Counselor

(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, as would otherwise be covered if furnished by a physician or as an 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)in the case of an individual performing services in a State that provides for licensure or certification of marriage and family therapists, is licensed or certified as a marriage and family therapist 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 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. (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 performed 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 certification of mental health counselors or professional counselors, is licensed or certified as a mental health counselor or professional counselor in such State. . (3)

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 and mental health counselor services; . (4)

Amount of payment

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended— (A)by striking and (V) and inserting (V); and (B)by inserting before the semicolon at the end the following: , and (W) with respect to marriage and family therapist services and mental health counselor services under section 1861(s)(2)(BB), 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 subparagraph (L). (5)

Exclusion of marriage and family therapist services and 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)) is amended by inserting marriage and family therapist services (as defined in section 1861(ccc)(1)), mental health counselor services (as defined in section 1861(ccc)(3)), after qualified psychologist services,. (6)

Inclusion of marriage and family therapists and 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)) is amended by adding at the end the following new clauses: (vii)A marriage and family therapist (as defined in section 1861(ccc)(2)). (viii)A mental health counselor (as defined in section 1861(ccc)(4)). . (b)

Coverage of Certain Mental Health Services Provided in Certain Settings

(1)

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)), by a marriage and family therapist (as defined in subsection (ccc)(2)), or by a mental health counselor (as defined in subsection (ccc)(4)),. (2)

Hospice programs

Section 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by inserting or one marriage and family therapist (as defined in subsection (ccc)(2)) after social worker. (c)

Authorization of Marriage and Family Therapists to Develop Discharge Plans for Post-Hospital Services

Section 1861(ee)(2)(G) of the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended by inserting marriage and family therapist (as defined in subsection (ccc)(2)), after social worker,. (d)

Effective Date

The amendments made by this section shall apply with respect to services furnished on or after January 1, 2007.

19.

Medicare remote monitoring pilot projects

(a)

Pilot projects

(1)

In general

Not later than 9 months after the date of enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall conduct pilot projects under title XVIII of the Social Security Act for the purpose of providing incentives to home health agencies to utilize home monitoring and communications technologies that— (A)enhance health outcomes for Medicare beneficiaries; and (B)reduce expenditures under such title. (2)

Site requirements

(A)

Urban and Rural

The Secretary shall conduct the pilot projects under this section in both urban and rural areas. (B)

Site in a small state

The Secretary shall conduct at least 3 of the pilot projects in a State with a population of less than 1,000,000. (3)

Definition of home health agency

In this section, the term home health agency has the meaning given that term in section 1861(o) of the Social Security Act (42 U.S.C. 1395x(o)). (b)

Medicare beneficiaries within the scope of projects

The Secretary shall specify the criteria for identifying those Medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection (c) and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section. Such criteria may provide for the inclusion in the projects of Medicare beneficiaries who begin receiving home health services under title XVIII of the Social Security Act after the date of the implementation of the projects. (c)

Incentives

(1)

Performance targets

The Secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies, as determined appropriate by the Secretary: (A)

Adjusted historical performance target

The Secretary shall establish for the agency— (i)a base expenditure amount equal to the average total payments made to the agency under parts A and B of title XVIII of the Social Security Act for Medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the Secretary; and (ii)an annual per capita expenditure target for such beneficiaries, reflecting the base expenditure amount adjusted for risk and adjusted growth rates. (B)

Comparative performance target

The Secretary shall establish for the agency a comparative performance target equal to the average total payments under such parts A and B during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project. (2)

Incentive

Subject to paragraph (3), the Secretary shall pay to each participating home care agency an incentive payment for each year under the pilot project equal to a portion of the Medicare savings realized for such year relative to the performance target under paragraph (1). (3)

Limitation on expenditures

The Secretary shall limit incentive payments under this section in order to ensure that the aggregate expenditures under title XVIII of the Social Security Act (including incentive payments under this subsection) do not exceed the amount that the Secretary estimates would have been expended if the pilot projects under this section had not been implemented. (d)

Waiver authority

The Secretary may waive such provisions of titles XI and XVIII of the Social Security Act as the Secretary determines to be appropriate for the conduct of the pilot projects under this section. (e)

Report to Congress

Not later than 5 years after the date that the first pilot project under this section is implemented, the Secretary shall submit to Congress a report on the pilot projects. Such report shall contain a detailed description of issues related to the expansion of the projects under subsection (f) and recommendations for such legislation and administrative actions as the Secretary considers appropriate. (f)

Expansion

If the Secretary determines that any of the pilot projects under this section enhance health outcomes for Medicare beneficiaries and reduce expenditures under title XVIII of the Social Security Act, the Secretary may initiate comparable projects in additional areas. (g)

Incentive payments have no effect on other Medicare payments to agencies

An incentive payment under this section— (1)shall be in addition to the payments that a home health agency would otherwise receive under title XVIII of the Social Security Act for the provision of home health services; and (2)shall have no effect on the amount of such payments.

20.

Facilitating the provision of telehealth services across State lines

(a)

In general

For purposes of expediting the provision of telehealth services, for which payment is made under the Medicare program, across State lines, the Secretary of Health and Human Services shall, in consultation with representatives of States, physicians, health care practitioners, and patient advocates, encourage and facilitate the adoption of provisions allowing for multistate practitioner practice across State lines. (b)

Definitions

In subsection (a): (1)

Telehealth service

The term telehealth service has the meaning given that term in subparagraph (F) of section 1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)). (2)

Physician, practitioner

The terms physician and practitioner have the meaning given those terms in subparagraphs (D) and (E), respectively, of such section. (3)

Medicare program

The term Medicare program means the program of health insurance administered by the Secretary of Health and Human Services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).