110 HR 1663 IH: To amend title XVIII of the Social Security Act to expand
U.S. House of Representatives
2007-03-23
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited as the Medicare Mental
Health Modernization Act of 2007
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
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.
<enum>I</enum><header>Establishing
Parity for Mental Health Services</header>
<section id="HD65771353EC14F4892945185D9541BF4"><enum>101.</enum><header>Elimination of
lifetime limit on inpatient mental health services</header>
<subsection id="HCA72940CA436438A93F725B86C3EF885"><enum>(a)</enum><header>In
General</header><text>Section 1812 of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395d">42 U.S.C. 1395d</external-xref>) is amended—</text>
<paragraph id="HD916248F28DE45FDA11DB62502E5C801"><enum>(1)</enum><text>in subsection
(b)—</text>
<subparagraph id="HFF59D743F0CA412E995535ADD004BE23"><enum>(A)</enum><text>in paragraph (1),
by adding <quote>or</quote> at the end;</text>
</subparagraph><subparagraph id="HAB6A8229EB784C68ADFB65BD6004D16"><enum>(B)</enum><text>in paragraph (2),
by striking <quote>; or</quote> at the end and inserting a period; and</text>
</subparagraph><subparagraph id="HCC103AC83516433DB93D0846BA004BB6"><enum>(C)</enum><text>by striking
paragraph (3); and</text>
</subparagraph></paragraph><paragraph id="H307BAA89E8CB44568427FD00FDA44C6D"><enum>(2)</enum><text>by striking
subsection (c).</text>
</paragraph></subsection><subsection id="H913B659C4C394612BB2EAAA47CB4F4B"><enum>(b)</enum><header>Effective
Date</header><text>The amendments made by subsection (a) shall apply to items
and services furnished on or after January 1, 2008.</text>
</subsection></section><section id="H056A0F8CB6E14C1FBB48B998E381442F"><enum>102.</enum><header>Parity in
treatment for outpatient mental health services</header>
<subsection id="H4003B9B60DAD4EB0AD162459BA164355"><enum>(a)</enum><header>In
General</header><text>Section 1833 of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (42 U.S.C. 1395<italic>l</italic>) is amended by
striking subsection (c).</text>
</subsection><subsection id="H329874FC9FAF46A78EB2B4A090426FBA"><enum>(b)</enum><header>Effective
Date</header><text>The amendment made by subsection (a) shall apply to items
and services furnished on or after January 1, 2008.</text>
</subsection></section><enum>II</enum><header>Expanding
Coverage of Community-Based Mental Health Services</header>
<section id="HCA06487C14CB4F8A85CAE0E091A085D2"><enum>201.</enum><header>Coverage of
intensive residential services</header>
<subsection id="H3F1D75B8ADC442C39CC454C94BC12F97"><enum>(a)</enum><header>Coverage Under
Part <enum-in-header>A</enum-in-header></header><text>Section 1812(a) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395d(a)) is amended—</text>
<paragraph id="H17FA1F838C4F4DE8B4AFF2685E53B2F"><enum>(1)</enum><text>in
paragraph (4), by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="H5989E9FBA4E541F6B65B008EE719C700"><enum>(2)</enum><text>in paragraph (5),
by striking the period at the end and inserting <quote>; and</quote>;
and</text>
</paragraph><paragraph id="H7D1C7AE952B44AF4AC6F6B5FB6CB1927"><enum>(3)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block id="H173873B16C2947CE86006F911230E2F7" style="OLC">
<paragraph id="HA423473CBD1640ECA974091D1E55D100"><enum>(6)</enum><text>intensive
residential services (as defined in section 1861(ccc)) 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.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H9D0290B5C74D44D100A823F6016B8BC6"><enum>(b)</enum><header>Services
Described</header><text>Section 1861 of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>) is amended
by adding at the end the following new subsection:</text>
<quoted-block act-name="Social Security Act" id="HCD40E78730BF4AD791966B6554438074" style="traditional">
<subsection id="HC588BD85AEAD4D738700EC16DC39F91"><enum>(ccc)</enum><header>Intensive
Residential Services</header><paragraph commented="no" display-inline="yes-display-inline" id="H19D093D288474CBD82AD316B91F1748B"><enum>(1)</enum><text>Subject to paragraphs
(3) and (4), the term <term>intensive residential services</term> means a
program of residential services (described in paragraph (2)) that is—</text>
<subparagraph id="H53DFFE5B4FAC4E21A27044B93BD8A695" indent="up1"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="HBDD1DDF321214486A691E958D9C26D2C" indent="up1"><enum>(B)</enum><text>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—</text>
<clause id="H8425FB002DB74DF18CA05D34FC157E7B"><enum>(i)</enum><text>the individual’s diagnosis,</text>
</clause><clause id="H0ABFF3E17C914258A8B69B230440DA91"><enum>(ii)</enum><text>the type, amount, frequency, and
duration of the items and services provided under the plan, and</text>
</clause><clause id="HBAF5D0A348DB400687CBAA4729168EC2"><enum>(iii)</enum><text>the goals for treatment under the
plan.</text>
</clause></subparagraph></paragraph><continuation-text continuation-text-level="subsection">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.</continuation-text><paragraph id="H7FF144CB9CBF47D18B6CB4737422002E" indent="up1"><enum>(2)</enum><text>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:</text>
<subparagraph id="H5CAF521507E0424380F726D3DAF0E4C"><enum>(A)</enum><text>Crisis residential programs or mental
illness residential treatment programs.</text>
</subparagraph><subparagraph id="H339E1D245EBC47CE88DC9836147BDCEB"><enum>(B)</enum><text>Therapeutic family or group treatment
homes.</text>
</subparagraph><subparagraph id="HA5A2DDAD46DE46CFBBDDD3540195803E"><enum>(C)</enum><text>Residential detoxification
centers.</text>
</subparagraph><subparagraph id="HB8354E77F26B4B9781495C36BFA09E92"><enum>(D)</enum><text>Residential centers for substance
abuse treatment.</text>
</subparagraph></paragraph><paragraph id="H8936FFE1BBF94689A5386B34497508E8" indent="up1"><enum>(3)</enum><text>No service may be treated as an
intensive residential service under paragraph (1) unless the facility at which
the service is provided—</text>
<subparagraph id="H7899BCDD95C3418FB92CFFA476F5D1F"><enum>(A)</enum><text>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</text>
</subparagraph><subparagraph id="HFF3EAD6DB1F14154A58632812D19AF00"><enum>(B)</enum><text>meets such other requirements as the
Secretary may impose to assure the quality of the intensive residential
services provided.</text>
</subparagraph></paragraph><paragraph id="H0E7ACA4DD1074221ABFB2131DE4D24C4" indent="up1"><enum>(4)</enum><text>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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H509F835F558D4A62B141ED4025B03E38"><enum>(c)</enum><header>Amount of
Payment</header><text>Section 1814 of the <act-name parsable-cite="SSA">Social
Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395f">42 U.S.C. 1395f</external-xref>) is amended—</text>
<paragraph id="H9B05ADE8C03D410A824100BFB400FC4F"><enum>(1)</enum><text>in subsection (b),
in the matter preceding paragraph (1), by inserting <quote>other than intensive
residential services,</quote> after <quote>hospice care,</quote>; and</text>
</paragraph><paragraph id="H02BA3B668E034D3281DAA1797FD422F"><enum>(2)</enum><text>by
adding at the end the following new subsection:</text>
<quoted-block id="HD543348676E849B9004F09F9D494962D" style="traditional">
<subsection id="HC9102AF8E5E5482A857530B5097802F"><enum>(m)</enum><header>Payment for
Intensive Residential Services</header><paragraph commented="no" display-inline="yes-display-inline" id="H6CC4247267DC4B0600A71B88788153CC"><enum>(1)</enum><text>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.</text>
</paragraph><paragraph id="H5399863A509B439FBECED5258709CDBA" indent="up1"><enum>(2)</enum><text>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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H6981813A5627458490AE95D446205B76"><enum>(d)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to items and
services furnished on or after January 1, 2008.</text>
</subsection></section><section id="HAC87360D3DC141F7B0BF6D695CB028A2"><enum>202.</enum><header>Coverage of
intensive outpatient services</header>
<subsection id="H4AE3BD8E3AE4437ABEAEA148B1C1B385"><enum>(a)</enum><header>Coverage</header><text>Section
1832(a)(2) of the <act-name parsable-cite="SSA">Social Security Act</act-name>
(<external-xref legal-doc="usc" parsable-cite="usc/42/1395k">42 U.S.C. 1395k(a)(2)</external-xref>) is amended—</text>
<paragraph id="H901B53E8430A4EE4BD006DF9156E6E9D"><enum>(1)</enum><text>in subparagraph
(I), by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="HB9B21DEBC4E6420C95CF1DCBE6B000D1"><enum>(2)</enum><text>in subparagraph
(J), by striking the period at the end and inserting <quote>; and</quote>;
and</text>
</paragraph><paragraph id="HB15314D15C734848B7A4D7736CF0F6D2"><enum>(3)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block id="H9B2C12DD8B25494DB16E17AC18D2F2F" style="OLC">
<subparagraph id="H5821660780BE4B2EB35EC0B386E47086"><enum>(K)</enum><text>intensive
outpatient services (as described in section
1861(ddd)).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H4FA1F73D4C5A4556A21D6105DB88E709"><enum>(b)</enum><header>Services
Described</header><text>Section 1861 of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>), as
amended by section 201(b), is amended by adding at the end the following new
subsection:</text>
<quoted-block act-name="Social Security Act" id="HE1CA7B32353446128795BC40C3EADEB" style="traditional">
<subsection id="H07953A758A174E878E44A8D2EC80C7AC"><enum>(ddd)</enum><header>Intensive
Outpatient Services</header><paragraph commented="no" display-inline="yes-display-inline" id="H1191E4EB7F81404499C9D473A8CC1E20"><enum>(1)</enum><text>The term <term>intensive
outpatient services</term> 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.</text>
</paragraph><paragraph id="H9C08B4892AF244DBB6C5757CDDC3B25" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="HA5825B5400DD4ED800A2D24469000027"><enum>(A)</enum><text>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).</text>
</subparagraph><subparagraph id="H150DB332958E4D5685CB3775DD3BE3E" indent="up1"><enum>(B)</enum><text>For purposes of subparagraph (A), the
items and services described in this paragraph are as follows:</text>
<clause id="H68151FCAD5D24369B188DB4F00290992"><enum>(i)</enum><text>Psychiatric rehabilitation.</text>
</clause><clause id="HF6AEBCF54FC44DADB6D5E1BB08D1CAEF"><enum>(ii)</enum><text>Assertive community treatment.</text>
</clause><clause id="H6E1EBAD4FFCA4A0CAA4DCD41F5143F1D"><enum>(iii)</enum><text>Intensive case management.</text>
</clause><clause id="HCA0801AFF9154B2F9D09E31200F2A8CF"><enum>(iv)</enum><text>Day treatment for individuals under
21 years of age.</text>
</clause><clause id="H97AFF6DC469A4DF4A8C5C5302218BCDC"><enum>(v)</enum><text>Ambulatory detoxification.</text>
</clause><clause id="H4B2D92C868AC4DF58CE228E4403D8338"><enum>(vi)</enum><text>Such other items and services as the
Secretary may provide (but in no event to include meals and
transportation).</text>
</clause></subparagraph></paragraph><paragraph id="H7993E675772F40CBA54DA7251D6F67C3" indent="up1"><enum>(3)</enum><text>The context described in this
paragraph for the provision of intensive outpatient services is as
follows:</text>
<subparagraph id="H3F8605A734DA417B8E51BDB78CB17F46"><enum>(A)</enum><text>Such services are furnished in a
facility, home, or community setting.</text>
</subparagraph><subparagraph id="H66AE0AC966AE415C92517101DE1BC23"><enum>(B)</enum><text>Such services are furnished—</text>
<clause id="H7FDFB8AAAC9B4390AF0069C63858EF49"><enum>(i)</enum><text>to assist the individual to
compensate for, or eliminate, functional deficits and interpersonal and
environmental barriers created by the disability; and</text>
</clause><clause id="H3B94A43466E545E9B8BFDBA4B624BAA"><enum>(ii)</enum><text>to restore skills to the
individual for independent living, socialization, and effective life
management.</text>
</clause></subparagraph><subparagraph id="H33696DEA49214642BAB5D6BA42CE1BD"><enum>(C)</enum><text>Such services are furnished by an
individual or entity that—</text>
<clause id="H212569A1E75A426BBAF888EC35A89BBF"><enum>(i)</enum><text>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</text>
</clause><clause id="H3A23E6C955D84B059CABBC30569C1D44"><enum>(ii)</enum><text>meets such other requirements as
the Secretary may impose to assure the quality of the intensive outpatient
services
provided.</text>
</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HE55AE82A83574D1B92FD48041E1CB1D7"><enum>(c)</enum><header>Payment</header>
<paragraph id="H27E31E3DFF03480BB7D9C721A85065EB"><enum>(1)</enum><header>In
general</header><text>With respect to intensive outpatient services (as defined
in section 1861(ddd)(1) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (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—</text>
<subparagraph id="HF5BB041CDC6441919BBFACF66C5CC66B"><enum>(A)</enum><text>during 2008 and
2009, the reasonable costs of furnishing such services; and</text>
</subparagraph><subparagraph id="H6714FE441DBE43D19B7087D2D5943D28"><enum>(B)</enum><text>on or after
January 1, 2010, the amount of payment established for such services under the
prospective payment system established by the Secretary under paragraph (2) for
such services.</text>
</subparagraph></paragraph><paragraph id="H1F8C42E660A34106B5C5A64BFCADC7C7"><enum>(2)</enum><header>Establishment of
pps</header>
<subparagraph id="HB4D89A8F55EB42E9AEEB350055E2FBFF"><enum>(A)</enum><header>In
general</header><text>With respect to intensive outpatient services (as defined
in section 1861(ddd)(1)) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (as added by subsection (b)) furnished under the medicare
program on or after January 1, 2010, the Secretary of Health and Human Services
(in this paragraph referred to as the <quote>Secretary</quote>) 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.</text>
</subparagraph><subparagraph id="H075626CA7E9542B4B75149DF16AC4B45"><enum>(B)</enum><header>Adjustments</header><text>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.</text>
</subparagraph><subparagraph id="HDFE7CFE1F39142F79B23278ECDEAF03F"><enum>(C)</enum><header>Collection of
data and evaluation</header><text>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.</text>
</subparagraph><subparagraph id="H81F3590C134E4F7492004695AC392EA6"><enum>(D)</enum><header>Reports to
congress</header><text>Not later than October 1 of each of 2008 and 2009, the
Secretary shall submit to Congress a report on the progress of the Secretary in
establishing the prospective payment system under this paragraph.</text>
</subparagraph></paragraph></subsection><subsection id="H7894D5432AB841DB93EB98B83711C0E9"><enum>(d)</enum><header>Conforming
Amendments</header><paragraph commented="no" display-inline="yes-display-inline" id="H9D6B1765F4E9447CB121D3E33948E2A8"><enum>(1)</enum><text>Section 1835(a)(2) of
the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395n(a)(2)) is amended—</text>
<subparagraph id="HBB48B8952E0F47CB916184991C7141C" indent="up1"><enum>(A)</enum><text>in subparagraph (E), by striking
<quote>and</quote> at the end;</text>
</subparagraph><subparagraph id="H0AD38A2037214D1BB0B1FE00E7B7A2B" indent="up1"><enum>(B)</enum><text>in subparagraph (F), by striking the
period at the end and inserting <quote>; and</quote>; and</text>
</subparagraph><subparagraph id="HF3C77F79BAD74D18B807E8AECFF000DE" indent="up1"><enum>(C)</enum><text>by inserting after subparagraph (F)
the following new subparagraph:</text>
<quoted-block id="HB1A7AC02C1274186A7A660C76BA7B280" style="OLC">
<subparagraph id="H6125E63C545844D59C614289FDC95FA1"><enum>(G)</enum><text>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.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="H0C0B23C29BCD4877B770056B9382A0B0" indent="up1"><enum>(2)</enum><text>Section 1861(s)(2)(B) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395x(s)(2)(B)) is amended by inserting <quote>and intensive outpatient
services</quote> after <quote>partial hospitalization services</quote>.</text>
</paragraph><paragraph id="HF65D95C4C6294B45B200C18F4CCF3C5D" indent="up1"><enum>(3)</enum><text>Section 1861(ff)(1) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395x(ff)(1)) is amended—</text>
<subparagraph id="HCFC362139B6C46628CCEC4EF988E2F3F"><enum>(A)</enum><text>by inserting <quote>or, to the extent
permitted under the law of the State in which the services are furnished, a
non-physician mental health professional,</quote> after <quote>under the
supervision of a physician</quote> and after <quote>periodically reviewed by a
physician</quote>; and</text>
</subparagraph><subparagraph id="H607423FDF05A4089AD40751E2C00BDBD"><enum>(B)</enum><text>by striking <quote>physician’s</quote>
and inserting <quote>patient’s</quote>.</text>
</subparagraph></paragraph><paragraph id="HD1303A17A24C41CFB350AE552E6FCB1F" indent="up1"><enum>(4)</enum><text>Section 1861(cc) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395x(cc)) is amended—</text>
<subparagraph id="HD0BE49C3341D4F77AE9B927C83DD03AB"><enum>(A)</enum><text>in paragraph (1), in the matter
preceding subparagraph (A), by striking <quote>physician—</quote> and inserting
<quote>physician or, to the extent permitted under the law of the State in
which the services are furnished, a non-physician mental health
professional—</quote>; and</text>
</subparagraph><subparagraph id="H93C526523FC44A36BDFBFD83F035BDC"><enum>(B)</enum><text>in paragraph (2)(E), by inserting
before the semicolon at the end the following: <quote>, 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</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="H84BC238C206247B780BC6C60D55B97E5"><enum>(e)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to items and
services furnished on or after January 1, 2008.</text>
</subsection></section><enum>III</enum><header>Improving
Beneficiary Access to Medicare-Covered Services</header>
<section id="HA04C57CBD56E4DDB8080DC76D504A7A2"><enum>301.</enum><header>Excluding
clinical social worker services from coverage under the Medicare skilled
nursing facility prospective payment system and consolidated payment</header>
<subsection id="H06F7212EDFD3402EA7159E09CA22C909"><enum>(a)</enum><header>In
General</header><text>Section 1888(e)(2)(A)(ii) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395yy(e)(2)(A)(ii)) is amended by inserting <quote>clinical social worker
services,</quote> after <quote>qualified psychologist services,</quote>.</text>
</subsection><subsection id="H52DE21FC02A84539ACEB1C42C4575F4"><enum>(b)</enum><header>Conforming
Amendment</header><text>Section 1861(hh)(2) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395x(hh)(2)) is amended by striking <quote>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</quote>.</text>
</subsection><subsection id="H0D9FB7F62F0D42FDAC150021CE53C80"><enum>(c)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to items and
services furnished on or after January 1, 2008.</text>
</subsection></section><section id="HD857F8523C204E35AA3B63CBD2D07F0"><enum>302.</enum><header>Coverage of
marriage and family therapist services</header>
<subsection id="H97DCCEF16E3448C5B9B8FD13AB42FEAE"><enum>(a)</enum><header>Coverage of
Services</header><text>Section 1861(s)(2) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(s)(2)</external-xref>) is
amended—</text>
<paragraph id="H54629776CEAB4ADD928004288764A14B"><enum>(1)</enum><text>in subparagraph
(Z), by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="H9524DD0B494748E182B8AC966FFCC32"><enum>(2)</enum><text>in
subparagraph (AA), by adding <quote>and</quote> at the end; and</text>
</paragraph><paragraph id="HE2CBCFB92AC241D19400DA662FA0698D"><enum>(3)</enum><text>by adding at the
end the following new subparagraph:</text>
<quoted-block id="H4B5A6F6689884EE4AA715F0100EECEFB" style="OLC">
<subitem id="H025A93652697422F97BA3C1834AA37F" indent="up5"><enum>(BB)</enum><text>marriage and family therapist
services (as defined in subsection
(eee));</text>
</subitem><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H70013AB700554261909B0800FF89E0F1"><enum>(b)</enum><header>Definition</header><text>Section
1861 of the <act-name parsable-cite="SSA">Social Security Act</act-name> (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:</text>
<quoted-block act-name="Social Security Act" id="H3DA62620587F47EC9300154133F2A77D" style="traditional">
<subsection id="HDB42D2A195D0482DAEA3A9B4DACF3E3"><enum>(eee)</enum><header>Marriage and
Family Therapist Services</header><paragraph commented="no" display-inline="yes-display-inline" id="H1672AADE7BCD43DAB5639600F6EFBDBC"><enum>(1)</enum><text>The term <term>marriage
and family therapist services</term> 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.</text>
</paragraph><paragraph id="H85B19DBF86DB4D96AB3B4E34EBF68784" indent="up1"><enum>(2)</enum><text>The term <term>marriage and family
therapist</term> means an individual who—</text>
<subparagraph id="HB9FF439B817F41CB91DDE42D3B5F6265"><enum>(A)</enum><text>possesses a master’s or doctoral
degree which qualifies for licensure or certification as a marriage and family
therapist pursuant to State law;</text>
</subparagraph><subparagraph id="H046591149CBD41909543BF8C496E153E"><enum>(B)</enum><text>after obtaining such degree has
performed at least 2 years of clinical supervised experience in marriage and
family therapy; and</text>
</subparagraph><subparagraph id="HF3126FABE30241DD9478F334B9B856B1"><enum>(C)</enum><text>is licensed or certified as a marriage
and family therapist in the State in which marriage and family therapist
services are
performed.</text>
</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H2CA42D367EB642C993E226EBCA077A5"><enum>(c)</enum><header>Provision for
Payment Under Part <enum-in-header>B</enum-in-header></header><text>Section
1832(a)(2)(B) of the <act-name parsable-cite="SSA">Social Security
Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395k">42 U.S.C. 1395k(a)(2)(B)</external-xref>) is amended by adding at the end the
following new clause:</text>
<quoted-block act-name="Social Security Act" id="HC76E5C67AB8C4BAD9F10E600F44B8148" style="OLC">
<clause id="HF99E4A28239840A18BFEC6B70F207E5"><enum>(v)</enum><text>marriage and family
therapist
services;</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HEE11EBF9B42F430B9F9649AFB96BB226"><enum>(d)</enum><header>Amount of
Payment</header>
<paragraph id="H62DCFFF58F3740AFADADBF9603FACF5"><enum>(1)</enum><header>In
general</header><text>Section 1833(a)(1) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395<italic>l</italic>(a)(1)) is amended—</text>
<subparagraph id="H5EB3864B7A8D47998CE2E3914264EDD4"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>(V)</quote>; and</text>
</subparagraph><subparagraph id="H150F2B01295546E5A3C2F1866990B2D1"><enum>(B)</enum><text>by inserting
before the semicolon at the end the following: <quote>, and (W) with respect to
marriage and family therapist 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)</quote>.</text>
</subparagraph></paragraph><paragraph id="H435C4792AD3D4283B1746770D9D54D66"><enum>(2)</enum><header>Development of
criteria with respect to consultation with a physician</header><text>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 <act-name parsable-cite="SSA">Social Security Act</act-name> (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.</text>
</paragraph></subsection><subsection id="H58AE734166704F66B2A73B86D9B746C4"><enum>(e)</enum><header>Exclusion of
Marriage and Family Therapist Services From Skilled Nursing Facility
Prospective Payment System</header><text>Section 1888(e)(2)(A)(ii) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395yy(e)(2)(A)(ii)), as amended in section 301(a), is amended by inserting
<quote>marriage and family therapist services (as defined in subsection
(eee)(1)),</quote> after <quote>clinical social worker
services,</quote>.</text>
</subsection><subsection id="HFA6B97EB6CDE4B9082612525DB698F5"><enum>(f)</enum><header>Coverage of
Marriage and Family Therapist Services Provided in Rural Health Clinics and
Federally Qualified Health Centers</header><text>Section 1861(aa)(1)(B) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395x(aa)(1)(B)) is amended by striking <quote>or by a clinical social worker
(as defined in subsection (hh)(1)),</quote> and inserting <quote>, by a
clinical social worker (as defined in subsection (hh)(1)), or by a marriage and
family therapist (as defined in subsection (eee)(2)),</quote>.</text>
</subsection><subsection id="HBF2B05F4735C454496328F21A2E0E7A3"><enum>(g)</enum><header>Inclusion of
Marriage and Family Therapists as Practitioners for Assignment of
Claims</header><text>Section 1842(b)(18)(C) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395u(b)(18)(C)) is amended by adding at the end the following new
clause:</text>
<quoted-block act-name="Social Security Act" id="HF1A40880DC974C2A0027863EEEEA6464" style="OLC">
<clause id="HA87234A80495445EAEF698DF348528DA" indent="up2"><enum>(vii)</enum><text>A marriage and family therapist (as
defined in section
1861(eee)(2)).</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HF1A4230A99214B42A6ECC2A92F656D00"><enum>(h)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to items and
services furnished on or after January 1, 2008.</text>
</subsection></section><section id="HE7D72AE40867406F8F1D9169D59BC98"><enum>303.</enum><header>Coverage of
mental health counselor services</header>
<subsection id="H8C2EA6B9941A438E91FFDC955E00DAA4"><enum>(a)</enum><header>Coverage of
Services</header><text>Section 1861(s)(2) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(s)(2)</external-xref>), as
amended in section 302(a), is amended—</text>
<paragraph id="HD3018A7AFA94412F9289E3FBE13C160"><enum>(1)</enum><text>in
subparagraph (AA), by striking <quote>and</quote> at the end;</text>
</paragraph><paragraph id="HB3DBAA5094004B32BB60F0B798930685"><enum>(2)</enum><text>in subparagraph
(BB), by inserting <quote>and</quote> at the end; and</text>
</paragraph><paragraph id="H7144B0B8A2A5466BBC028F3552FAFD2"><enum>(3)</enum><text>by
adding at the end the following new subparagraph:</text>
<quoted-block id="H1477CB2AFC934904AF3D08BC3B8D422B" style="OLC">
<subitem id="HB9F91CC8D2954DAAAF69F613B2DCA5B7" indent="up4"><enum>(CC)</enum><text>mental health counselor services
(as defined in subsection
(fff)(2));</text>
</subitem><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HA4826396A91E490DAC575701B222EDD6"><enum>(b)</enum><header>Definition</header><text>Section
1861 of the <act-name parsable-cite="SSA">Social Security Act</act-name> (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:</text>
<quoted-block act-name="Social Security Act" id="HC9530A582A5843F38887B7E9BC71DA80" style="traditional">
<subsection id="H2E4541A1B6DF49A09391E416F651916"><enum>(fff)</enum><header>Mental Health
Counselor; Mental Health Counselor Services</header><paragraph commented="no" display-inline="yes-display-inline" id="HD779D03EA30E4D7181AFF5531B4BEBD8"><enum>(1)</enum><text>The term <term>mental
health counselor</term> means an individual who—</text>
<subparagraph id="H86DBFE826E7B40DF8680FCEB2401F74F" indent="up1"><enum>(A)</enum><text>possesses a master’s or doctor’s
degree in mental health counseling or a related field;</text>
</subparagraph><subparagraph id="HBD75D335CCA3477288CAFF7B6747A4B8" indent="up1"><enum>(B)</enum><text>after obtaining such a degree has
performed at least 2 years of supervised mental health counselor practice;
and</text>
</subparagraph><subparagraph id="HA9BF34594BCE47C8AB550314DA83E67C" indent="up1"><enum>(C)</enum><text>is licensed or certified as a mental
health counselor or professional counselor by the State in which the services
are performed.</text>
</subparagraph></paragraph><paragraph id="HCF3A2FDBD4D941E7AE4B03D3D1D80028" indent="up1"><enum>(2)</enum><text>The term <term>mental health
counselor services</term> 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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H07F7158FAB6D4BDB88D33FD82F3CF410"><enum>(c)</enum><header>Payment</header>
<paragraph id="HFDB0B2DE6650481B88AA303BE9C13960"><enum>(1)</enum><header>In
general</header><text>Section 1833(a)(1) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395<italic>l</italic>(a)(1)), as amended by section 302(d), is amended—</text>
<subparagraph id="H02FD999FE4DE490F8D1CB9AB5CBA8F3F"><enum>(A)</enum><text>by striking
<quote>and</quote> before <quote>(W)</quote>; and</text>
</subparagraph><subparagraph id="HE6A4D57EB59C4EFC84B6232596B05697"><enum>(B)</enum><text>by inserting
before the semicolon at the end the following: <quote>, and (X) with respect to
mental health counselor services under section 1861(s)(2)(CC), 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)</quote>.</text>
</subparagraph></paragraph><paragraph id="HBE67ED8C669B435DBCABF5D37F47B596"><enum>(2)</enum><header>Development of
criteria with respect to consultation with a physician</header><text>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
<act-name parsable-cite="SSA">Social Security Act</act-name> (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.</text>
</paragraph></subsection><subsection id="HA4F25A66AF734837BE5B48047DB79422"><enum>(d)</enum><header>Exclusion of
Mental Health Counselor Services From Skilled Nursing Facility Prospective
Payment System</header><text>Section 1888(e)(2)(A)(ii) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395yy(e)(2)(A)(ii)), as amended by sections 301(a) and 302(e), is amended by
inserting <quote>mental health counselor services (as defined in section
1861(fff)(2)),</quote> after <quote>marriage and family therapist services (as
defined in subsection (eee)(1)),</quote>.</text>
</subsection><subsection id="HB3CB914A243040D5875868001739C086"><enum>(e)</enum><header>Coverage of
Mental Health Counselor Services Provided in Rural Health Clinics and Federally
Qualified Health Centers</header><text>Section 1861(aa)(1)(B) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
1395x(aa)(1)(B)), as amended by section 302(f), is amended—</text>
<paragraph id="H73DBB117EFF54550BBA8DF6918BBED62"><enum>(1)</enum><text>by striking
<quote>or by a marriage</quote> and inserting <quote>by a marriage</quote>;
and</text>
</paragraph><paragraph id="HF2D18ABA8C9A4D53B6F5393CB2AA63B3"><enum>(2)</enum><text>by inserting
<quote>or a mental health counselor (as defined in subsection
(fff)(1)),</quote> after <quote>marriage and family therapist (as defined in
subsection (eee)(2)),</quote>.</text>
</paragraph></subsection><subsection id="H4FF57AC794DE4CCB8E2D2D096F17F43C"><enum>(f)</enum><header>Inclusion of
Mental Health Counselors as Practitioners for Assignment of
Claims</header><text>Section 1842(b)(18)(C) of the
<act-name parsable-cite="SSA">Social Security Act</act-name> (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:</text>
<quoted-block act-name="Social Security Act" id="HC205F9CC1E7C4718AB97AA42281D6B06" style="OLC">
<clause id="HF68F114FC59F4C38B842128B1C3CC94E" indent="up2"><enum>(viii)</enum><text>A mental health counselor (as
defined in section
1861(fff)(1)).</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H8E24FCEDCE19427B9C004DEEEE0090AF"><enum>(g)</enum><header>Effective
Date</header><text>The amendments made by this section shall apply to items and
services furnished on or after January 1, 2008.</text>
</subsection></section><section id="HB9175A904D2F4C6BACEEC3F5FDE468B8"><enum>304.</enum><header>Study of
coverage criteria for Alzheimer’s disease and related mental illnesses</header>
<subsection id="H2B543BA36C0042059174CD7FF8CF5DF"><enum>(a)</enum><header>Study</header>
<paragraph id="H287AB26A493548BBA6FFF31F003662DF"><enum>(1)</enum><header>In
general</header><text>The Secretary of Health and Human Services (in this
section referred to as the <quote>Secretary</quote>) 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
<act-name parsable-cite="SSA">Social Security Act</act-name> (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.</text>
</paragraph><paragraph id="H3532AED415BA4E3B0077B7899D3FD774"><enum>(2)</enum><header>Determination of
new coverage criteria</header><text>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.</text>
</paragraph></subsection><subsection id="H4B9E030F55574D4AADA5958CD4005786"><enum>(b)</enum><header>Report</header><text>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.</text>
</subsection></section>