Coverage of peer support services under the Medicare program

(a)

Coverage

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—(1)in subsection (s)(2)—(A)in subparagraph (JJ), by inserting and after the semicolon at the end; and(B)by adding at the end the following new subparagraph:

(KK)peer support services (as defined in subsection (nnn)) furnished on or after January 1, 2025;

; and

(2)by adding at the end the following new subsection:

(nnn)

Peer support services

(1)

Peer support services

The term peer support services means emotional, informational, instrumental, and affiliational support services—(A)furnished—(i)by a Federally qualified health center, a rural health clinic, a community mental health center, or a certified community behavioral health clinic (as described in section 223 of the Protecting Access to Medicare Act of 2014), using a peer support specialist; and(ii)to an individual who has been diagnosed with—(I)a mental disorder; or (II)a substance use disorder; and(B)that are designed to assist such individual in achieving recovery, integration in the community, self-empowerment, and self-determination (as specified by the Secretary).(2)

Peer support specialist

The term peer support specialist means an individual who—(A)is recovering from a mental health or substance use condition; and(B)is certified as qualified to furnish peer support services under a certification process consistent with the National Practice Guidelines for Peer Supporters and inclusive of the Substance Abuse and Mental Health Services Administration Core Competencies for Peer Workers in Behavioral Health Settings (as established by the State in which such individual furnishes such services or under such certification process determined appropriate by the Secretary of Health and Human Services.

(b)

Payment

(1)

Community mental health centers and certified community behavioral health clinics

Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—(A)by striking and before (HH); and (B)by inserting before the semicolon: , and (II) with respect to peer support services (as defined in section 1861(nnn)) furnished by a community mental health center or a certified community behavioral health clinic, the amount paid shall be an amount equal to 80 percent of the lesser of the actual charge for the services or the amount determined by a fee schedule established by the Secretary for the purposes of this subparagraph. (2)

Inclusion as RHC and FQHC services

Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)) is amended—(A)by striking or by a mental and inserting by a mental; and(B)by inserting or when using a peer support specialist, after subsection (ll)(4)),.(c)

Exclusion modification

Section 1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) is amended—(1)in subparagraph (O), by striking and at the end;(2)in subparagraph (P), by striking the semicolon at the end and inserting , and; and(3)by adding at the end the following new subparagraph:

(Q)in the case of peer support services (as defined in section 1861(nnn)), which are not furnished by a rural health clinic, a Federally qualified health center, a community mental health center, or a certified community behavioral health clinic;