[Congressional Record Volume 147, Number 48 (Wednesday, April 4, 2001)]
[Senate]
[Pages S3437-S3442]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WELLSTONE:
  S. 690. A bill to amend title XVIII of the Social Security Act to 
expand and improve coverage of mental health services under the 
medicare program; to the Committee on Finance.
  Mr. WELLSTONE. Mr. President, I rise today to reintroduce the 
Medicare Mental Health Modernization Act, a bill to improve the 
delivery of mental health services through the Medicare health care 
system. This improvement and modernization of mental health services in 
the Medicare system is long overdue. It has remained virtually 
unchanged since it was enacted by Congress in 1965. In the 36 years 
since then, the scientific breakthroughs in our understanding of mental 
illnesses and the vast improvements in medications and other effective 
treatments have dramatically changed our understanding and treatment of 
mental illness. Yet, the health care systems, both public and private, 
lag behind in the treatment of this potentially life-threatening 
disease. As we work to improve health care for all Americans, in all 
health care systems, the ever-growing population of older Americans 
make it all the more urgent that we bring the Medicare system into the 
21st century, and bring mental health care to those in need.
  Though often undetected and untreated, mental health problems among 
the elderly are widespread and life-threatening. Americans aged 65 
years and older have the highest rate of suicide of any population in 
the United States. Sadly, these suicide rates increase with age. While 
this age group accounts for just 13 percent of the U.S. population, 
Americans 65 and older account for 20 percent of all suicide deaths. 
All too often, depression among the elderly is ignored or 
inappropriately treated. This disease, and other illnesses such as 
Alzheimer's disease, anxiety and late-life schizophrenia, can lead to 
severe impairment or death.
  Major depression is strikingly prevalent among older people, with 
between 8 and 20 percent of older people in community-based studies 
showing symptoms of depression. Studies of patients in primary care 
settings show that up to 37 percent report such symptoms, although they 
often go untreated. Depression is not a ``normal'' part of aging, but a 
serious, debilitating disease. Almost 20 percent of individuals age 55 
and older experience a serious mental disorder. What is most alarming 
is that most elderly suicide victims, 70 percent, have visited their 
primary care doctor in the month prior to their completed suicide. It 
is critical that the mental health expertise be provided within the 
Medicare system, and that screening, diagnosis, and treatment be 
provided in a timely manner.
  Despite this need, Medicare coverage for mental health services is 
much more expensive for elderly patients than coverage for other 
outpatient services. In order to receive mental health care, seniors 
must pay, out of their own pockets, 50 percent of the cost of a visit 
to their mental health specialist, an extremely unfair burden to 
place on the elderly, who are so often facing other health or life 
difficulties as well. For all other health care services, the copayment 
for Medicare participants is 20 percent, not 50 percent.

  We know that substance abuse, particularly of alcohol and 
prescription drugs, among adults 65 and older is one of the fastest 
growing health problems in the United States. With seventeen percent of 
this age group suffers from addiction or substance abuse. While 
addiction often goes undetected and untreated among older adults, aging 
and disability only makes the body more vulnerable to the effects of 
these drugs, further exacerbating underlying health problems, and 
creating a serious need for treatment that recognizes these 
vulnerabilities.
  Medicare also provides health care coverage for non-elderly 
individuals who are disabled, through Social Security Disability 
Insurance, SSDI. According to the Health Care Financing Agency, HCFA, 
Medicare is the primary health care coverage for the 5 million non-
elderly, disabled people on SSDI. More than 20 percent of these 
individuals have a diagnosis of mental illness and/or addiction, and 
also face severe discrimination in their mental health coverage.
  What will this bill do? The Medicare Mental Health Modernization Act 
has several important components. First, the bill reduces the 50 
percent copayment for mental health care to 20 percent, which makes the 
copayment equal to every other outpatient service in Medicare. This is 
straightforward, fair, and the right thing to do. By doing so, this 
provision will increase access to mental health care overall, 
especially for those who currently forego seeking treatment and find 
themselves suffering from worsening mental health conditions. Second, 
the bill adds intensive residential services to the Medicare mental 
health benefit package. This provision will give people suffering from 
diseases such as schizophrenia or Alzheimer's disease an alternative to 
going to nursing homes. Instead, they will be able to be cared for in 
their homes or in more appropriate residential settings. I also ask the 
Secretary for Health and Human Services to conduct a study of the 
current Medicare coverage criteria to determine the extent to which 
people with these forms of illnesses are receiving the appropriate care 
that is needed.
  Finally, my bill expands the number of mental health professionals 
eligible to provide services through Medicare to include clinical 
social workers and licensed professional mental health counselors. 
Provision of adequate mental health services provided through Medicare 
requires more trained and experienced providers for the aging and 
growing population and should include those who are appropriately 
licensed and qualified to deliver such care.
  These changes are needed now. The bill enjoys the strong support of 
many mental health groups including, among others, the National 
Alliance for the Mentally Ill, the National Mental Health Association, 
theAmerican Psychological Association, the National

[[Page S3439]]

Association of School Psychologists, the National Association of Social 
Workers, the American Association of Geriatric Psychiatry, the Bazelon 
Center for Mental Health Law, the International Association of 
Psychosocial Rehabilitation Services, the American Counseling 
Association, the American Mental Health Counselors Association, the 
Association for Ambulatory Behavioral Health, the American Association 
of Marriage and Family Therapists, the National Association of 
Psychiatric Health Systems, the American Association of Pastoral 
Counselors, the Association for the Advancement of Psychology, the 
National Association of County Behavioral Health Directors, the 
Tourette Syndrome Association, the National Association of Anorexia 
Nervosa and Associated Disorders, the Suicide Prevention and Advocacy 
Network, the Suicide Awareness/Voices of Education organization, the 
American Foundation for Suicide Prevention, the American Association of 
Suicidology, the Kristin Brooks Hope Center, the The National Hopeline 
Network 1-800-SUICIDE, the Suicide Prevention Services of Illinois, and 
the National Resource Center for Suicide Prevention and Aftercare. I 
commend these organizations and the American Psychiatric Association 
for their leadership role in fighting for improved mental health care 
coverage for seniors under Medicare.

  U.S. Surgeon General David Satcher recognized the urgency of the 
problems with Medicare in his recent reports on mental health: ``Mental 
Health: A Report of the Surgeon General'' and ``The Surgeon General's 
Call to Action to Prevent Suicide''. Dr. Satcher stated, ``Disability 
due to mental illness in individuals over 65 years old will become a 
major public health problem in the near future because of demographic 
changes. In particular, dementia, depression and schizophrenia, among 
other conditions, will all present special problems for this age 
group.'' Dr. Satcher also underscored the life-threatening nature of 
this problem. He noted that the rate of major clinical depression and 
the incidence of suicide among senior citizens is alarmingly high. This 
report cites that about one-half of patients relocated to nursing homes 
from the community are at greater risk for depression. At the same 
time, the Surgeon General emphasizes that depression ``is not well-
recognized or treated in primary care settings,'' and calls attention 
to the alarming fact that older people have the highest rates of 
suicide in the U.S. population. Contrary to what is widely believed, 
suicide rates actually increase with age, and, as the Surgeon General 
points out, ``depression is a foremost risk factor for suicide in older 
adults.''
  Clearly, our nation must take steps to ensure that mental health care 
is easily and readily available under the Medicare program. The 
Medicare Mental Health Modernization Act of 2001 takes an important 
first step in that direction. It is time to take this potential fatal 
illness seriously. I believe we must do everything we can to make 
effective treatments available in a timely manner for older adults and 
others covered by Medicare, and help prevent relapse and recurrence 
once mental illness is diagnosed.
  I urge my colleagues to support this bill as we begin our work in 
this new century. It is time to treat the elderly in our society, 
particularly those with serious, debilitating diseases, with the care, 
respect and fairness they deserve. I ask unanimous consent that the 
text of the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 690

       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 2001''.
       (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.

       The 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, 
     dementia, depression, schizophrenia, among other conditions, 
     will all present special problems for this age group.
       (3) Major depression is strikingly prevalent among older 
     people, with between 8 and 20 percent of older people in 
     community studies and up to 37 percent of those seen in 
     primary care settings experiencing symptoms of depression.
       (4) Almost 20 percent of the population of individuals age 
     55 and older, experience specific mental disorders that are 
     not part of normal aging.
       (5) Unrecognized and untreated depression, Alzheimer's 
     disease, anxiety, late-life schizophrenia, and other mental 
     conditions can be severely impairing and may even be fatal.
       (6) Substance abuse, particularly the abuse of alcohol and 
     prescription drugs, among adults 65 and older is one of the 
     fastest growing health problems in the United States, with 17 
     percent of this age group suffering from addiction or 
     substance abuse. While addiction often goes undetected and 
     untreated among older adults, aging and disability makes the 
     body more vulnerable to the effects of alcohol and drugs, 
     further exacerbating other age-related health problems. 
     Medicare coverage for addiction treatment of the elderly 
     needs to recognize these special vulnerabilities.
       (7) The disabled are another population receiving 
     inadequate mental health care through medicare. According to 
     the Health Care Financing Administration, medicare is the 
     primary health care coverage for the 5,000,000 non-elderly, 
     disabled people on Social Security Disability Insurance. Up 
     to 40 percent of these individuals have a diagnosis of mental 
     illness.
       (8) 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) by adding ``and'' at the end of paragraph (1);
       (B) by striking ``; and'' at the end of paragraph (2); 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, 2002.

     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, 2002.

 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) by striking ``and'' at the end of paragraph (3);
       (2) by striking the period at the end of paragraph (4) and 
     inserting ``; and''; and

[[Page S3440]]

       (3) by adding at the end the following new paragraph:
       ``(5) intensive residential services (as defined in section 
     1861(ww)) 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), as amended by sections 102(b) 
     and 105(b) of the Medicare, Medicaid, and SCHIP Benefits 
     Improvement and Protection Act of 2000, as enacted into law 
     by section 1(a)(6) of Public Law 106-554, is amended by 
     adding at the end the following new subsection:

                    ``Intensive Residential Services

       ``(ww)(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 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)(5) shall 
     be equal to an amount specified under a prospective payment 
     system established by the Secretary, taking into account the 
     prospective payment system to be established for psychiatric 
     hospitals under 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, 2002.

     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 and 
     inserting ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(K) intensive outpatient services (as described in 
     section 1861(xx)).''.
       (b) Services Described.--Section 1861 of the Social 
     Security Act (42 U.S.C. 1395x), as amended by section 202(b), 
     is further amended by adding at the end the following new 
     subsection:

                    ``Intensive Outpatient Services

       ``(xx)(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 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 (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 
     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(xx)(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 2002 and 2003, the reasonable costs of 
     furnishing such services; and
       (B) on or after January 1, 2004, 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(xx)(1) of the Social 
     Security Act (as added by subsection (b)) furnished under the 
     medicare program on or after January 1, 2004, the Secretary 
     of Health and Human Services 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, 
     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 2002 and 2003, 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;

[[Page S3441]]

       (B) in subparagraph (F), by striking the period and 
     inserting ``; 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 such 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 such 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 such Act (42 U.S.C. 1395x(cc)) is 
     amended--
       (A) in paragraph (1), 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 
     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, 2002.

  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, 2002.

     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)), as amended by sections 
     102(a) and 105(a) of the Medicare, Medicaid, and SCHIP 
     Benefits Improvement and Protection Act of 2000, as enacted 
     into law by section 1(a)(6) of Public Law 106-554, is 
     amended--
       (1) by striking ``and'' at the end of subparagraph (U);
       (2) by inserting ``and'' at the end of subparagraph (V); 
     and
       (3) by adding at the end the following new subparagraph:
       ``(W) marriage and family therapist services (as defined in 
     subsection (yy));''.
       (b) Definition.--Section 1861 of the Social Security Act 
     (42 U.S.C. 1395x), as amended by sections 201(b) and 202(b), 
     is further amended by adding at the end the following new 
     subsection:

                ``Marriage and Family Therapist Services

       ``(yy)(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 
     two 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)), as amended by sections 105(c) 
     and 223(c) of the Medicare, Medicaid, and SCHIP Benefits 
     Improvement and Protection Act of 2000, as enacted into law 
     by section 1(a)(6) of Public Law 106-554, is amended--
       (A) by striking ``and'' before ``(U)''; and
       (B) by inserting before the semicolon at the end the 
     following: ``, and (V) with respect to marriage and family 
     therapist services under section 1861(s)(2)(W), 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 clause (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 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 
     further amended by inserting ``marriage and family therapist 
     services (as defined in subsection (yy)(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 
     (yy)(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)), as amended by section 105(d) of the 
     Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000, as enacted into law by section 
     1(a)(6) of Public Law 106-554, is amended by adding at the 
     end the following new clause:
       ``(vii) A marriage and family therapist (as defined in 
     section 1861(yy)(2)).''.
       (h) Effective Date.--The amendments made by this section 
     shall apply to items and services furnished on or after 
     January 1, 2002.

     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 further amended--
       (1) by striking ``and'' at the end of subparagraph (V);
       (2) by inserting ``and'' at the end of subparagraph (W); 
     and
       (3) by adding at the end the following new subparagraph:
       ``(X) mental health counselor services (as defined in 
     subsection (zz)(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 further amended by adding at the end the following 
     new subsection:

      ``Mental Health Counselor; Mental Health Counselor Services

       ``(zz)(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. 13951(a)(1)), as amended by section 302(d), is 
     further amended--
       (A) by striking ``and'' before ``(V)''; and
       (B) by inserting before the semicolon at the end the 
     following: ``, and (W) with respect to mental health 
     counselor services

[[Page S3442]]

     under section 1861(s)(2)(X), 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 clause (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 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 further amended by inserting ``mental health 
     counselor services (as defined in section 1861(zz)(2)),'' 
     after ``marriage and family therapist services (as defined in 
     subsection (yy)(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 
     further amended--
       (1) by striking ``or'' before ``marriage and family 
     therapist services''; and
       (2) by inserting ``or mental health counselor services (as 
     defined in section 1861(zz)(2)),'' after ``marriage and 
     family therapist services (as defined in subsection 
     (yy)(1)),''.
       (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 further amended by adding at the end 
     the following new clause:
       ``(viii) A mental health counselor (as defined in section 
     1861(zz)(1)).''.
       (g) Effective Date.--The amendments made by this section 
     shall apply to items and services furnished on or after 
     January 1, 2002.

     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 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.
                                 ______