[Congressional Record Volume 149, Number 21 (Wednesday, February 5, 2003)]
[Senate]
[Pages S1987-S1989]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. THOMAS (for himself, Mrs. Lincoln, Ms. Cantwell, Mr. 
        Inhofe, Ms. Landrieu, Mr. Johnson, and Mrs. Boxer):
  S. 310. A bill to amend title XVIII of the Social Security Act to 
provide for the coverage of marriage and family therapist services and 
mental health counselor services under part B of the Medicare program, 
and for other purposes; to the Committee on Finance.
  Mr. THOMAS. Mr. President, I am pleased to rise today to introduce 
the ``Seniors Mental Health Access Improvement Act of 2003'' with my 
distinguished colleague from Arkansas, Mrs. Lincoln. Specifically, the 
``Seniors Mental Health Access Improvement Act of 2003'' permits mental 
health counselors and marriage and family therapists to bill Medicare 
for services provided to seniors. This will result in an increased 
choice of mental health providers for seniors and enhance their ability 
to access mental health services in their communities.
  This legislation is especially crucial to rural seniors who are often 
forced to travel long distances to utilize the services of mental 
health providers currently recognized by the Medicare program. Rural 
communities have difficulty recruiting and retaining providers, 
especially mental health providers. In many small towns, a mental 
health counselor or a marriage and family therapist is the only mental 
health care provider in the area. Medicare law--as it exists today-
compounds the situation because only psychiatrists, clinical 
psychologists, clinical social workers and clinical nurse specialists 
are able to bill Medicare for their services.
  It is time the Medicare program recognized the qualifications of 
mental health counselors and marriage and family therapists as well as 
the critical role they play in the mental health care infrastructure. 
These providers go through rigorous training, similar to the curriculum 
of masters level social workers, and yet are excluded from the Medicare 
program.
  Particularly troubling to me is the fact that seniors have 
disproportionately higher rates of depression and suicide than other 
populations. Additionally, 75 percent of the 518 nationally designated 
Mental Health Professional Shortage Areas are located in rural areas 
and one-fifth of all rural counties have ``no'' mental health services 
of any kind. Frontier counties have even more drastic numbers as 95 
percent do not have a psychiatrist, 68 percent do not have a 
psychologist and 78 percent do not have a social worker. It is quite 
obvious we have an enormous task ahead of us to reduce these staggering 
statistics. providing mental health counselors and marriage and family 
therapists the ability to bill Medicare for their services is a key 
part of the solution.
  Virtually all of Wyoming is designated a mental health professional 
shortage area and will greatly benefit from this legislation. Wyoming 
has 174 psychologists, 37 psychiatrists and 263

[[Page S1988]]

clinical social workers for a total of 474 Medicare eligible mental 
health providers. Enactment of the ``Seniors Mental Health Access 
Improvement Act of 2001'' will more than double the number of mental 
health providers available to seniors in my State with the addition of 
528 mental health counselors and 61 marriage and family therapists 
currently licensed in the state.
  I believe this legislation is critically important to the health and 
well-being of our Nation's seniors and I strongly urge all my 
colleagues to become a cosponsor.
  Mr. President, 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. 310

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Seniors Mental Health Access 
     Improvement Act of 2003''.

     SEC. 2. 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)) is amended--
       (A) in subparagraph (U), by striking ``and'' after the 
     semicolon at the end;
       (B) in subparagraph (V)(iii), by inserting ``and'' after 
     the semicolon at the end; and
       (C) by adding at the end the following new subparagraph:
       ``(W) marriage and family therapist services (as defined in 
     subsection (ww)(1)) and mental health counselor services (as 
     defined in subsection (ww)(3));''.
       (2) Definitions.--Section 1861 of the Social Security Act 
     (42 U.S.C. 1395x) is amended by adding at the end the 
     following new subsection:

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

       ``(ww)(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 (U)'' and inserting ``(U)''; and
       (B) by inserting before the semicolon at the end the 
     following: ``, and (V) with respect to marriage and family 
     therapist services and mental health counselor services under 
     section 1861(s)(2)(W), 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)), as amended in section 301(a), is 
     amended by inserting ``marriage and family therapist services 
     (as defined in subsection (ww)(1)), mental health counselor 
     services (as defined in section 1861(ww)(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(ww)(2)).
       ``(viii) A mental health counselor (as defined in section 
     1861(ww)(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 (ww)(2)), or by a mental health 
     counselor (as defined in subsection (ww)(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 a marriage and family therapist 
     (as defined in subsection (ww)(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 (ww)(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, 2004.
  Mrs. LINCOLN. Mr. President, I am pleased to join my colleague 
Senator Craig Thomas today in introducing the ``Seniors Mental Health 
Access Improvement Act of 2003.''
  This bill would expand Medicare coverage to Licensed Professional 
Counselors and Licensed Marriage and Family Therapists. One result of 
this expanded coverage will be to increase seniors' access to mental 
health services, especially in rural and underserved areas.
  Licensed Professional Counselors and Marriage and Family Therapist 
are currently excluded from Medicare coverage even though they meet the 
same education, training, and examination requirements that clinical 
social workers do. The only difference is that clinical social workers 
have been covered under Medicare for over a decade.
  Why do we need this legislation? The mental health needs of older 
Americans are not being met. Although the rate of suicide among older 
Americans is higher than for any other age group, less than three 
percent of older Americans report seeing mental health professionals 
for treatment. And going to their primary care physician is simply not 
enough. Research shows that most primary care providers receive 
inadequate mental health training, particularly in geriatrics.
  Lack of access to mental health providers is one of the primary 
reasons why older Americans don't get the mental health treatment they 
need. Not surprisingly, this problem is exacerbated in rural and 
underserved areas.
  Licensed Professional Counselors are often the only mental health 
specialists available in rural and underserved communities. This is 
true in my home state of Arkansas, where 91 percent of Arkansans reside 
in a mental health professional shortage area.
  Since there are more Licensed Professional Counselors practicing in 
my state than any other mental health professional, this legislation 
will significantly increase the number of Medicare-eligible mental 
health providers in Arkansas. Licensed Professional Counselors are 
already serving patients who have private insurance or Medicaid. It is 
time for Medicare patients to also have access to these professionals.

[[Page S1989]]

  The bill we are introducing today is an important first step in 
expanding access to good mental health. By including Licensed 
Professional Counselors and licensed Marriage and Family Therapists 
among the list of providers who deliver mental health services to 
Medicare beneficiaries, we will help ensure that all seniors, no matter 
where they live, have the opportunity to receive mental health 
treatment.
                                 ______