[Congressional Record Volume 153, Number 48 (Tuesday, March 20, 2007)]
[Senate]
[Pages S3355-S3356]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. THOMAS (for himself and Mrs. Lincoln):
  S. 921. 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 2007'' with my 
distinguished colleague from Arkansas, Mrs. Lincoln. Specifically, the 
``Seniors Mental Health Access Improvement Act of 2007'' 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 
disproportionally 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

[[Page S3356]]

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 clinical social workers 
for a total of 474 Medicare eligible mental health providers. Enactment 
of the ``Seniors Mental Health Access Improvement Act of 2007'' 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 text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 921

       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 2007''.

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

       ``(ccc)(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 (as defined in 
     section 1861(ccc)(1)) and mental health counselor services 
     (as defined in section 1861(ccc)(3));''.
       (4) Amount of payment.--Section 1833(a)(1) of the Social 
     Security Act (42 U.S.C. 1395l(a)(1)) is amended--
       (A) by striking ``and (V)'' and inserting ``(V)''; and
       (B) by inserting before the semicolon at the end the 
     following: ``, and (W) with respect to marriage and family 
     therapist services and mental health counselor services under 
     section 1861(s)(2)(BB), the amounts paid shall be 80 percent 
     of the lesser of the actual charge for the services or 75 
     percent of the amount determined for payment of a 
     psychologist under subparagraph (L)''.
       (5) Exclusion of marriage and family therapist services and 
     mental health counselor services from skilled nursing 
     facility prospective payment system.--Section 
     1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 
     1395yy(e)(2)(A)(ii)) is amended by inserting ``marriage and 
     family therapist services (as defined in section 
     1861(ccc)(1)), mental health counselor services (as defined 
     in section 1861(ccc)(3)),'' after ``qualified psychologist 
     services,''.
       (6) Inclusion of marriage and family therapists and mental 
     health counselors as practitioners for assignment of 
     claims.--Section 1842(b)(18)(C) of the Social Security Act 
     (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end 
     the following new clauses:
       ``(vii) A marriage and family therapist (as defined in 
     section 1861(ccc)(2)).
       ``(viii) A mental health counselor (as defined in section 
     1861(ccc)(4)).''.
       (b) Coverage of Certain Mental Health Services Provided in 
     Certain Settings.--
       (1) Rural health clinics and federally qualified health 
     centers.--Section 1861(aa)(1)(B) of the Social Security Act 
     (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking ``or by a 
     clinical social worker (as defined in subsection (hh)(1))'' 
     and inserting ``, by a clinical social worker (as defined in 
     subsection (hh)(1)), by a marriage and family therapist (as 
     defined in subsection (ccc)(2)), or by a mental health 
     counselor (as defined in subsection (ccc)(4))''.
       (2) Hospice programs.--Section 1861(dd)(2)(B)(i)(III) of 
     the Social Security Act (42 U.S.C. 1395x(dd)(2)(B)(i)(III)) 
     is amended by inserting ``or one marriage and family 
     therapist (as defined in subsection (ccc)(2))'' after 
     ``social worker''.
       (c) Authorization of Marriage and Family Therapists to 
     Develop Discharge Plans for Post-Hospital Services.--Section 
     1861(ee)(2)(G) of the Social Security Act (42 U.S.C. 
     1395x(ee)(2)(G)) is amended by inserting ``marriage and 
     family therapist (as defined in subsection (ccc)(2)),'' after 
     ``social worker,''.
       (d) Effective Date.--The amendments made by this section 
     shall apply with respect to services furnished on or after 
     January 1, 2008.
                                 ______