What This Bill Does
This bill changes Medicare rules to give more mental health services to Americans. It makes it easier for clinical psychologists (mental health doctors who have earned a doctorate degree in psychology) to get paid and work in areas where there are not enough health professionals.
Who It Affects
Medicare patients who need mental health services, clinical psychologists, rural and underserved communities, skilled nursing facilities, home health agencies, hospitals and rehabilitation centers that accept Medicare.
Key Provisions
• Clinical psychologists working in areas with not enough health professionals get an extra payment equal to 10 percent of the regular payment amount, paid monthly or quarterly starting in 2025. (Sec. 2(1)(B))
• Clinical psychologists can now supervise patients receiving mental health services in skilled nursing facilities without a physician's approval, as allowed by state law. (Sec. 3(b))
• Clinical psychologists can oversee mental health services for patients in comprehensive rehabilitation facilities, partial hospitalization programs and home health services without a physician's approval, as allowed by state law. (Sec. 3(a), 3(c), 3(d))
• Clinical psychologists can oversee mental health services for patients in psychiatric hospitals without a physician's approval, as allowed by state law. (Sec. 3(e))
What Changes
If this becomes law, Medicare will pay clinical psychologists an extra 10 percent bonus starting in 2025 if they work in areas with too few health professionals. Clinical psychologists will be able to directly oversee patients' mental health care in hospitals, nursing homes and other facilities without needing a physician to supervise them, as long as state law allows it.
Important Definitions
Clinical psychologist: A mental health professional defined by the Secretary for purposes of section 1861(ii) of the Social Security Act. Health professional shortage area: An area designated under section 332(a)(1)(A) of the Public Health Service Act as having too few health professionals.
Effective Date
The changes take effect on January 1, 2025.
II
118TH CONGRESS
1ST SESSION
S. 669
To amend title XVIII of the Social Security Act to expand access to
psychological and behavioral services.
IN THE SENATE OF THE UNITED STATES
MARCH 7, 2023
Mr. BROWN (for himself, Ms. COLLINS, Mr. HEINRICH, and Mr. MULLIN) in-
troduced the following bill; which was read twice and referred to the Com-
mittee on Finance
A BILL
To amend title XVIII of the Social Security Act to expand
access to psychological and behavioral services.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Increasing Mental
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Health Options Act of 2023’’.
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SEC. 2. EXPANDING ELIGIBILITY FOR INCENTIVES TO
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PRACTICE IN RURAL AND UNDERSERVED
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AREAS.
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Section 1833(m) of the Social Security Act (42
9
U.S.C. 1395l(m)) is amended—
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(1) in paragraph (1)—
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(A) by inserting ‘‘(A)’’ before ‘‘In the
2
case’’; and
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(B) by adding at the end the following new
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subparagraph:
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‘‘(B) In the case of services furnished by a clinical
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psychologist (as defined by the Secretary for purposes of
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section 1861(ii)) in a year (beginning with 2025) to an
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individual, who is covered under the insurance program
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established by this part and who incurs expenses for such
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services, in an area that is designated (under section
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332(a)(1)(A) of the Public Health Service Act) as a health
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professional shortage area as identified by the Secretary
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prior to the beginning of such year, in addition to the
14
amount otherwise paid under this part, there also shall
15
be paid to the clinical psychologist (or to an employer or
16
facility in the cases described in clause (A) of section
17
1842(b)(6)) (on a monthly or quarterly basis) from the
18
Federal Supplementary Medical Insurance Trust Fund an
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amount equal to 10 percent of the payment amount for
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the service under this part’’; and
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(2) in paragraph (2), by inserting ‘‘or clinical
22
psychologist’’ after ‘‘physician’’.
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•S 669 IS
SEC. 3. ELIMINATING UNNECESSARY OVERSIGHT AND AP-
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PROVAL REQUIREMENTS FOR BEHAVIORAL
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HEALTH SERVICES PROVIDED BY CLINICAL
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PSYCHOLOGISTS.
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(a) COMPREHENSIVE OUTPATIENT REHABILITATION
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FACILITIES.—Section 1835(a)(2)(E)(iii) of the Social Se-
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curity Act (42 U.S.C. 1395n(a)(2)(E)(iii)) is amended by
7
inserting ‘‘, except that an individual receiving qualified
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psychologist services as described in section 1861(ii) may
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be under the care of a clinical psychologist with respect
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to such services to the extent authorized under State law’’
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before the semicolon.
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(b)
SKILLED
NURSING
FACILITIES.—Section
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1819(b) of such Act (42 U.S.C. 1395i–3(b)) is amended—
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(1) in paragraph (5)(G), by inserting ‘‘clinical
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psychologist,’’ after ‘‘nurse practitioner,’’; and
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(2) in paragraph (6)(A), by inserting ‘‘, except
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that a resident receiving qualified psychologist serv-
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ices as described in section 1861(ii) may be under
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the supervision of a clinical psychologist with respect
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to such services to the extent authorized under State
21
law’’ before the semicolon.
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(c) PARTIAL HOSPITALIZATION SERVICES.—
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(1) Section 1835(a)(2)(F)(iii) of the Social Se-
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curity Act (42 U.S.C. 1395n(a)(2)(F)(iii)) is amend-
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ed by inserting ‘‘, except that an individual receiving
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•S 669 IS
qualified psychologist services as described in section
1
1861(ii) may be under the care of a clinical psychol-
2
ogist with respect to such services to the extent au-
3
thorized under State law’’ before the period.
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(2) Section 1861(ff)(1) of such Act (42 U.S.C.
5
1395x(ff)(1)) is amended by inserting ‘‘(or, in the
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case of qualified psychologist services, under the su-
7
pervision of a clinical psychologist to the extent au-
8
thorized under State law)’’ after ‘‘under the super-
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vision of a physician’’.
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(d) HOME HEALTH SERVICES.—
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(1) Section 1861(m) of such Act (42 U.S.C.
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1395x(m)) is amended—
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(A) in paragraph (6), by striking ‘‘and’’ at
14
the end;
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(B) in paragraph (7), by inserting ‘‘and’’
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after the semicolon; and
17
(C) by inserting after paragraph (7) the
18
following new paragraph:
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‘‘(8) an individual receiving qualified psycholo-
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gist services may be under the care of a clinical psy-
21
chologist with respect to such services to the extent
22
authorized under State law;’’.
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(2) Section 1891(a)(3)(F) of such Act (42
1
U.S.C. 1395bbb(a)(3)(F)) is amended by inserting
2
‘‘clinical psychologist,’’ after ‘‘physician,’’.
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(e) INPATIENT PSYCHIATRIC HOSPITAL SERVICES.—
4
Section
1814(a)(2)(A)
of
such
Act
(42
U.S.C.
5
1395f(a)(2)(A)) is amended by inserting ‘‘(or, in the case
6
of qualified psychologist services, under the supervision of
7
a clinical psychologist to the extent authorized under State
8
law)’’ after ‘‘under the supervision of a physician’’.
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(f) RULE OF CONSTRUCTION.—In accordance with
10
section 410.71(e) of title 42, Code of Federal Regulations
11
(or any successor regulation), nothing in the provisions of,
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and amendments made by, this section shall be construed
13
as changing or eliminating existing requirements regard-
14
ing clinical consultation by clinical psychologists with a
15
beneficiary’s physician, in accordance with accepted pro-
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fessional ethical norms and taking into consideration pa-
17
tient confidentiality.
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(g) EFFECTIVE DATE.—The amendments made by
19
this section shall apply to services furnished on or after
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January 1, 2025.
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