What This Bill Does
This bill changes how Medicare pays for mental health services provided by clinical social workers. It increases payment rates for these services and expands which mental health services Medicare will cover when provided by clinical social workers.
Who It Affects
Medicare patients receiving mental health services from clinical social workers. Skilled nursing facilities (medical care centers where patients receive nursing services and rehabilitation). Clinical social workers who provide mental health services to Medicare patients.
Key Provisions
• Medicare will pay clinical social workers 85 percent of the fee schedule amount (the standard payment rate used for other mental health providers) instead of 75 percent of what psychologists receive (Sec. 2(a))
• Clinical social worker services provided in skilled nursing facilities will no longer be bundled into the facility's overall payment system and will be paid separately (Sec. 2(b)(1))
• Clinical social workers can now provide and get paid for health and behavior assessment and intervention services in addition to diagnosis and treatment of mental illness (Sec. 2(c))
What Changes
The payment Medicare makes to clinical social workers will increase from 75 percent of psychologist payment rates to 85 percent of the standard fee schedule amount. Skilled nursing facilities will bill Medicare separately for clinical social worker services instead of including them in the facility's bundled payment. Clinical social workers will be able to provide additional types of mental health services that were previously not covered.
Important Definitions
Clinical social worker: Not defined in this bill text.
Effective Date
These changes apply to services provided on or after January 1, 2024 (Sec. 2(d))
II
118TH CONGRESS
1ST SESSION
S. 838
To amend title XVIII of the Social Security Act to improve access to mental
health services under the Medicare program.
IN THE SENATE OF THE UNITED STATES
MARCH 16, 2023
Ms. STABENOW (for herself and Mr. BARRASSO) introduced the following bill;
which was read twice and referred to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to improve
access to mental health services under the Medicare program.
Be it enacted by the Senate and House of Representa-
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tives of the United States of America in Congress assembled,
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SECTION 1. SHORT TITLE.
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This Act may be cited as the ‘‘Improving Access to
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Mental Health Act of 2023’’.
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SEC. 2. IMPROVED ACCESS TO MENTAL HEALTH SERVICES
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UNDER THE MEDICARE PROGRAM.
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(a) ACCESS TO CLINICAL SOCIAL WORKERS.—Sec-
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tion 1833(a)(1)(F)(ii) of the Social Security Act (42
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U.S.C. 1395l(a)(1)(F)(ii)) is amended by striking ‘‘75
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•S 838 IS
percent of the amount determined for payment of a psy-
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chologist under clause (L)’’ and inserting ‘‘85 percent of
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the fee schedule amount provided under section 1848’’.
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(b) ACCESS TO CLINICAL SOCIAL WORKER SERVICES
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PROVIDED TO RESIDENTS OF SKILLED NURSING FACILI-
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TIES.—
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(1) EXCLUSION OF CLINICAL SOCIAL WORKER
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SERVICES FROM THE SKILLED NURSING FACILITY
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PROSPECTIVE
PAYMENT
SYSTEM.—Section
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1888(e)(2)(A)(ii) of the Social Security Act (42
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U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting
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‘‘clinical social worker services,’’ after ‘‘qualified psy-
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chologist services,’’.
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(2)
CONFORMING
AMENDMENT.—Section
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1861(hh)(2) of the Social Security Act (42 U.S.C.
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1395x(hh)(2)) is amended by striking ‘‘and other
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than services furnished to an inpatient of a skilled
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nursing facility which the facility is required to pro-
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vide as a requirement for participation’’.
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(c) ACCESS TO THE COMPLETE SET OF CLINICAL SO-
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CIAL WORKER SERVICES.—Section 1861(hh)(2) of the So-
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cial Security Act (42 U.S.C. 1395x(hh)(2)), as amended
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by subsection (b)(2), is amended—
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(1) by striking ‘‘for the diagnosis and treatment
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of mental illnesses (other than services’’ and insert-
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ing ‘‘, including services for the diagnosis and treat-
1
ment of mental illnesses or services for health and
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behavior assessment and intervention (identified as
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of January 1, 2023, by HCPCS codes 96156,
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96158–96161, 96164–96168, and 96170–96171
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(and any succeeding codes)) but not including serv-
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ices’’; and
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(2) by striking ‘‘inpatient of a hospital)’’ and
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inserting ‘‘inpatient of a hospital,’’.
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(d) EFFECTIVE DATE.—The amendments made by
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this section shall apply to items and services furnished on
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or after January 1, 2024.
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Æ
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