What This Bill Does
This bill changes how Medicare pays for mental health services provided by clinical social workers. It also expands the types of mental health services that Medicare covers for people in skilled nursing facilities.
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Who It Affects
Medicare beneficiaries who receive mental health services from clinical social workers, particularly those living in skilled nursing facilities.
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Key Provisions
- Medicare will now pay clinical social workers at 85 percent of the standard fee schedule amount instead of the previous payment rate (Sec. 2(a))
- Clinical social worker services provided in skilled nursing facilities are no longer included in the facility's overall payment system, meaning these services get paid separately (Sec. 2(b)(1))
- Clinical social workers can now provide health and behavior assessment and intervention services in addition to mental illness diagnosis and treatment services (Sec. 2(c))
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What Changes
Clinical social workers will receive higher Medicare reimbursement (payment) rates. Skilled nursing facilities will no longer bundle clinical social worker services into their regular facility payments. Medicare coverage expands to include specific health and behavior assessment and intervention services identified by specific billing codes.
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Important Definitions
Clinical social workers are professionals who provide mental health services. Skilled nursing facilities are medical facilities that provide nursing care to patients. A prospective payment system is a method of paying medical facilities a fixed amount for patient care.
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Effective Date
January 1, 2024
I
118TH CONGRESS
1ST SESSION H. R. 1638
To amend title XVIII of the Social Security Act to improve access to mental
health services under the Medicare program.
IN THE HOUSE OF REPRESENTATIVES
MARCH 17, 2023
Ms. LEE of California (for herself, Mr. FITZPATRICK, Mr. POCAN, Ms. BLUNT
ROCHESTER, Ms. TOKUDA, Mr. TRONE, Ms. MCCOLLUM, Ms. SCHA-
KOWSKY, Mr. LYNCH, Mr. COHEN, Mr. GARCI´A of Illinois, Mr. SMITH of
Washington, Mrs. WATSON COLEMAN, Ms. SCANLON, Ms. KUSTER, Mr.
CARTER of Louisiana, Ms. PORTER, Mr. TONKO, and Mr. GRIJALVA) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committee on Ways and
Means, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned
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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•HR 1638 IH
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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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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•HR 1638 IH
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-
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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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