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108th CONGRESS
  1st Session
                                H. R. 1340

 To amend title XVIII of the Social Security Act to expand and improve 
     coverage of mental health services under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 18, 2003

 Mr. Stark (for himself, Mr. Kennedy of Rhode Island, Mr. Rangel, Ms. 
 Schakowsky, Mr. Frank of Massachusetts, Mr. Abercrombie, Ms. Berkley, 
Mr. Strickland, Mr. Holden, Mr. Serrano, Ms. Jackson-Lee of Texas, Mrs. 
Jones of Ohio, Mr. Cardin, Mr. Green of Texas, Mr. Carson of Oklahoma, 
and Mr. McDermott) introduced the following bill; which was referred to 
 the Committee on Ways and Means, and in addition to the Committee on 
Energy and Commerce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to expand and improve 
     coverage of mental health services under the Medicare Program.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) In General.--This Act may be cited as the ``Medicare Mental 
Health Modernization Act of 2003''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
        TITLE I--ESTABLISHING PARITY FOR MENTAL HEALTH SERVICES

Sec. 101. Elimination of lifetime limit on inpatient mental health 
                            services.
Sec. 102. Parity in treatment for outpatient mental health services.
 TITLE II--EXPANDING COVERAGE OF COMMUNITY-BASED MENTAL HEALTH SERVICES

Sec. 201. Coverage of intensive residential services.
Sec. 202. Coverage of intensive outpatient services.
  TITLE III--IMPROVING BENEFICIARY ACCESS TO MEDICARE-COVERED SERVICES

Sec. 301. Excluding clinical social worker services from coverage under 
                            the medicare skilled nursing facility 
                            prospective payment system and consolidated 
                            payment.
Sec. 302. Coverage of marriage and family therapist services.
Sec. 303. Coverage of mental health counselor services.
Sec. 304. Study of coverage criteria for Alzheimer's disease and 
                            related mental illnesses.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Older people have the highest rate of suicide of any 
        population in the United States, and the suicide rate of that 
        population increases with age, with individuals 65 and older 
        accounting for 20 percent of all suicide deaths in the United 
        States, while comprising only 13 percent of the population of 
        the United States.
            (2) Disability due to mental illness in individuals over 65 
        years old will become a major public health problem in the near 
        future because of demographic changes. In particular, dementia, 
        depression, schizophrenia, among other conditions, will all 
        present special problems for this age group.
            (3) Major depression is strikingly prevalent among older 
        people, with between 8 and 20 percent of older people in 
        community studies and up to 37 percent of those seen in primary 
        care settings experiencing symptoms of depression.
            (4) Almost 20 percent of the population of individuals age 
        55 and older, experience specific mental disorders that are not 
        part of normal aging.
            (5) Unrecognized and untreated depression, Alzheimer's 
        disease, anxiety, late-life schizophrenia, and other mental 
        conditions can be severely impairing and may even be fatal.
            (6) Substance abuse, particularly the abuse of alcohol and 
        prescription drugs, among adults 65 and older is one of the 
        fastest growing health problems in the United States, with 17 
        percent of this age group suffering from addiction or substance 
        abuse. While addiction often goes undetected and untreated 
        among older adults, aging and disability makes the body more 
        vulnerable to the effects of alcohol and drugs, further 
        exacerbating other age-related health problems. Medicare 
        coverage for addiction treatment of the elderly needs to 
        recognize these special vulnerabilities.
            (7) The disabled are another population receiving 
        inadequate mental health care through medicare. According to 
        the Health Care Financing Administration, medicare is the 
        primary health care coverage for the 6,000,000 nonelderly, 
        disabled people on Social Security Disability Insurance. Up to 
        40 percent of these individuals have a diagnosis of mental 
        illness.
            (8) The current medicare benefit structure discriminates 
        against the millions of Americans who suffer from mental 
        illness and maintains an outdated bias toward institutionally 
        based service delivery. According to the report of the Surgeon 
        General on mental health for 1999, intensive outpatient 
        services, such as psychiatric rehabilitation and assertive 
        community treatment, represent state-of-the-art mental health 
        services. These evidence-based community support services help 
        people with psychiatric disabilities improve their ability to 
        function in the community and reduce hospitalization rates by 
        30 to 60 percent, even for people with the most severe mental 
        illnesses.

        TITLE I--ESTABLISHING PARITY FOR MENTAL HEALTH SERVICES

SEC. 101. ELIMINATION OF LIFETIME LIMIT ON INPATIENT MENTAL HEALTH 
              SERVICES.

    (a) In General.--Section 1812 of the Social Security Act (42 U.S.C. 
1395d) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (1), by adding ``and'' at the end;
                    (B) in paragraph (2), by striking ``; and'' at the 
                end; and
                    (C) by striking paragraph (3); and
            (2) by striking subsection (c).
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to items and services furnished on or after January 1, 2004.

SEC. 102. PARITY IN TREATMENT FOR OUTPATIENT MENTAL HEALTH SERVICES.

    (a) In General.--Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by striking subsection (c).
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items and services furnished on or after January 1, 2004.

 TITLE II--EXPANDING COVERAGE OF COMMUNITY-BASED MENTAL HEALTH SERVICES

SEC. 201. COVERAGE OF INTENSIVE RESIDENTIAL SERVICES.

    (a) Coverage Under Part A.--Section 1812(a) of the Social Security 
Act (42 U.S.C. 1395d(a)) is amended--
            (1) in paragraph (3), by striking ``and'' at the end;
            (2) in paragraph (4), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(5) intensive residential services (as defined in section 
        1861(ww)) furnished to an individual for up to 120 days during 
        any calendar year, except that such services may be furnished 
        to the individual for additional days (not to exceed 20 days) 
        during the year if necessary for the individual to complete a 
        course of treatment.''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended by adding at the end the following new 
subsection:

                    ``Intensive Residential Services

    ``(ww)(1) Subject to paragraphs (3) and (4), the term `intensive 
residential services' means a program of residential services 
(described in paragraph (2)) that is--
            ``(A) prescribed by a physician for an individual entitled 
        to, or enrolled for, benefits under part A who is under the 
        care of the physician; and
            ``(B) furnished under the supervision of a physician 
        pursuant to an individualized, written plan of treatment 
        established and periodically reviewed by a physician (in 
        consultation with appropriate staff participating in such 
        services), which plan sets forth--
                    ``(i) the individual's diagnosis,
                    ``(ii) the type, amount, frequency, and duration of 
                the items and services provided under the plan, and
                    ``(iii) the goals for treatment under the plan.
        In the case of such an individual who is receiving qualified 
        psychologist services (as defined in subsection (ii)), the 
        individual may be under the care of the clinical psychologist 
        with respect to such services under this subsection to the 
        extent permitted under State law.
    ``(2) The program of residential services described in this 
paragraph is a nonhospital-based community residential program that 
furnishes acute mental health services or substance abuse services, or 
both, on a 24-hour basis. Such services shall include treatment 
planning and development, medication management, case management, 
crisis intervention, individual therapy, group therapy, and 
detoxification services. Such services shall be furnished in any of the 
following facilities:
            ``(A) Crisis residential programs or mental illness 
        residential treatment programs.
            ``(B) Therapeutic family or group treatment homes.
            ``(C) Residential detoxification centers.
            ``(D) Residential centers for substance abuse treatment.
    ``(3) No service may be treated as an intensive residential service 
under paragraph (1) unless the facility at which the service is 
provided--
            ``(A) is legally authorized to provide such service under 
        the law of the State (or under a State regulatory mechanism 
        provided by State law) in which the facility is located or 
        meets such certification requirements that the Secretary may 
        impose; and
            ``(B) meets such other requirements as the Secretary may 
        impose to assure the quality of the intensive residential 
        services provided.
    ``(4) No service may be treated as an intensive residential service 
under paragraph (1) unless the service is furnished in accordance with 
standards established by the Secretary for the management of such 
services.''.
    (c) Amount of Payment.--Section 1814 of the Social Security Act (42 
U.S.C. 1395f) is amended--
            (1) in subsection (b), in the matter preceding paragraph 
        (1), by inserting ``other than intensive residential 
        services,'' after ``hospice care,''; and
            (2) by adding at the end the following new subsection:

              ``Payment for Intensive Residential Services

    ``(m)(1) The amount of payment under this part for intensive 
residential services under section 1812(a)(5) shall be equal to an 
amount specified under a prospective payment system established by the 
Secretary, taking into account the prospective payment system 
established for psychiatric hospitals pursuant to section 124 of the 
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 
(113 Stat. 1501A-332), as enacted into law by section 1000(a)(6) of 
Public Law 106-113.
    ``(2) Prior to the date on which the Secretary implements the 
prospective payment system established under paragraph (1), the amount 
of payment under this part for such intensive residential services is 
the reasonable costs of providing such services.''.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2004.

SEC. 202. COVERAGE OF INTENSIVE OUTPATIENT SERVICES.

    (a) Coverage.--Section 1832(a)(2) of the Social Security Act (42 
U.S.C. 1395k(a)(2)) is amended--
            (1) in subparagraph (I), by striking ``and'' at the end;
            (2) in subparagraph (J), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(K) intensive outpatient services (as described 
                in section 1861(xx)).''.
    (b) Services Described.--Section 1861 of the Social Security Act 
(42 U.S.C. 1395x), as amended by section 201(b), is amended by adding 
at the end the following new subsection:

                    ``Intensive Outpatient Services

    ``(xx)(1) The term `intensive outpatient services' means the items 
and services described in paragraph (2) prescribed by a physician and 
provided within the context described in paragraph (3) under the 
supervision of a physician (or, to the extent permitted under the law 
of the State in which the services are furnished, a non-physician 
mental health professional) pursuant to an individualized, written plan 
of treatment that is established by a physician and periodically 
reviewed by a physician or, to the extent permitted under the laws of 
the State in which the services are furnished, a non-physician mental 
health professional (in consultation with appropriate staff 
participating in such services), which plan sets forth the patient's 
diagnosis, the type, amount, frequency, and duration of the items and 
services provided under the plan, and the goals for treatment under the 
plan.
    ``(2)(A) The items and services described in this paragraph are the 
items and services described in subparagraph (B) that are reasonable 
and necessary for the diagnosis or treatment of the individual's 
condition, reasonably expected to improve or maintain the individual's 
condition and functional level and to prevent relapse or 
hospitalization, and furnished pursuant to such guidelines relating to 
frequency and duration of services as the Secretary shall by regulation 
establish (taking into account accepted norms of clinical practice).
    ``(B) For purposes of subparagraph (A), the items and services 
described in this paragraph are as follows:
            ``(i) Psychiatric rehabilitation.
            ``(ii) Assertive community treatment.
            ``(iii) Intensive case management.
            ``(iv) Day treatment for individuals under 21 years of age.
            ``(v) Ambulatory detoxification.
            ``(vi) Such other items and services as the Secretary may 
        provide (but in no event to include meals and transportation).
    ``(3) The context described in this paragraph for the provision of 
intensive outpatient services is as follows:
            ``(A) Such services are furnished in a facility, home, or 
        community setting.
            ``(B) Such services are furnished--
                    ``(i) to assist the individual to compensate for, 
                or eliminate, functional deficits and interpersonal and 
                environmental barriers created by the disability; and
                    ``(ii) to restore skills to the individual for 

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