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H.R. 1341 (ih) To amend the Internal Revenue Code of 1986 to provide capital gain treatment under section 631(b) of such Code for outright sales of timber by landowners. [Introduced in House] ...
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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