text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Medicare Mental Health Modernization 
  Act of 2000''.
  
  SEC. 2. FINDINGS.
  
      The Senate 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 5,000,000 non-elderly, 
          disabled people on Social Security Disability Insurance. Up to 
          40 percent of these individuals have a diagnosis of mental 
          illness, and also face severe discrimination in mental health 
          coverage.
  
  SEC. 3. DECREASE IN MEDICARE BENEFICIARY COPAYMENT FOR OUTPATIENT 
                MENTAL HEALTH SERVICES.
  
      (a) In General.--Section 1833(c) of the Social Security Act (42 
  U.S.C. 1395l(c)) is repealed.
      (b) Conforming Amendment.--Section 1866(a)(2)(A) of such Act (42 
  U.S.C. 1395cc(a)(2)(A)) is amended by striking the second sentence.
      (c) Effective Date.--The amendments made by subsections (a) and (b) 
  shall apply to items and services furnished on or after the date of 
  enactment of this Act.
  
  SEC. 4. INTENSIVE RESIDENTIAL SERVICES.
  
      (a) Coverage Under Part A.--Section 1812(a) (42 U.S.C. 1395d(a)) is 
  amended--
              (1) in paragraph (4), by striking ``and'' at the end;
              (2) in paragraph (5), by striking the period at the end of 
          and inserting ``; and''; and
              (3) by adding at the end the following new paragraph:
              ``(5) intensive residential services (as defined in section 
          1861(uu)) furnished to an individual for up to 120 days during 
          any calendar year.''.
      (b) Intensive Residential Services Defined.--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
  
      ``(uu)(1) Subject to paragraphs (2) and (3), the term `intensive 
  residential services' means inpatient services provided in any of the 
  following facilities:
              ``(A) Residential detoxification centers.
              ``(B) Crisis residential programs or mental illness 
          residential treatment programs.
              ``(C) Therapeutic family or group treatment homes.
              ``(D) Residential centers for substance abuse treatment.
      ``(2) No service may be treated as an intensive residential service 
  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 is 
          certified to provide such service by an appropriate 
          accreditation entity approved by the State in consultation with 
          the Secretary; and
              ``(B) meets such other requirements as the Secretary may 
          impose to assure the quality of the intensive residential 
          services provided.
      ``(3) 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) Reduction in Days of Coverage for Inpatient Services.--Section 
  1812(b)(3) of the Social Security Act (42 U.S.C. 1395d(b)(3)) is 
  amended by striking the period at the end and inserting the following: 
  ``, reduced by a number of days determined by the Secretary so that the 
  actuarial value of providing such number of days of services under this 
  paragraph to the individual is equal to the actuarial value of the days 
  of inpatient residential services furnished to the individual under 
  subsection (a)(5) during the year after such services have been 
  furnished to the individual for 120 days during the year (rounded to 
  the nearest day).''.
      (d) 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 a provider of intensive 
          residential services,'' after ``hospice care,''; and
              (2) by adding at the end the following new subsection:
  
                ``Payment for Intensive Residential Services
  
      ``(m)(1) Except as provided in paragraphs (2) and (3), the amount 
  of payment under this part for intensive residential services under 
  section 1812(a)(5) shall be equal to the lesser of--
              ``(A) the reasonable cost of such services, as determined 
          under section 1861(v), or
              ``(B) the customary charges with respect to such services,
  less the amount a provider may charge as described in clause (ii) of 
  section 1866(a)(2)(A).
      ``(2) If intensive residential services are furnished by a public 
  provider of services or by another provider which demonstrates to the 
  satisfaction of the Secretary that a significant portion of its 
  patients are low-income (and requests that payment be made under this 
  clause), free of charge or at nominal charges to the public, the 
  Secretary shall determine the amount of payment for such services in 
  accordance with subsection (b)(2).
      ``(3) If (and for so long as) the conditions described in 
  subsection (b)(3) are met, the Secretary shall determine the amount of 
  payment for intensive residential services under the reimbursement 
  system described in such subsection.''.
  
  SEC. 5. STUDY OF COVERAGE CRITERIA FOR ALZHEIMER'S DISEASE AND RELATED 
                MENTAL ILLNESSES.
  
      (a) Study.--
              (1) In general.--The Secretary of Health and Human Services 
          (in this section referred to as the ``Secretary'') shall 
          conduct a study to determine whether the criteria for coverage 
          of any therapy service (including occupational therapy services 
          and physical therapy services) or any outpatient mental health 
          care service under the medicare program under title XVIII of 
          the Social Security Act unduly restricts the access of any 
          medicare beneficiary who has been diagnosed with Alzheimer's 
          disease or a related mental illness to such a service because 
          the coverage criteria requires the medicare beneficiary to 
          display continuing clinical improvement to continue to receive 
          the service.
              (2) Determination of new coverage criteria.--If the 
          Secretary determines that the coverage criteria described in 
          paragraph (1) unduly restricts the access of any medicare 
          beneficiary to the services described in such paragraph, the 
          Secretary shall identify alternative coverage criteria that 
          would permit a medicare beneficiary who has been diagnosed with 
  Alzheimer's disease or a related mental illness to receive coverage for 
  health care services under the medicare program that are designed to 
  control symptoms, maintain functional capabilities, reduce or deter 
  deterioration, and prevent or reduce hospitalization of the 
  beneficiary.
      (b) Report.--Not later than 1 year after the date of enactment of 
  this Act, the Secretary shall submit to the committees of jurisdiction 
  of Congress a report on the study conducted under subsection (a) 
  together with such recommendations for legislative and administrative 
  action as the Secretary determines appropriate.
  
  SEC. 6. MENTAL HEALTH COUNSELING SERVICES.
  
      (a) Adding Mental Health Counselor Services to the Definition of 
  Medical and Other Health Services.--Section 1861(s)(2) of the Social 
  Security Act (42 U.S.C. 1395(s)(2)) is amended--
              (1) in subparagraph (S), by striking ``and'' at the end;
              (2) in subparagraph (T)(ii), by adding ``and'' at the end; 
          and
              (3) by adding at the end the following new subparagraph:
                      ``(U) mental health counselor services (as defined 
                  in subsection (vv));''.
      (b) Mental Health Counselor; Mental Health Counselor Services 
  Defined.--Section 1861 of the Social Security Act (42 U.S.C. 1395x), as 
  amended by section 4, is amended by adding at the end the following new 
  subsection:
  
        ``Mental Health Counselor; Mental Health Counselor Services
  
      ``(vv)(1) The term `mental health counselor' means an individual 
  who--
              ``(A) possesses a master's or doctor's degree in counseling 
          or a related field;
              ``(B) after obtaining such a degree has performed at least 
          2 years of supervised mental health counselor practice; and
              ``(C)(i) is licensed or certified as a mental health 
          counselor or professional counselor by the State in which the 
          services are performed; or
              ``(ii) in the case of an individual in a State that does 
          not provide for licensure or certification--
                      ``(I) has completed at least 2 years or 3,000 hours 
                  of post-master's degree supervised mental health 
                  counselor practice under the supervision of a master's 
                  or doctor's level mental health provider in an 
                  appropriate setting (as determined by the Secretary); 
                  and
                      ``(II) meet such other criteria as the Secretary 
                  establishes.
      ``(2) The term `mental health counselor services' means services 
  performed by a mental health counselor (as defined in paragraph (1)) 
  for the diagnosis and treatment of mental illnesses which the mental 
  health counselor is legally authorized to perform under State law (or 
  the State regulatory mechanism provided by the State law) of the State 
  in which such services as performed as would otherwise be covered if 
  furnished by a physician or as incident to a physician's professional 
  service.''.
      (c) Payment.--Section 1833(a)(1) of the Social Security Act (42 
  U.S.C. 1395l(a)(1)) is amended--
              (1) by striking ``and'' before ``(S)''; and
              (2) by inserting before the semicolon at the end the 
          following: ``, and (T) with respect to mental health counselor 
          services under section 1861(s)(2)(U), the amounts paid shall be 
          80 percent of (i) the actual charge for the services or (ii) 75 
          percent of the amount determined for payment of a psychologist 
          under clause (L)''.
  
  SEC. 7. EXCLUDING CLINICAL SOCIAL WORKER SERVICES FROM COVERAGE UNDER 
                THE MEDICARE SKILLED NURSING FACILITY PROSPECTIVE PAYMENT 
                SYSTEM AND CONSOLIDATED PAYMENT.
  
      (a) In General.--Section 1888(e)(2)(A)(ii) of the Social Security 
  Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting ``clinical 
  social worker services,'' after ``qualified psychologist services,''.
      (b) Conforming Amendment.--Section 1861(hh)(2) of such Act (42 
  U.S.C. 1395x(hh)(2)) is amended by striking ``and other than services 
  furnished to an inpatient of a skilled nursing facility which the 
  facility is required to provide as a requirement for participation''.
      (c) Effective Date.--The amendments made by this section apply as 
  if included in the enactment of section 4432(a) of the Balanced Budget 
  Act of 1997.
target: Amends Medicare part A (Hospital Insurance) to provide for coverage of intensive residential services.
  Directs the Secretary of Health and Human Services to study and report to Congress on whether the criteria for Medicare coverage of any therapy service (including occupational and physical therapy) or any outpatient mental health care service unduly restricts the access to such a service of any Medicare beneficiary diagnosed with Alzheimer's disease or a related mental illness because the coverage criteria requires the beneficiary to display continuing clinical improvement to continue to receive the service.
  Amends Medicare to: (1) cover mental health counselor services; and (2) exclude clinical social worker services from coverage under the Medicare skilled nursing facility prospective payment system.
feat_title: Medicare Mental Health Modernization Act of 2000