text: SECTION 1. SHORT TITLE; REFERENCES IN ACT.
  
      (a) Short Title.--This Act may be cited as the ``Medicare Mental 
  Health Improvement Act''.
      (b) References to Social Security Act.--Whenever in this Act an 
  amendment is expressed in terms of an amendment to or repeal of a 
  section or other provision, the reference shall be considered to be 
  made to that section or other provision of the Social Security Act.
  
  SEC. 2. INPATIENT PSYCHIATRIC HOSPITAL SERVICES.
  
      (a) Services Covered.--Section 1812(a) (42 U.S.C. 1395d(a)) is 
  amended--
              (1) by striking ``and'' at the end of paragraph (3);
              (2) by striking the period at the end of paragraph (4) and 
          inserting ``; and''; and
              (3) by adding at the end the following new paragraph:
              ``(5) inpatient hospital services furnished primarily for 
          the diagnosis or treatment of mental illness or substance abuse 
          for up to 60 days during a year.''.
      (b) Limitation on Coverage.--Section 1812(b)(3) (42 U.S.C. 
  1395d(b)) is amended to read as follows:
              ``(3) inpatient hospital services furnished primarily for 
          the diagnosis or treatment of mental illness or substance abuse 
          that are furnished to the individual during a year after such 
          services have been furnished to the individual for a total of 
          60 days during the year.''.
      (c) Conforming Amendments.--(1) Section 1812(a)(1) (42 U.S.C. 
  1395d(a)(1)) is amended by inserting ``(other than services described 
  in paragraph (5))'' after ``inpatient hospital services'' the first 
  place it appears.
      (2) Section 1812(b)(1) (42 U.S.C. 1395d(b)(1)) is amended by 
  inserting ``(other than services described in paragraph (3))'' after 
  ``inpatient hospital services'' the first place it appears.
      (3) Section 1812 (42 U.S.C. 1395d) is amended by striking 
  subsection (c).
      (4) Section 1814(a) (42 U.S.C. 1395f(a)) is amended--
              (A) in paragraph (2), by striking subparagraph (A);
              (B) in paragraph (3), by striking ``(other than inpatient 
          psychiatric hospital services)''; and
              (C) by striking paragraph (4).
      (5) Section 1861 (42 U.S.C. 1395x) is amended by striking 
  subsection (c).
      (d) Effective Date; Transition.--The amendments made by this 
  section shall take effect January 1, 1996, except that--
              (1) an individual who at any time prior to such date has 
          been furnished inpatient psychiatric hospital services (as 
          defined for purposes of title XVIII of the Social Security Act 
          as of the date of the enactment of this Act) for 190 
          consecutive days is not entitled to any services under section 
          1812(a)(5) (as added by subsection (a)(3)); and
              (2) in the case of an individual who is not described in 
          paragraph (1) and is receiving inpatient psychiatric hospital 
          services (as defined for purposes of title XVIII of the Social 
          Security Act as of the date of the enactment of this Act) on 
          December 31, 1995, for which payment may be made under section 
          1812 of such Act, the number of days of services for which the 
          individual is entitled under section 1812(a)(5) (and the number 
          of days applicable under section 1812(b)(3)) shall be equal to 
          the greater of 60 or the difference between 190 days and the 
          number of days of such inpatient psychiatric hospital services 
          furnished to the individual prior to January 1, 1996.
  
  SEC. 3. INTENSIVE RESIDENTIAL SERVICES.
  
      (a) Coverage Under Part A.--Section 1812(a) (42 U.S.C. 1395d(a)), 
  as amended by section 2(a), is amended--
              (1) by striking ``and'' at the end of paragraph (4);
              (2) by striking the period at the end of paragraph (5) and 
          inserting ``; and''; and
              (3) by adding at the end the following new paragraph:
              ``(6) intensive residential services (as described in 
          section 1861(qq)) 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 during the year 
          if necessary for the individual to complete a course of 
          treatment to the extent that the number of days of inpatient 
          hospital services described in paragraph (5) that may be 
          furnished to the individual during the year (as reduced under 
          such paragraph) is not less than 15.''.
              (2) Services described.--Section 1861 (42 U.S.C. 1395x), as 
          amended by section 146(a) of the Social Security Act Amendments 
          of 1994, is amended by adding at the end the following new 
          subsection:
  
                      ``Intensive Residential Services
  
      ``(mm)(1) Subject to paragraph (2), 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 
  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 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.''.
              (3) Reduction in days of coverage for inpatient services.--
          Section 1812(a)(5) and section 1812(b)(3), as amended by 
          section 2, are each 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 paragraph (6) during the year after such services have 
          been furnished to the individual for 120 days during the year 
          (rounded to the nearest day).''.
              (4) Amount of payment.--Section 1814 (42 U.S.C. 1395f) is 
          amended--
                      (A) in subsection (b) in the matter preceding 
                  paragraph (1), by inserting ``other than intensive 
                  residential services,'' after ``hospice care,''; and
                      (B) by adding at the end the following new 
                  subsection:
  
                ``Payment for Intensive Residential Services
  
      ``(m) The amount of payment under this part for intensive 
  residential services under section 1812(a)(6) shall be equal to--
              ``(1) 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 such 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 amount determined in accordance with subsection 
          (b)(2); and
              ``(3) if (and for so long as) the conditions described in 
          subsection (b)(3) are met, the amounts determined under the 
          reimbursement system described in such section.''.
  
  SEC. 4. LOWERING COINSURANCE FOR CERTAIN OUTPATIENT MENTAL HEALTH AND 
                SUBSTANCE ABUSE SERVICES.
  
      (a) In General.--Section 1833(c) (42 U.S.C. 1395l(c)) is amended by 
  striking ``mental, psychoneurotic, and personality disorders'' and all 
  that follows through ``are incurred'' and inserting the following: 
  ``mental illness or substance abuse of an individual who, at the time 
  such expenses are incurred, is over 18 years of age, is not an 
  inpatient of a hospital, and has received 5 or more sessions of such 
  treatment during the calendar year,''.
      (b) Requiring Services To Be Furnished in Accordance With 
  Management Standards.--Section 1862(a) (42 U.S.C. 1395y(a)), as amended 
  by section 156(a)(2)(D) of the Social Security Act Amendments of 1994, 
  is amended--
              (1) by striking ``or'' at the end of paragraph (14);
              (2) by striking the period at the end of paragraph (15) and 
          inserting ``; or''; and
              (3) by inserting after paragraph (15) the following new 
          paragraph:
              ``(16) in the case of any items or services furnished under 
          part B for the treatment of mental illness or emotional 
          disturbance (including substance abuse), if the services are 
          not furnished in accordance with standards established by the 
          Secretary for the management of such services.''.
  
  SEC. 5. INTENSIVE COMMUNITY-BASED SERVICES.
  
      (a) Coverage.--
              (1) In general.--Section 1832(a)(2)(J) (42 U.S.C. 
          1395k(a)(2)(J)) is amended to read as follows:
                      ``(J) intensive community-based services (as 
                  described in section 1861(ff))--
                              ``(i) for an unlimited number of days 
                          during any calendar year, in the case of 
                          services described in section 1861(ff)(2)(E) 
                          that are furnished to an individual who is a 
                          seriously mentally ill adult, a seriously 
                          emotionally disturbed child, or an adult or 
                          child with serious substance abuse disorder (as 
                          determined in accordance with criteria 
                          established by the Secretary),
                              ``(ii) in the case of day treatment 
                          services for an individual under 19 years of 
                          age described in section 1861(ff)(2)(C), for up 
                          to 180 days during any calendar year, except 
                          that such services may be furnished to the 
                          individual for a number of additional days 
                          during the year equal to the difference between 
                          the total number of days of intensive 
                          residential services which the individual may 
                          receive during the year under part A (as 
                          determined under section 1812(a)(6)) and the 
                          number of days of such services which the 
                          individual has received during the year, or
                              ``(iii) in the case of any other such 
                          services, for up to 90 days during any calendar 
                          year, except that such services may be 
                          furnished to the individual for the number of 
                          additional days during the year described in 
                          clause (ii).''.
              (2) Reduction in number of days of intensive residential 
          services.--Section 1812(a)(6) (42 U.S.C. 1395d(a)(6)), as added 
          by section 3(a), is amended--
                      (A) by inserting ``(A)'' before ``such services''; 
                  and
                      (B) by striking the period at the end and inserting 
                  the following: ``, and (B) 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 intensive community-based services 
                  furnished to the individual under section 1832(a)(2)(J) 
                  during the year after such services have been furnished 
                  to the individual for 90 days (or, in the case of 
                  services described in section 1832(a)(2)(J)(ii), for 
                  180 days) during the year (rounded to the nearest 
                  day).''.
      (b) Services Described.--Section 1861(ff)(2) (42 U.S.C. 
  1395x(ff)(2)) is amended--
              (1) in the matter preceding subparagraph (A), by striking 
          ``are--'' and inserting ``are as follows:'';
              (2) in subparagraph (C)--
                      (A) by inserting ``behavioral aide services,'' 
                  after ``nurses'', and
                      (B) by adding at the end the following: ``(to the 
                  extent authorized under State law)'';
              (3) by adding ``and'' at the end of subparagraph (G);
              (4) in subparagraph (H), by striking ``, and'' and 
          inserting a period;
              (5) by redesignating subparagraphs (A) through (H) as 
          clauses (i) through (viii) and moving such subparagraphs 2 ems 
          to the right;
              (6) by inserting before clause (i) (as so redesignated) the 
          following:
                      ``(A) Partial hospitalization services consisting 
                  of--'';
              (7) by inserting after clause (viii) (as so redesignated) 
          the following new subparagraphs:
              ``(B) Psychiatric rehabilitation services.
              ``(C) Day treatment services for substance abuse treatment 
          for individuals of any age and for other mental health services 
          for individuals under 19 years of age.
              ``(D) In-home services.
              ``(E) Case management services, including collateral 
          services designated as such case management services by the 
          Secretary.
              ``(F) Ambulatory detoxification services.''; and
              (8) in subparagraph (I)--
                      (A) by striking ``such'' and inserting ``Such'', 
                  and
                      (B) by redesignating such subparagraph as 
                  subparagraph (G).
      (c) Permitting Non-Physician Providers To Supervise Individual 
  Program of Treatment.--Section 1861(ff)(1) (42 U.S.C. 1395x(ff)(1)) is 
  amended by inserting after ``supervision of a physician'' the 
  following: ``(or, to the extent permitted under the law of the State in 
  which the services are furnished, a non-physician mental health or 
  substance abuse treatment professional)''.
      (d) Requiring Services To Meet Management Standards.--Section 
  1861(ff)(1) (42 U.S.C. 1395x(ff)(1)) is amended by striking the period 
  at the end and inserting the following: ``, but does not include any 
  item or service that is not furnished in accordance with standards 
  established by the Secretary for the management of such services.''.
      (e) Programs Eligible To Provide Services.--Section 1861(ff)(3) (42 
  U.S.C. 1395x(ff)(3)) is amended to read as follows:
      ``(3) A program described in this paragraph is a program (whether 
  facility-based or freestanding) which is furnished by an entity--
              ``(A) legally authorized to furnish such a program under 
          State law (or the State regulatory mechanism provided by State 
          law) or certified to furnish such a program by an appropriate 
          accreditation entity approved by the State in consultation with 
          the Secretary; and
              ``(B) meeting such other requirements as the Secretary may 
          impose to assure the quality of the intensive community-based 
          services provided.''.
      (f) Waiver of Copayment for Case Management Services Furnished to 
  Certain Individuals.--Section 1833(a)(2) (42 U.S.C. 1395l(a)(2)), as 
  amended by section 147(f)(6)(C) of the Social Security Act Amendments 
  of 1994, is amended--
              (1) in subparagraph (B), by striking ``or (E)'' and 
          inserting ``(E), or (F)'';
              (2) by striking ``and'' at the end of subparagraph (E);
              (3) by adding ``and'' at the end of subparagraph (F); and
              (4) by adding at the end the following new subparagraph:
                      ``(G) with respect to services described in section 
                  1832(a)(2)(J)(i), the amount determined under 
                  subparagraph (B), except that `100 percent' shall be 
                  substituted for any reference in such subparagraph to 
                  `80 percent';''.
      (g) Conforming Amendments.--(1) Section 1835(a)(2)(F) (42 U.S.C. 
  1395n(a)(2)(F)) is amended--
              (A) by striking ``partial hospitalization'' and inserting 
          ``intensive community-based''; and
              (B) in clause (ii), by striking ``physician'' and inserting 
          ``physician (or, to the extent permitted under the law of the 
          State in which the services are furnished, a non-physician 
          mental health professional)''.
      (2) Section 1861(s)(2)(B) (42 U.S.C. 1395x(s)(2)(B)) is amended by 
  striking ``partial hospitalization'' and inserting ``intensive 
  community-based''.
      (3) Section 1861(ff) (42 U.S.C. 1395x(ff)) is amended--
              (A) in the heading, by striking ``Partial Hospitalization'' 
          and inserting ``Intensive Community-Based''; and
              (B) in paragraph (1), by striking ``partial 
          hospitalization'' and inserting ``intensive community-based''.
      (4) Section 1866(e)(2) (42 U.S.C. 1395cc(e)(2)) is amended by 
  striking ``partial hospitalization'' and inserting ``intensive 
  community-based''.
  
  SEC. 6. EFFECTIVE DATE.
  
      The amendments made by this Act shall apply to items and services 
  furnished on or after January 1, 1996.
target: Medicare Mental Health Improvement Act - Amends title XVIII (Medicare) of the Social Security Act to:  (1) include under Medicare coverage inpatient hospital services for up to 60 days during a year when furnished primarily for the diagnosis or treatment of mental illness or substance abuse; (2) require patient payment for services rendered beyond such limit; and (3) make such changes effective on January 1, 1996 (with exceptions and transition provisions). 
  (Sec. 3) Includes under Medicare coverage the following "intensive residential services" for up to 120 days in a year:  (1) residential detoxification centers; (2) crisis or mental illness residential treatment programs; (3) therapeutic family or group treatment homes; and (4) residential centers for substance abuse treatment.  Requires facilities providing such services to be authorized to do so and to meet quality standards imposed by the Secretary of Health and Human Services.  Allows additional days to be taken for intensive residential services from the 60 days permitted for inpatient hospital services (with an actuarial cost limit), requiring at least 15 days to be retained yearly for the latter services.  Provides for the determination of payment amounts for intensive residential services. 
  (Sec. 4) Subjects inpatient hospitalization and intensive residential services to the same deductibles and copayment as inpatient hospital services for physical disorders. 
  (Sec. 5) Makes mental health case management services available with no copayment and for an unlimited duration for an adult with serious mental illness, a child with a serious emotional disturbance, or an adult or child with a serious substance abuse disorder.  Makes day treatment available for up to 180 days annually for children under 19.  Allows additional days for day treatment services for such children to be taken from intensive residential services (with an actuarial cost limit). Authorizes coverage for up to 90 days annually, with a 20 percent copayment requirement, for:  (1) partial hospitalization; (2) psychiatric rehabilitation; (3) day treatment for substance abuse and for children under age 19; (4) in-home services; (5) case management; and (6) ambulatory detoxification.  Permits non-physician mental health or substance abuse professionals to supervise an individual plan of treatment to the extent permitted under State law.  Requires any program furnishing mental health or substance abuse services to be legally authorized under State law or accredited by an organization approved by the Secretary in consultation with the State.  Requires such programs to meet standards established by the Secretary for the management of such services.
feat_title: Medicare Mental Health Improvement Act