[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8878 Introduced in House (IH)]
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117th CONGRESS
2d Session
H. R. 8878
To amend title XVIII of the Social Security Act to ensure adequate
coverage of outpatient mental health services under the Medicare
program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 19, 2022
Ms. Chu (for herself, Mr. Pascrell, and Mr. Smith of Nebraska)
introduced the following bill; which was referred to the Committee on
Energy 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
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to ensure adequate
coverage of outpatient 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. ENSURING ADEQUATE COVERAGE OF OUTPATIENT MENTAL HEALTH
SERVICES UNDER THE MEDICARE PROGRAM.
(a) Modification of Definition of Partial Hospitalization
Services.--Section 1861(ff)(1) of the Social Security Act (42 U.S.C.
1395x(ff)(1)) is amended by inserting ``for an individual determined
(not less frequently than monthly) by a physician to have a need for
such services for a minimum of 20 hours per week'' after ``prescribed
by a physician''.
(b) Coverage of Intensive Outpatient Services.--
(1) Scope of benefits.--
(A) Community mental health centers.--Section
1832(a)(2)(J) of the Social Security Act (42 U.S.C.
1395k(a)(2)(J)) is amended by inserting ``and intensive
outpatient services'' after ``partial hospitalization
services''.
(B) Incident-to services.--Section 1861(s)(2)(B) is
amended by inserting ``or intensive outpatient
services'' after ``partial hospitalization services''.
(2) Definition.--Section 1861(ff) of the Social Security
Act (42 U.S.C. 1395x(ff)) is amended--
(A) in the header, by inserting ``; Intensive
Outpatient Services'' after ``Partial Hospitalization
Services''; and
(B) by adding at the end the following new
paragraph:
``(4) The term `intensive outpatient services' has the meaning
given the term `partial hospitalization services' in paragraph (1),
except that--
``(A) section 1835(a)(2)(F)(i) shall not apply;
``(B) the reference in such paragraph to an individual
`determined (not less frequently than monthly) by a physician
to have a need for such services for a minimum of 20 hours per
week' shall be treated as a reference to an individual
`determined (not less frequently than once every other month)
by a physician to have a need for such services for a minimum
of 9 hours per week'; and
``(C) the reference to `a community mental health center
(as defined in subparagraph (B))' in paragraph (3) shall be
treated as a reference to `a community mental health center (as
defined in subparagraph (B)), a Federally qualified health
center, or a rural health clinic'.''.
(3) Exclusion from calculation of certain treatment
costs.--Section 1833(c)(2) of the Social Security Act (42
U.S.C. 1395l(c)(2)) is amended by inserting ``or intensive
outpatient services'' after ``partial hospitalization
services''.
(4) Conforming amendments.--
(A) Intensive outpatient services.--Section
1861(aa) of the Social Security Act (42 U.S.C.
1395x(aa)) is amended--
(i) in paragraph (1)--
(I) in subparagraph (B), by
striking ``and'' at the end;
(II) in subparagraph (C), by adding
``and'' at the end; and
(III) by inserting after
subparagraph (C) the following new
subparagraph:
``(D) intensive outpatient services (as defined in section
1861(ff)(4)),''; and
(ii) in paragraph (3), by striking
``through (C)'' and inserting ``through (D)''.
(B) Provider of services.--Section 1866(e)(2) of
the Social Security Act (42 U.S.C. 1395cc(e)(2)) is
amended by inserting ``, or intensive outpatient
services (as described in section 1861(ff)(4))'' after
``partial hospitalization services (as described in
section 1861(ff)(1))''.
(c) Special Payment Rule for FQHCs and RHCs.--Section 1834 of the
Social Security Act (42 U.S.C. 1395m) is amended--
(1) in subsection (o), by adding at the end the following
new paragraph:
``(5) Special payment rule for intensive outpatient
services.--
``(A) In general.--In the case of intensive
outpatient services furnished by a Federally qualified
health center, the payment amount for such services
shall be equal to the amount that would have been paid
under this title for such services had such services
been covered OPD services furnished by a hospital.
``(B) Exclusion.--Costs associated with intensive
outpatient services shall not be used to determine the
amount of payment for Federally qualified health center
services under the prospective payment system under
this subsection.''; and
(2) in subsection (y)--
(A) in the header, by striking ``to Hospice
Patients''; and
(B) by adding at the end the following new
paragraph:
``(3) Special payment rule for intensive outpatient
services.--
``(A) In general.--In the case of intensive
outpatient services furnished by a rural health clinic,
the payment amount for such services shall be equal to
the amount that would have been paid under this title
for such services had such services been covered OPD
services furnished by a hospital.
``(B) Exclusion.--Costs associated with intensive
outpatient services shall not be used to determine the
amount of payment for rural health clinic services
under the methodology for all-inclusive rates
(established by the Secretary) under section
1833(a)(3).''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to items and services furnished on or after January
1, 2024.
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