[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3430 Reported in Senate (RS)]
<DOC>
Calendar No. 265
118th CONGRESS
1st Session
S. 3430
[Report No. 118-121]
To amend titles XVIII and XIX of the Social Security Act to expand the
mental health care workforce and services, reduce prescription drug
costs, and extend certain expiring provisions under Medicare and
Medicaid, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 7, 2023
Mr. Wyden, from the Committee on Finance, reported the following
original bill; which was read twice and placed on the calendar
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to expand the
mental health care workforce and services, reduce prescription drug
costs, and extend certain expiring provisions under Medicare and
Medicaid, and for other purposes.
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) Short Title.--This Act may be cited as the ``Better Mental
Health Care, Lower-Cost Drugs, and Extenders Act of 2023''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--EXPANDING MENTAL HEALTH CARE WORKFORCE AND SERVICES UNDER
MEDICARE AND MEDICAID
Sec. 101. Expanding eligibility for incentives under the Medicare
health professional shortage area bonus
program to practitioners furnishing mental
health and substance use disorder services.
Sec. 102. Improved access to mental health services under the Medicare
program.
Sec. 103. Clarifying coverage of occupational therapy under the
Medicare program.
Sec. 104. Medicare incentives for behavioral health integration with
primary care.
Sec. 105. Establishment of Medicare incident to modifier for mental
health services furnished through
telehealth.
Sec. 106. Guidance on furnishing behavioral health services via
telehealth to individuals with limited
English proficiency under Medicare program.
Sec. 107. Ensuring timely communication regarding telehealth and
interstate licensure requirements.
Sec. 108. Facilitating accessibility for behavioral health services
furnished through telehealth.
Sec. 109. Requiring Enhanced & Accurate Lists of (REAL) Health
Providers Act.
Sec. 110. Guidance to States on strategies under Medicaid and CHIP to
increase mental health and substance use
disorder care provider capacity.
Sec. 111. Guidance to States on supporting mental health services and
substance use disorder care for children
and youth.
Sec. 112. Recurring analysis and publication of Medicaid health care
data related to mental health services.
Sec. 113. Guidance to States on supporting mental health services or
substance use disorder care integration
with primary care in Medicaid and CHIP.
Sec. 114. Medicaid State option relating to inmates with a substance
use disorder pending disposition of
charges.
Sec. 115. Definition of Certified Community Behavioral Health Clinic
Services under Medicaid.
TITLE II--REDUCING PRESCRIPTION DRUG COSTS UNDER MEDICARE AND MEDICAID
Sec. 201. Assuring pharmacy access and choice for Medicare
beneficiaries.
Sec. 202. Ensuring accurate payments to pharmacies under Medicaid.
Sec. 203. Protecting seniors from excessive cost-sharing for certain
medicines.
TITLE III--MEDICAID EXPIRING PROVISIONS
Sec. 301. Delaying certain disproportionate share hospital payment
reductions under the Medicaid program.
Sec. 302. Extension of State option to provide medical assistance for
certain individuals who are patients in
certain institutions for mental diseases.
TITLE IV--MEDICARE EXPIRING PROVISIONS AND PROVIDER PAYMENT CHANGES
Sec. 401. Extension of funding for quality measure endorsement, input,
and selection.
Sec. 402. Extension of funding outreach and assistance for low-income
programs.
Sec. 403. Extension of the work geographic index floor under the
Medicare program.
Sec. 404. Extending incentive payments for participation in eligible
alternative payment models.
Sec. 405. Payment rates for durable medical equipment under the
Medicare Program.
Sec. 406. Extending the independence at home medical practice
demonstration program under the Medicare
program.
Sec. 407. Increase in support for physicians and other professionals in
adjusting to Medicare payment changes.
Sec. 408. Revised phase-in of Medicare clinical laboratory test payment
changes.
Sec. 409. Extension of adjustment to calculation of hospice cap amount
under Medicare.
TITLE V--OFFSETS
Sec. 501. Medicaid Improvement Fund.
Sec. 502. Medicare Improvement Fund.
TITLE I--EXPANDING MENTAL HEALTH CARE WORKFORCE AND SERVICES UNDER
MEDICARE AND MEDICAID
SEC. 101. EXPANDING ELIGIBILITY FOR INCENTIVES UNDER THE MEDICARE
HEALTH PROFESSIONAL SHORTAGE AREA BONUS PROGRAM TO
PRACTITIONERS FURNISHING MENTAL HEALTH AND SUBSTANCE USE
DISORDER SERVICES.
Section 1833(m) of the Social Security Act (42 U.S.C. 1395l(m)) is
amended--
(1) by striking paragraph (1) and inserting the following
new paragraph:
``(1) In the case of--
``(A) physicians' services (other than specified health
services that are eligible for the additional payment under
subparagraph (B)) furnished in a year to an individual, who is
covered under the insurance program established by this part
and who incurs expenses for such services, in an area that is
designated (under section 332(a)(1)(A) of the Public Health
Service Act) as a health professional shortage area as
identified by the Secretary prior to the beginning of such
year, in addition to the amount otherwise paid under this part,
there also shall be paid to the physician (or to an employer or
facility in the cases described in clause (A) of section
1842(b)(6)) (on a monthly or quarterly basis) from the Federal
Supplementary Medical Insurance Trust Fund an amount equal to
10 percent of the payment amount for the service under this
part; and
``(B) specified health services (as defined in paragraph
(5)) furnished in a year to an individual, who is covered under
the insurance program established by this part and who incurs
expenses for such services, in an area that is designated
(under such section 332(a)(1)(A)) as a mental health
professional shortage area as identified by the Secretary prior
to the beginning of such year, in addition to the amount
otherwise paid under this part, there also shall be paid to the
physician or applicable practitioner (as defined in paragraph
(6)) (or to an employer or facility in the cases described in
clause (A) of section 1842(b)(6)) (on a monthly or quarterly
basis) from such Trust Fund an amount equal to 15 percent of
the payment amount for the service under this part.'';
(2) in paragraph (2)--
(A) by striking ``in paragraph (1)'' and inserting
``in subparagraph (A) or (B) of paragraph (1)'';
(B) by inserting ``or, in the case of specified
health services, the physician or applicable
practitioner'' after ``physician'';
(3) in paragraph (3), by striking ``in paragraph (1)'' and
inserting ``in subparagraph (A) or (B) of paragraph (1)'';
(4) in paragraph (4)--
(A) in subparagraph (B), by inserting ``or
applicable practitioner'' after ``physician''; and
(B) in subparagraph (C), by inserting ``or
applicable practitioner'' after ``physician''; and
(5) by adding at the end the following new paragraphs:
``(5) In this subsection, the term `specified health services'
means services otherwise covered under this part that are furnished on
or after January 1, 2026, by a physician or an applicable practitioner
to an individual--
``(A) for purposes of diagnosis, evaluation, or treatment
of a mental health disorder, as determined by the Secretary; or
``(B) with a substance use disorder diagnosis for purposes
of treatment of such disorder or co-occurring mental health
disorder, as determined by the Secretary.
``(6) In this subsection, the term `applicable practitioner' means
the following:
``(A) A physician assistant, nurse practitioner, or
clinical nurse specialist (as defined in section 1861(aa)(5)).
``(B) A clinical social worker (as defined in section
1861(hh)(1)).
``(C) A clinical psychologist (as defined by the Secretary
for purposes of section 1861(ii)).
``(D) A marriage and family therapist (as defined in
section 1861(lll)(2)).
``(E) A mental health counselor (as defined in section
1861(lll)(4)).''.
SEC. 102. IMPROVED ACCESS TO MENTAL HEALTH SERVICES UNDER THE MEDICARE
PROGRAM.
(a) Access to Clinical Social Worker Services Provided to Residents
of Skilled Nursing Facilities.--
(1) Exclusion of clinical social worker services from the
skilled nursing facility prospective payment system.--Section
1888(e)(2)(A)(iii) of the Social Security Act (42 U.S.C.
1395yy(e)(2)(A)(iii)) is amended by adding at the end the
following new subclause:
``(VII) Clinical social worker
services (as defined in section
1861(hh)(2)).''.
(2) Conforming amendment.--Section 1861(hh)(2) of the
Social Security 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''.
(b) Access to the Complete Scope of Clinical Social Worker
Services.--Section 1861(hh)(2) of the Social Security Act (42 U.S.C.
1395x(hh)(2)), as amended by subsection (a)(2), is amended by striking
``for the diagnosis and treatment of mental illnesses (other than
services furnished to an inpatient of a hospital)'' and inserting ``,
including services for the diagnosis and treatment of mental illnesses
or services for health behavior assessment and intervention (identified
as of January 1, 2023, by HCPCS codes 96160 and 96161 (and any
succeeding codes)), but not including services furnished to an
inpatient of a hospital,''.
(c) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2026.
SEC. 103. CLARIFYING COVERAGE OF OCCUPATIONAL THERAPY UNDER THE
MEDICARE PROGRAM.
Not later than 1 year after the date of enactment of this Act, the
Secretary of Health and Human Services shall use existing communication
mechanisms to provide education and outreach to stakeholders about the
Medicare Benefit Policy Manual with respect to occupational therapy
services furnished to individuals under the Medicare program for the
treatment of a substance use or mental health disorder diagnosis using
applicable Healthcare Common Procedure Coding System (HCPCS) codes.
SEC. 104. MEDICARE INCENTIVES FOR BEHAVIORAL HEALTH INTEGRATION WITH
PRIMARY CARE.
(a) Incentives.--
(1) In general.--Section 1848(b) of the Social Security Act
(42 U.S.C. 1395w-4(b)) is amended by adding at the end the
following new paragraph:
``(13) Incentives for behavioral health integration.--
``(A) In general.--For services described in
subparagraph (B) that are furnished during 2026, 2027,
or 2028, instead of the payment amount that would
otherwise be determined under this section for such
year, the payment amount shall be equal to the
applicable percent (as defined in subparagraph (C)) of
such payment amount for such year.
``(B) Services described.--The services described
in this subparagraph are services identified, as of
January 1, 2023, by HCPCS codes 99484, 99492, 99493,
99494, and G2214 (and any successor or similar codes as
determined appropriate by the Secretary).
``(C) Applicable percent.--In this paragraph, the
term `applicable percent' means, with respect to a
service described in subparagraph (A), the following:
``(i) For services furnished during 2026 ,
175 percent.
``(ii) For services furnished during 2027,
150 percent.
``(iii) For services furnished during 2028,
125 percent.''.
(2) Waiver of budget neutrality.--Section 1848(c)(2)(B)(iv)
of such Act (42 U.S.C. 1395w-4(c)(2)(B)(iv)) is amended--
(A) in subclause (V), by striking ``and'' at the
end;
(B) in subclause (VI), by striking the period at
the end and inserting ``; and'' and
(C) by adding at the end the following new
subclause:
``(VII) the increase in payment
amounts as a result of the application
of subsection (b)(13) shall not be
taken into account in applying clause
(ii)(II) for 2026, 2027, or 2028.''.
(b) Technical Assistance for the Adoption of Behavioral Health
Integration.--
(1) In general.--Not later than January 1, 2025, the
Secretary of Health and Human Services (in this subsection
referred to as the ``Secretary'') shall enter into contracts or
agreements with appropriate entities to offer technical
assistance to primary care practices that are seeking to adopt
behavioral health integration models in such practices.
(2) Behavioral health integration models.--For purposes of
paragraph (1), behavioral health integration models include the
Collaborative Care Model (with services identified as of
January 1, 2023, by HCPCS codes 99492, 99493, 99494, and G2214
(and any successor codes)), the Primary Care Behavioral Health
model (with services identified as of January 1, 2023, by HCPCS
code 99484 (and any successor code)), and other models
identified by the Secretary.
(3) Implementation.--Notwithstanding any other provision of
law, the Secretary may implement the provisions of this
subsection by program instruction or otherwise.
(4) Funding.--In addition to amounts otherwise available,
there is appropriated to the Secretary for fiscal year 2024,
out of any money in the Treasury not otherwise appropriated,
$5,000,000, to remain available until expended, for purposes of
carrying out this subsection.
SEC. 105. ESTABLISHMENT OF MEDICARE INCIDENT TO MODIFIER FOR MENTAL
HEALTH SERVICES FURNISHED THROUGH TELEHEALTH.
Section 1834(m)(7) of the Social Security Act (42 U.S.C.
1395m(m)(7)) is amended by adding at the end the following new
subparagraph:
``(C) Establishment of incident to modifier for
mental health services furnished through telehealth.--
Not later than 2 years after the date of the enactment
of this subparagraph, the Secretary shall establish
requirements to include a code or modifier, as
determined appropriate by the Secretary, on claims for
mental health services furnished through telehealth
under this paragraph that are furnished by auxiliary
personnel (as defined in section 410.26(a)(1) of title
42, Code of Federal Regulations, or any successor
regulation) and billed incident to a physician or
practitioner's professional services.''.
SEC. 106. GUIDANCE ON FURNISHING BEHAVIORAL HEALTH SERVICES VIA
TELEHEALTH TO INDIVIDUALS WITH LIMITED ENGLISH
PROFICIENCY UNDER MEDICARE PROGRAM.
Not later than 1 year after the date of the enactment of this
section, the Secretary of Health and Human Services shall issue and
disseminate, or update and revise as applicable, guidance on the
following:
(1) Best practices for providers to work with interpreters
to furnish behavioral health services via video-based and
audio-only telehealth, when video-based telehealth is not an
option.
(2) Best practices on integrating the use of video
platforms that enable multi-person video calls into behavioral
health services furnished via telehealth.
(3) Best practices on teaching patients, especially those
with limited English proficiency, to use video-based telehealth
platforms.
(4) Best practices for providing patient materials,
communications, and instructions in multiple languages,
including text message appointment reminders and prescription
information.
SEC. 107. ENSURING TIMELY COMMUNICATION REGARDING TELEHEALTH AND
INTERSTATE LICENSURE REQUIREMENTS.
The Secretary of Health and Human Services shall provide
information--
(1) on licensure requirements for furnishing telehealth
services under titles XVIII and XIX of the Social Security Act
(42 U.S.C. 1395 et seq.; 1396 et seq.); and
(2) clarifying the extent to which licenses through an
interstate license compact pathway can qualify as valid and
full