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
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/bill/118/s/3430/rs/section-101·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1833(m) of the Social Security Act ( 42 U.S.C. 1395l(m) ) is amended— by striking paragraph
(1)and inserting the following new paragraph: In the case of— 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 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. ; in paragraph (2)— by striking in paragraph
(1)and inserting in subparagraph
(A)or
(B)of paragraph
(1); by inserting or, in the case of specified health services, the physician or applicable practitioner after physician ; in paragraph (3), by striking in paragraph
(1)and inserting in subparagraph
(A)or
(B)of paragraph
(1); in paragraph (4)— in subparagraph (B), by inserting or applicable practitioner after physician ; and in subparagraph (C), by inserting or applicable practitioner after physician ; and by adding at the end the following new paragraphs: 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— for purposes of diagnosis, evaluation, or treatment of a mental health disorder, as determined by the Secretary; or with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder, as determined by the Secretary. In this subsection, the term applicable practitioner means the following: A physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)). A clinical social worker (as defined in section 1861(hh)(1)). A clinical psychologist (as defined by the Secretary for purposes of section 1861(ii)). A marriage and family therapist (as defined in section 1861(lll)(2)). A mental health counselor (as defined in section 1861(lll)(4)). .
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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
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