Expanding Seniors Access to Mental Health Services Act
- Bill Number
- H.R. 3808
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-06-06: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
- Last Updated
- 2026-07-01T08:09:02Z
AI-Generated Summary
Purpose
The "Expanding Seniors Access to Mental Health Services Act" (H.R. 3808) aims to enhance Medicare beneficiaries' access to mental health services provided by clinical social workers. It focuses on removing barriers in skilled nursing facilities (SNFs) and broadening the types of covered services, particularly for seniors dealing with mental illnesses or behavioral health needs.
Key Provisions
- Short Title: The bill is officially named the "Expanding Seniors Access to Mental Health Services Act."
- Exclusion from SNF Payment System: Amends the Social Security Act to exclude clinical social worker services (defined as counseling and therapy for mental health by licensed social workers) from the bundled payment system used in SNFs. This allows these services to be billed and reimbursed separately under Medicare Part B.
- Expansion of Covered Services: Updates the definition of clinical social worker services under Medicare to include a wider range, such as diagnosis and treatment of mental illnesses, plus specific health and behavior assessment and intervention services (identified by Healthcare Common Procedure Coding System, or HCPCS, codes like 96156, 96158–96161, 96164–96168, and 96170–96171, or their successors). It removes the prior exclusion for services provided to SNF inpatients (while keeping the exclusion for hospital inpatients).
- Effective Date: Changes apply to services provided on or after January 1, 2026.
Significant Changes to Existing Law
- Previously, clinical social worker services in SNFs were bundled into the facility's overall prospective payment system (PPS), which could limit separate reimbursement and access. The bill decouples these services, enabling direct Medicare billing.
- The scope of reimbursable services was narrower, excluding certain behavioral health assessments and interventions, and fully barring SNF inpatient coverage. The amendments expand eligibility to include these services and lift the SNF inpatient restriction, promoting more comprehensive mental health support without altering hospital inpatient rules.
Potential Impacts
- On Citizens: Medicare enrollees, especially older adults in SNFs, will likely gain easier access to specialized mental health care, potentially improving treatment for conditions like depression, anxiety, or behavioral issues related to chronic illness. This could reduce wait times and encourage preventive care.
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) will need to update billing codes, guidelines, and oversight to implement the changes, which may increase short-term administrative costs but align with broader goals of mental health parity in federal programs.
- On International Relations: No direct impacts, as the bill is domestic and focused on U.S. healthcare policy.
- Overall, it could lead to higher Medicare expenditures due to expanded coverage but may lower long-term costs by addressing mental health earlier and reducing hospital readmissions.
Main Stakeholders Affected
- Medicare Beneficiaries: Primarily seniors (age 65+) in SNFs or receiving outpatient care, who benefit from improved mental health access.
- Clinical Social Workers: Gain expanded reimbursement opportunities and ability to provide a fuller range of services under Medicare.
- Skilled Nursing Facilities: Face potential shifts in how mental health services are funded, possibly easing their bundled payment burdens but requiring coordination with external providers.
- Healthcare Providers and Insurers: Broader implications for mental health professionals and Medicare administrators in processing claims.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicare's framework under Title XVIII of the Social Security Act by promoting equity in mental health coverage, aligning with existing laws like the Mental Health Parity and Addiction Equity Act (which requires equal treatment of mental and physical health benefits). It introduces no new enforcement mechanisms but relies on CMS rulemaking for implementation.
- Constitutional: No significant issues; the bill operates within Congress's enumerated powers to regulate interstate commerce and spend for the general welfare, without infringing on individual rights or federalism concerns.
- Political: Introduced bipartisanship (by Reps. Fitzpatrick, R-PA, and Tonko, D-NY) signals cross-party support for elderly mental health, potentially influencing future expansions in Medicare benefits amid ongoing debates on healthcare costs and aging populations. Referred to key committees (Ways and Means, Energy and Commerce) for review, indicating standard legislative progression without controversial elements.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Fitzpatrick, Brian K. [R-PA-1]
Cosponsors (18)
Rep. Tonko, Paul [D-NY-20], Rep. Matsui, Doris O. [D-CA-7], Rep. Vasquez, Gabe [D-NM-2], Rep. Scholten, Hillary J. [D-MI-3], Rep. Smith, Adam [D-WA-9], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Gottheimer, Josh [D-NJ-5], Rep. Bresnahan, Robert P. [R-PA-8], Rep. Gillen, Laura [D-NY-4], Rep. Harder, Josh [D-CA-9], Rep. Pocan, Mark [D-WI-2], Rep. Pingree, Chellie [D-ME-1], Rep. Neguse, Joe [D-CO-2], Rep. Kiggans, Jennifer A. [R-VA-2], Rep. Balint, Becca [D-VT-At Large], Rep. Ross, Deborah K. [D-NC-2], Rep. Riley, Josh [D-NY-19], Rep. Goodlander, Maggie [D-NH-2]
Recent Actions
- 2025-06-06: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
- 2025-06-06: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
- 2025-06-06: Introduced in House
- 2025-06-06: Introduced in House
Bill Versions
- Expanding Seniors Access to Mental Health Services Act — issued 2025-06-06 — PDF (3 pages)