PEERS Act of 2025
- Bill Number
- H.R. 6841
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-12-18: 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.
- Last Updated
- 2026-03-11T14:07:28Z
AI-Generated Summary
Purpose
The Promoting Effective and Empowering Recovery Services in Medicare Act of 2025 (PEERS Act of 2025) aims to expand Medicare coverage to include peer support services—non-clinical support provided by individuals in recovery from mental health or substance use issues—at specific healthcare facilities. This promotes recovery, community integration, and self-empowerment for beneficiaries with mental health conditions or substance use disorders.
Key Provisions
- Coverage Expansion at Facilities:
- Adds peer support services to Medicare-covered services at community mental health centers, alongside existing partial hospitalization and intensive outpatient services.
- Includes peer support services as reimbursable when provided by rural health clinics (RHCs) or federally qualified health centers (FQHCs) through certified peer support specialists.
- Definitions:
- Peer support services: Emotional, informational, practical, and social support services delivered by qualified peers to individuals diagnosed with mental health conditions or substance use disorders. These services must be provided at RHCs, FQHCs, community mental health centers, or certified community behavioral health clinics, and focus on recovery goals as specified by the Secretary of Health and Human Services.
- Peer support specialist: A person recovering from a mental health or substance use condition, certified under state processes or federal guidelines that align with national standards from the Substance Abuse and Mental Health Services Administration (SAMHSA).
- Exclusion Rules:
- Modifies Medicare's general exclusions to allow coverage for peer support services only when furnished at the specified facilities; services outside these settings remain non-reimbursable.
- Implementation:
- Applies to services provided on or after January 1, 2027.
Significant Changes to Existing Law
- Amends Section 1832(a)(2)(J) of the Social Security Act to explicitly include peer support services at community mental health centers, building on prior coverage for partial hospitalization and intensive outpatient care.
- Updates Section 1861(aa)(1)(B) to permit RHCs and FQHCs to bill Medicare for peer support services delivered by certified specialists, expanding beyond traditional clinical services.
- Adds a new subsection (nnn) to Section 1861, providing formal definitions for peer support services and specialists, which did not previously exist in Medicare law.
- Revises Section 1862(a)(1) to create a targeted exception for these services, narrowing exclusions that previously barred non-medical supports from coverage.
Potential Impacts
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) will need to develop reimbursement mechanisms, certification guidelines, and oversight for peer support services, potentially increasing administrative workload and Medicare expenditures for behavioral health.
- On Citizens: Medicare beneficiaries (primarily those 65 and older or with disabilities) with mental health conditions or substance use disorders gain improved access to supportive, recovery-focused care, which may enhance treatment outcomes and reduce reliance on more intensive services.
- On International Relations: No direct impact, as the bill focuses on domestic U.S. healthcare policy.
Main Stakeholders Affected
- Medicare Beneficiaries: Especially older adults or disabled individuals recovering from mental health or substance use issues, who benefit from expanded non-clinical support options.
- Healthcare Providers: Community mental health centers, RHCs, FQHCs, and certified community behavioral health clinics, which can now receive Medicare payments for peer support services; peer support specialists gain formal recognition and employment opportunities.
- Government Entities: U.S. Department of Health and Human Services (HHS) and CMS, responsible for implementation, certification, and funding allocation.
- Recovery Community: Individuals and organizations involved in peer support, including SAMHSA, which influences certification standards.
Notable Legal, Constitutional, or Political Implications
- Legal: Establishes peer support as a reimbursable Medicare benefit, potentially setting precedents for integrating lived-experience providers into federal health programs; requires alignment with existing state certification processes, which may lead to variations in implementation across states.
- Constitutional: No direct challenges, but supports equal access to healthcare under the Social Security Act framework, aligning with broader federal efforts to address behavioral health disparities.
- Political: Advances bipartisan interest in mental health and addiction recovery (introduced by Reps. Chu and Smith), but could spark debates over Medicare costs and the role of non-licensed providers in taxpayer-funded care; may influence future expansions of community-based services.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Recent Actions
- 2025-12-18: 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.
- 2025-12-18: 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.
- 2025-12-18: Introduced in House
- 2025-12-18: Introduced in House
Bill Versions
- Promoting Effective and Empowering Recovery Services in Medicare Act of 2025 — issued 2025-12-18 — PDF (5 pages)