Pub. L. 101-239, tit. VI, subtit. A, pt. 2, subpt. A, sec. 6113
MENTAL HEALTH SERVICES.
SEC. 6113. MENTAL HEALTH SERVICES. (a) Eliminating Restriction on Psychologists’ Services to Services Furnished at Community Mental Health Centers.—Section 1861(ii) of the Social Security Act (42 U.S.C. 1395x(ii)) is amended by striking “on-site at a community mental health center” and all that follows through “because of similar circumstances of the individual,”. (b) Clinical Social Workers.— (1) Coverage of services.— Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended— (A) by striking “and” at the end of subparagraph (L); (B) by adding “and” at the end of subparagraph (M); and (C) by adding at the end the following new subparagraph: “(N) clinical social worker services (as defined in subsection (hh)(2));”. (2) Definitions.— Section 1861 of such Act (42 U.S.C. 1395x) is amended— (A) in subsection (s)(2)(H)(ii), by striking “(hh)” and inserting “(hh)(2)”, and (B) in subsection (hh)— (i) by amending the heading to read as follows: “Clinical Social Worker, Clinical Social Worker Services”, (ii) by redesignating clauses (i) and (ii) of paragraph (3)(B) as subclauses (I) and (II), respectively, (iii) by redesignating subparagraphs (A) and (B) of paragraph (3) as clauses (i) and (ii), respectively, (iv) by redesignating paragraphs (1), (2), and (3) as subparagraphs (A), (B), and (C), respectively, (v) by striking “(hh)” and inserting “(hh)(1)”, and 103 STAT. 2217 (vi) by adding at the end the following new paragraph: “(2) The term ‘clinical social worker services’ means services performed by a clinical social worker (as defined in paragraph (1)) for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital 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) which the clinical social worker is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed as would otherwise be covered if furnished by a physician or as an incident to a physician’s professional service.”. (3) Payment basis.— Section 1833 of such Act (42 U.S.C. 1395l) is amended— (A) by inserting after clause (E) of subsection (a)(1) the following new clause: “(F) with respect to clinical social worker services under section 1861(s)(2)(N), the amounts paid shall be 80 percent of the lesser of (i) the actual charge for the services or (ii) 75 percent of the amount determined for payment of a psychologist under clause (L),”; and (B) in subsection (p)— (i) by striking “1861(s)(2)(L) and” and by inserting “1861(s)(2)(L),”, and (ii) by inserting “and in the case of clinical social worker services for which payment may be made under this part only pursuant to section 1861(s)(2)(N),” after “1861(s)(2)(M),”. (c) Development of Criteria Regarding Consultation with a Physician.—The Secretary of Health and Human Services shall, taking into consideration concerns for patient confidentiality, develop criteria with respect to payment for qualified psychologist services for which payment may be made directly to the psychologist under part B of title XVIII of the Social Security Act under which such a psychologist must agree to consult with a patient’s attending physician in accordance with such criteria. (d) Eliminating Dollar Limitation on Mental Health Services.—Section 1833(d)(1) of the Social Security Act (42 U.S.C. 1395l(d)(1)) is amended by striking “whichever” and all that follows in the first sentence and inserting “62½ percent of such expenses.”. (e) Effective Date.—The amendments made by this section, and the provisions of subsection (c), shall apply to services furnished on or after July 1, 1990, and the amendments made by subsection (d) shall apply to expenses incurred in a year beginning with 1990.