COVERAGE OF MENTAL HEALTH SERVICES.

SEC. 4070. COVERAGE OF MENTAL HEALTH SERVICES. (a) Outpatient Services Under Part B.— Section 1833(c) of the Social Security Act (42 U.S.C. 13951(c)) is amended— (1) by striking “$312.50” and inserting “$1375.00”; and (2) by adding at the end thereof the following: “For purposes of this subsection, the term ‘treatment’ does not include brief office visits (as defined by the Secretary) for the sole purpose of prescribing or monitoring prescription drugs used in the treatment of such disorders.”. (b) Partial Hospitalization Coverage.— (1) Section 1861(s)(2)(B) of such Act (42 U.S.C. 1395x(s)(2)(B)) is amended by inserting “and partial hospitalization services incident to such services” before the semicolon. (2) Section 1861 of such Act (42 U.S.C. 1395x) is amended by adding at the end thereof the following new subsection: “(ff) (1) The term ‘partial hospitalization services’ means the items and services described in paragraph (2) prescribed by a physician and provided under a program described in paragraph (3) under the supervision of a physician pursuant to an individualized, written plan of treatment established and periodically reviewed by a physician (in consultation with appropriate staff participating in such program), which plan sets forth the physician’s diagnosis, the type, amount, frequency, and duration of the items and services provided under the plan, and the goals for treatment under the plan. “(2) The items and services described in this paragraph are— “(A) individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under State law), “(B) occupational therapy requiring the skills of a qualified occupational therapist, “(C) services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients, 101 STAT. 1330–115 “(D) drugs and biologicals furnished for therapeutic purposes (which cannot, as determined in accordance with regulations, be self-administered), “(E) individualized activity therapies that are not primarily recreational or diversionary, “(F) family counseling (the primary purpose of which is treatment of the individual’s condition), “(G) patient training and education (to the extent that training and educational activities are closely and clearly related to individual’s care and treatment), “(H) diagnostic services, and “(I) such other items and services as the Secretary may provide (but in no event to include meals and transportation); that are reasonable and necessary for the diagnosis or active treatment of the individual’s condition, reasonably expected to improve or maintain the individual’s condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services as the Secretary shall by regulation establish (taking into account accepted norms of medical practice and the reasonable expectation of patient improvement). “(3) A program described in this paragraph is a program which is hospital-based or hospital-affiliated (as defined by the Secretary) and which is a distinct and organized intensive ambulatory treatment service offering less than 24-hour-daily care.”. (3) Section 1835(a)(2) of such Act (42 U.S.C. 1395n(a)(2)) is amended— (A) by striking “and” at the end of subparagraph (D); (B) by striking the period at the end of subparagraph (E) and inserting “; and”; and (C) by inserting sifter subparagraph (E) the following new subparagraph: “(F) in the case of partial hospitalization services, (i) the individual would require inpatient psychiatric care in the absence of such services, (ii) an individualized, written plan for furnishing such services has been established by a physician and is reviewed periodically by a physician, and (iii) such services are or were furnished while the individual is or was under the care of a physician.”. (4) Section 1833(c) of such Act, as amended by subsection (a), is further amended at the end thereof by inserting “or partial hospitalization services that are not directly provided by a physician” before the period. (c) Effective Date; Implementation.— (1) The amendment made by subsection (a)(1) shall apply with respect to calendar years beginning with 1988; except that with respect to 1988, any reference in section 1833(c) of the Social Security Act, as amended by subsection (a), to “$1375.00” is deemed a reference to “$562.50”. The amendment made by subsection (a)(2) shall apply to services furnished on or after January 1, 1989. (2) (A) The amendments made by subsection (b) shall become effective on the date of enactment of this Act. (B) The Secretary of Health and Human Services shall implement the amendments made by subsection (b) so as to ensure that there is no additional cost to the medicare program by reason of such amendments.