Expanding Seniors Access to Mental Health Services Act
Summary
What This Bill Does
The Expanding Seniors Access to Mental Health Services Act changes Medicare payment for clinical social workers. It amends the skilled nursing facility prospective payment provision to add clinical social worker services to the covered service list. It also amends the Medicare definition of clinical social worker services so that, beyond diagnosis and treatment of mental illness, it includes health and behavior assessment and intervention services identified as of January 1, 2023 by HCPCS codes 96156, 96158 through 96161, 96164 through 96168, and 96170 through 96171, including successor codes. It keeps the exclusion for services furnished to hospital inpatients. The amendments apply to items and services furnished on or after January 1, 2026. The bill makes clinical social workers more available for Medicare beneficiaries in skilled nursing settings and for behavioral interventions tied to physical health conditions.
Who Benefits and How
Medicare beneficiaries in skilled nursing facilities benefit from access to clinical social worker services. Seniors with behavioral health needs benefit from Medicare coverage of health and behavior assessment and intervention services. Clinical social workers benefit from expanded Medicare-recognized service categories. Skilled nursing facilities benefit if social worker services are recognized in Medicare payment rules.
Who Bears the Burden and How
CMS payment policy staff must update Medicare skilled nursing and clinical social worker billing rules by 2026. Medicare administrative contractors must process claims for the added service categories. Federal taxpayers and Medicare trust funds bear higher utilization costs if coverage expands access. Skilled nursing facility billing departments must code and document the newly covered services.
Key Provisions
- Adds clinical social worker services to Medicare skilled nursing facility payment rules.
- Expands clinical social worker services to include health and behavior assessment and intervention codes.
- Keeps the inpatient hospital exclusion in the Medicare service definition.
- Applies the amendments to items and services furnished on or after January 1, 2026.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Adds clinical social worker services to the Medicare skilled nursing facility prospective payment system and expands the Medicare clinical social worker services definition to include health and behavior assessment and intervention HCPCS codes, effective for items and services furnished on or after January 1, 2026.
Key Policy Areas
Medicare, Mental Health, Skilled Nursing
Primary Purpose
Adds clinical social worker services to the Medicare skilled nursing facility prospective payment system and expands the Medicare clinical social worker services definition to include health and behavior assessment and intervention HCPCS codes, effective for items and services furnished on or after January 1, 2026.
Policy Domains
Resolution provisions
Identified Gains
- Medicare beneficiaries in skilled nursing facilities
- Seniors with behavioral health needs
- Clinical social workers
- Skilled nursing facilities
Identified Costs
- CMS payment policy staff
- Medicare administrative contractors
- Medicare trust funds
- Skilled nursing billing departments
Sponsors
Legislative Progress
In CommitteeMr. Fitzpatrick (for himself and Mr. Tonko) introduced the following …
Referred to the Committee on Ways and Means, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Medicare beneficiaries in skilled nursing facilities, Medicare trust funds
Positive-direction: Medicare beneficiaries in skilled nursing facilities
Negative-direction: Medicare trust funds
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology