Medicare Access
Expanding Seniors Access to Mental Health Services Act
(S. 1797/H.R. 3808)
July 2025
Download the 2025 Medicare Access Issue Brief
Background
Across the country, millions of Medicare beneficiaries experience
significant health and mental health challenges and struggle to access
the care they need. The beneficiary population is rapidly increasing in
size, changing demographically, and coping with concerns such as
functional limitations, multiple chronic conditions, social isolation,
economic insecurity, and ageism. Our health care system must remove
barriers to care provided by social workers in order to be able to meet
beneficiaries’ health and mental health needs.
Clinical social workers (CSWs) are among the professions that can bill
Medicare Part B for mental health services 1 and are one of the largest
groups of mental health service providers in the United States. They
have a graduate degree (master’s or doctorate) in social work, two years
of postgraduate supervised experience in a clinical setting, and a clinical
license in their state or jurisdiction of practice. They use a holistic
approach in providing services, focusing on biological, psychological,
and social factors. Independent licensed CSWs are currently able to
bill Medicare Part B for the diagnosis and treatment of mental illness.
However, they are not able to bill Medicare Part B for mental health
services provided to residents in skilled nursing facilities (SNFs). Nor
does CSWs statutory definition include access to HBAI services even
though it’s within the scope of their practice.
Legislative Solution: Support the Expanding Seniors Access to Mental Health Services Act (S. 1797/H.R. 3808)
NASW urges Members of Congress to cosponsor and advance the
Expanding Seniors Access to Mental Health Services Act (S. 1797/
H.R. 3808). This legislation was introduced in a bipartisan and bicameral
manner by Senators John Barrasso, MD (R-WY) and Chris Coons (D-DE)
and Representatives Brian Fitzpatrick (R-PA-01) and Paul Tonko (D-NY-20).
The legislation enhances Medicare beneficiaries’ access to the valuable
services provided by independent licensed CSWs in two scenarios:
- While residing in SNFs and receiving services under Medicare Part A; and
- While in need of mental health services because of emotional or psychosocial concerns that arise due to a medical condition
Overview of Provisions
Increase Medicare Beneficiaries’ Access to Mental Health Services in Skilled Nursing Facilities (SNFs)
Mental health concerns, such as depression and anxiety, are common
among SNF residents, and SNFs frequently address these concerns by
arranging for services from an independent mental health provider.
However, beneficiaries who receive SNF services under Medicare Part
A cannot simultaneously receive services from an independent licensed
CSW under Part B. This limits the pool of practitioners who can serve
SNF residents, which is problematic given the high incidence of mental
health conditions among SNF residents. This access barrier exists
because when SNF consolidated billing was implemented, psychiatrists’
and psychologists’ services were excluded from the Prospective Payment
System (PPS), but CSW services were not. Furthermore, when Licensed
Marriage and Family Therapists and Licensed Mental Health Counselors
were added to the Medicare program in 2024, their services were also
excluded from the PPS, confirming a pressing need for these services.
When Medicare beneficiaries transfer from a setting in which they
receive mental health services from an independent licensed CSW
under Medicare Part B to a SNF they can no longer receive such services
and experience disruption in care. Such care transitions can occur even
if the beneficiary is moved within the same building or remains in the
same bed. The reimbursement restriction also limits the pool of Medicare
providers available to meet newly identified mental health needs of
beneficiaries during a SNF stay. Correcting this will enhance beneficiaries’
access to mental health services rather than limit that access simply
because they are residing in SNFs.
Increase Medicare Beneficiaries’ Access to Health and Behavior Assessment and Intervention (HBAI) Services
HBAI services help Medicare beneficiaries with emotional and
psychosocial concerns that arise because of a medical condition (such
as a diagnosis of cancer or an exacerbation of multiple sclerosis) and
are unrelated to a mental health condition. Because the Medicare
definition of CSW services is restricted to the diagnosis and treatment of
mental illness, beneficiaries have historically been unable to receive HBAI services when provided by CSWs. NASW was gratified that the Centers
for Medicare and Medicaid Services (CMS) permitted CSWs to bill
certain HBAI codes as part of its Calendar Year (CY) 2024 Medicare
Physician Fee Schedule (PFS) Final Rule. Modifying the statutory definition
of CSW services to include HBAI services for Medicare beneficiaries will
both codify the changes CMS made in the CY 2024 PFS Final Rule and
ensure beneficiary access to HBAI services performed by CSWs.
- Centers for Medicare & Medicaid Services. (n.d.). Mental health care: Outpatient. Retrieved from www.medicare.gov/coverage/mental-health-care-outpatient
For more information
Contact Dina Kastner, MSS, MLSP, at dkastner.nasw@socialworkers.org or 202.336.8218.