Expanding Seniors Access to Mental Health Services Act
Expanding Seniors Access to Mental Health Services Act aims to improve Medicare beneficiaries’ access to mental health care by two main changes focused on clinical social worker (CSW) services in skilled nursing facilities (SNFs) and broader coverage of CSW services under Medicare. First, CSW services would be excluded from the SNF Medicare Prospective Payment System (PPS) rate, meaning these services would be billed separately rather than included in the per-diem SNF payment. Second, the bill broadens the set of CSW services eligible for Medicare reimbursement, extending coverage beyond the narrowly defined “diagnosis and treatment of mental illnesses” to include health and behavior assessment and intervention (HBIA), and explicitly authorizes billing for certain HCPCS-coded CSW services (as listed in the bill). The effective date for these changes is January 1, 2026. Overall, the bill seeks to expand access to mental health services for seniors, particularly within SNFs, by ensuring CSWs are reimbursed and by widening the range of CSW services covered.
Key Points
- 1Exclusion from SNF PPS: The bill would add CSW services to the list of items not paid through the Skilled Nursing Facility Prospective Payment System, shifting payment for these services to other Medicare channels (e.g., Part B).
- 2Expanded CSW coverage: CSW services would include not only diagnosis and treatment of mental illnesses but also HBIA services, expanding the scope of reimbursable CSW care.
- 3Specific covered codes: Coverage would apply to CSW services identified by HCPCS codes 96156, 96158-96161, 96164-96168, and 96170-96171 (and any succeeding codes), which relate to neuropsychological testing-related services and HBIA.
- 4Effective date: The amendments would apply to items and services furnished on or after January 1, 2026.
- 5Inpatient hospital exclusion: The changes apply to non-inpatient settings; services furnished to inpatients of hospitals are not included under this expansion.