Sponsors (2)
The bill expands a targeted 15% Medicare payment bonus to more mental health providers and clinics in shortage areas to improve access for Medicare beneficiaries, at the cost of higher Part B spending, potential mis-targeting of funds, and added administrative complexity.
Medicare beneficiaries in mental health shortage areas will likely have better access to mental health and substance-use care because a new 15% Part B payment bonus applies to a broader set of mental health services and providers.
Non-physician clinicians (PAs, NPs, social workers, psychologists, MFTs, counselors) and clinics/employers billing under 1842(b)(6) become eligible for the bonus, increasing financial incentives to practice or remain in underserved areas.
The bill preserves the existing 10% HPSA bonus for physicians' general services, maintaining ongoing incentives for primary care in shortage areas.
The Medicare Supplementary Medical Insurance (Part B) trust fund will face higher costs to pay the new 15% bonuses, which could put upward pressure on Part B spending and future premiums or require additional federal outlays.
Bonuses may disproportionately go to providers who already bill Medicare in shortage areas rather than expanding true access in the most remote or underserved communities, limiting the policy's effectiveness.
Implementing new definitions, area designations, and distinct billing rules could increase administrative burden for HHS, providers, and facilities, raising compliance costs and complexity.
Based on analysis of 2 sections of legislative text.
Creates a 15% Medicare bonus for defined mental health/substance use Part B services in Secretary-designated mental health HPSAs and extends it to specified non-physician practitioners.
Official title: Amend title XVIII of the Social Security Act to expand eligibility for incentives under the Medicare health professional shortage area bonus program to practitioners furnishing mental health and substance use disorder services.
Introduced February 24, 2025 by Gary C. Peters · Last progress February 24, 2025
Creates a new 15% Medicare payment bonus for defined mental health and substance use disorder services provided in Secretary-designated mental health professional shortage areas, and extends that bonus to a set of non-physician behavioral health practitioners. It preserves the existing 10% HPSA bonus for physicians in general HPSAs and clarifies payment routing and definitions; the bonus applies to Part B services furnished on or after January 1, 2024 and is paid from the Federal Supplementary Medical Insurance Trust Fund.