Sponsors (2)
The bill expands and standardizes Medicare-covered peer support services through qualified clinics—improving access and quality for beneficiaries—while restricting coverage to certain settings and imposing administrative and training costs that may delay or limit who can benefit and where services are available.
Medicare beneficiaries with mental health or substance use disorders gain Medicare-covered access to peer support services when delivered by qualified clinics, improving nonclinical recovery supports and culturally informed community integration.
Federally qualified health centers (FQHCs), rural health clinics (RHCs), and community mental health centers can bill Medicare for peer support services, potentially increasing clinic revenue and expanding behavioral health capacity—especially in underserved and rural areas.
Establishes a federal definition and certification expectation for peer support specialists, promoting more standardized training, clearer quality expectations, and potentially more consistent service delivery across providers.
Medicare will not cover peer support services provided by independent peer workers outside designated clinic types, limiting access for beneficiaries who rely on community-based or non‑clinic peer programs.
States and providers will face administrative and training costs to implement certification standards and adapt billing workflows, imposing financial and operational burdens on clinics and state systems.
Creating and enforcing the new Medicare benefit will require federal and clinic administrative resources and oversight, which could slow rollout and delay beneficiaries seeing expanded peer support services.
Based on analysis of 2 sections of legislative text.
Introduced December 18, 2025 by Judy Chu · Last progress December 18, 2025
Adds peer support services and certified peer support specialists to Medicare coverage when those services are provided by Federally qualified health centers (FQHCs), rural health clinics (RHCs), community mental health centers, or certified community behavioral health clinics. The bill defines "peer support services" and "peer support specialist," ties certification to State processes consistent with SAMHSA core competencies (or a Secretary‑determined process), and makes these services count as Medicare Part B services in specified settings. Limits Medicare coverage to peer support furnished inside those covered clinic settings by certified peer specialists and excludes peer support provided outside those settings from Medicare coverage. The changes take effect for items and services furnished on or after January 1, 2027.