Medicare expands mental health coverage for seniors in nursing homes
H.R. 3808 — Expanding Seniors Access to Mental Health Services Act · Filed by Brian Fitzpatrick (R-PA) · 19 cosponsors · Introduced Jun 6, 2025 · Referred to committee
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What it does
This bill expands Medicare coverage for mental health services provided by clinical social workers. It removes a restriction that prevented skilled nursing facilities from billing Medicare separately for clinical social worker services, and it broadens the types of mental health services that clinical social workers can provide under Medicare to include health and behavior assessment and intervention—not just diagnosis and treatment of mental illness. The changes take effect January 1, 2026.
Why we flagged it
The bill's core function is to remove billing restrictions and expand the scope of mental health services covered under Medicare for seniors, specifically enabling clinical social workers to provide a broader range of evidence-based interventions.
What the text implies
- Removal of SNF prospective payment system exclusion may increase Medicare spending on mental health services in skilled nursing facilities, as services previously bundled into facility payments become separately billable.
- Expansion of covered services to include health and behavior assessment/intervention (HCPCS codes 96156, 96158–96161, 96164–96168, 96170–96171) aligns Medicare with CPT coding standards but may create administrative burden for SNFs and other providers to track and bill new service categories.
The full analysis lists 3 implications of this text.
Who stands to gain
clinical social workers and their employers; skilled nursing facilities (via separate billing authority); mental health service providers