Medicare expands mental health coverage for seniors in nursing homes

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.
• Clinical social workers gain competitive advantage over other mental health providers (psychologists, counselors) in SNF settings, potentially shifting referral patterns and revenue flows within the mental health care ecosystem.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Medicare beneficiaries (seniors) gain expanded access to mental health services without cost increases to them; the bill removes barriers to care and broadens the types of evidence-based mental health interventions available. Clinical social workers are empowered to bill for services they are already trained to provide, improving care coordination and access.

Who stands to gain

• clinical social workers and their employers
• skilled nursing facilities (via separate billing authority)
• mental health service providers

Named in the bill

Medicare, Social Security Act, skilled nursing facilities (SNFs), clinical social workers, HCPCS codes 96156, 96158–96161, 96164–96168, 96170–96171

Where it stands

19 cosponsors: 17 Democrats, 2 Republicans.

• Jun 6, 2025 — Introduced · Congress.gov: “Introduced in House”
• Jun 6, 2025 — Referred to House Committee on Energy and Commerce and House Committee on Ways and Means · Congress.gov: “Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

4 lobbying clients named this bill on 6 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $970,000 in lobbying spend. A filing names 16 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 72% of bills with at least one filing.

Brian Fitzpatrick, the sponsor, reported $2,362,211 in PAC receipts in the 2026 cycle.

• Marathon Petroleum Company Lp — $710,000 on 1 filing
• National Association of Social Workers — $110,000 on 2 filings
• Plasma Protein Therapeutics Association — $100,000 on 1 filing
• National Association of Social Workers — $50,000 on 2 filings

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.