HR-9990-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Nicole Malliotakis (R-NY)
What it does
This bill would make two main changes to Medicare (Title XVIII of the Social Security Act). First, it would add clinical psychologists to an existing bonus payment program, giving them a 10% payment increase when they provide services in federally designated health professional shortage areas. Second, it would allow clinical psychologists to independently supervise or oversee patients receiving mental health services across several Medicare care settings — including skilled nursing facilities, home health, partial hospitalization programs, comprehensive outpatient rehabilitation facilities, and inpatient psychiatric hospitals — without requiring physician oversight, to the extent permitted by state law. Changes would take effect January 1, 2027.
Who benefits
Medicare beneficiaries in rural and underserved areas who currently have limited access to mental health care. Clinical psychologists, who would gain greater practice autonomy and a 10% payment bonus in shortage areas. Skilled nursing facility and home health residents who need behavioral health services. Employers and facilities in shortage areas that employ clinical psychologists. Indirectly, communities with high unmet mental health needs, including rural populations and low-income urban areas designated as health professional shortage areas.
Who is hurt
Physicians and psychiatrists who currently serve as required supervisors for mental health services in these settings may see reduced referrals and a diminished supervisory role. Medical professional associations that favor physician-led care teams may oppose the shift in oversight authority. Patients who prefer physician-coordinated care could face changes to their care team structure. Medicare's Federal Supplementary Medical Insurance Trust Fund would bear the cost of the 10% bonus payments, potentially affecting program finances. States with restrictive scope-of-practice laws would see limited practical effect from the bill, creating uneven access across states.
Supporters argue
Supporters argue that the U.S. faces a severe mental health provider shortage — the Health Resources and Services Administration has identified hundreds of mental health professional shortage areas nationwide — and that requiring physician oversight for psychologist services creates an unnecessary bottleneck that delays or prevents care. They contend that clinical psychologists hold doctoral-level training specifically in psychological assessment and treatment, making physician supervision redundant for services within their established scope of practice, and that the 10% bonus mirrors an existing incentive already available to physicians, correcting an inequity that discourages psychologists from practicing in underserved communities.
Opponents argue
Opponents argue that removing physician oversight requirements could compromise patient safety, particularly for Medicare beneficiaries who are elderly or medically complex and may have physical health conditions that interact with mental health treatment. They contend that integrated, physician-coordinated care reduces the risk of missed diagnoses and medication interactions, and that the bill's deference to state scope-of-practice law will produce a patchwork of access rather than a uniform national standard — meaning beneficiaries in states with restrictive laws would see little benefit while the Trust Fund bears bonus payment costs regardless of access outcomes.
Constitutional context
Congress has broad authority to structure Medicare under the Taxing and Spending Clause (Art. I, §8, cl. 1), and NFIB v. Sebelius (2012) affirmed wide latitude to set conditions on federal healthcare spending. Because this bill modifies existing Medicare program rules rather than imposing new mandates on states or individuals, it does not raise significant constitutional concerns. The bill's deference to state scope-of-practice law also avoids Supremacy Clause or anti-commandeering issues.
Checks and balances
Congress modifies Medicare payment and supervision rules; HHS and CMS retain authority to implement regulations and define "clinical psychologist" for program purposes; state licensing boards retain authority over scope-of-practice, which serves as a practical ceiling on the bill's effect in each state.
Historical precedent
Congress has previously expanded non-physician provider autonomy in Medicare, including granting nurse practitioners and physician assistants independent billing and supervision authority in certain settings under the Balanced Budget Act of 1997 and subsequent legislation.