Medicare Bill Expands Mental Health Services for Seniors, Separating Social Worker Pay from SNF Bundles by 2026

This bill, the Expanding Seniors Access to Mental Health Services Act, is a targeted effort to boost mental and behavioral health access for Medicare beneficiaries, especially those in skilled nursing facilities (SNFs). It makes two key changes to how Medicare pays for services delivered by clinical social workers, with both changes kicking in on January 1, 2026.

The first major shift tackles how SNFs get paid. Right now, Medicare uses a bundled payment system—called the prospective payment system (PPS)—that gives the SNF one lump sum to cover almost everything, including clinical social worker services. This bill pulls those social worker services out of that bundle. This means SNFs can no longer just absorb the cost of these services into their general operating budget; they must now bill Medicare separately for them. For seniors, this is a big deal because when mental health services are bundled, they can often be underutilized or difficult to track. Separating the payment should increase transparency and ensure better access to these specific services within the nursing home setting.

The second change is about expanding what clinical social workers can actually bill Medicare for. Currently, their services are mostly limited to diagnosing and treating mental illnesses. The new law broadens this definition to include health and behavior assessment and intervention. Think of this as covering services that help people manage chronic diseases or cope with lifestyle changes related to their physical health. The bill explicitly references specific codes (HCPCS codes 96156, 96158, 96161, 96164 through 96168, and 96170 through 96171) used for these behavioral services. This modernization acknowledges that mental and physical health are deeply connected, allowing seniors access to a wider range of necessary support.

Why Separate Billing Matters

For the clinical social workers, this change is a win because it creates a clear, distinct path for reimbursement, making it more financially viable for them to work in SNFs. For the SNFs themselves, it means an administrative adjustment; they’ll need to set up new billing procedures to capture these separate payments starting in 2026. While this adds complexity to their paperwork, it frees up funds previously dedicated to covering these services under the PPS bundle. In short, it clarifies who pays for what, which usually leads to better service delivery.

The Real-World Impact on Seniors

Imagine a senior recovering from a stroke in a skilled nursing facility. Before this bill, the focus might have been strictly on physical therapy, with behavioral support being an afterthought or hard to access. Under the expanded definition, that senior could now receive specific, billable behavioral interventions to help them cope with the emotional toll of their recovery, manage medication adherence, or adjust to new physical limitations. This shifts Medicare coverage toward a more holistic view of health, which is crucial for older adults facing complex medical conditions. The only group left out of this specific expansion are hospital inpatients—the expanded coverage only applies in other settings.