Support CSWMEA (S. 343/H.R.
707) to Help Seniors enrolled in Medicare get the Mental
Health Services They Need October 8, 2003 THE ISSUE AT HAND Seniors are not
getting the mental health services they need because clinical
social workers are excluded from billing Medicare directly
for psychotherapy services rendered in skilled nursing facilities
(SNFs).
“I
was devastated. My insurance carrier
told me they would no longer reimburse social
workers under Medicare Part A for mental
health services. I did not have the money
to repay the carrier for old claims. After
20 years in private practice, I had to file
for bankruptcy and close my practice. My
former clients had to go without mental health
services because I am the only mental health
therapist in the community.”
-
Clinical Social Worker in Florida |
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Section 4432 of
the Balanced Budget Act of 1997, through the creation of
the Prospective Pay System (PPS) for Medicare SNFs, revoked
clinical social workers’ ability to bill Medicare directly
for psychotherapy services rendered in the SNF setting. Section
4432 fails to exempt clinical social workers from the PPS,
in contrast to physicians and psychologists, who are statutorily
exempt, and thus do not face such restrictions. The situation is
further complicated by the fact that the Centers for Medicare
and Medicaid Services delegate most decision-making on mental
health services to the regional Medicare fiscal intermediaries
(FIs). Although some Fis continue to reimburse clinical social
workers for SNF patients, others do not. Therefore, it is
often the case in many areas of the country that clinical
social workers may no longer bill Medicare directly for psychotherapy
services in SNFs, even though they may bill Medicare independently
in other settings.
Of
Mental Health Professionals:
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•
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60%
are clinically trained social workers
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•
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23%
are psychologists
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10%
are psychiatrists
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The Clinical Social
Work Medicare Equity Act of 2003 — sponsored
in the House by Reps. Pete Stark (D-CA) and Jim Leach (R-IA),
along with 30 cosponsors, and in the Senate by Sen. Barbara
Mikulski (D-MD), along with seven (7) cosponsors — would
rectify this inequity. It would restore the ability of CSW
to bill Medicare Part B directly for services furnished to
SNF patients nationwide. Seniors in Skilled Nursing Facilities
need Social Workers
- Seniors
who receive skilled nursing care often have mental health
needs.
- Social
workers are trained and licensed to provide mental health
services.
- Social
workers already work in skilled nursing facilities.
- Social
workers are more likely than psychologists and psychiatrists
to work in rural communities.
Social Workers Provide Cost-Effective
Services in Skilled Nursing Facilities
FACT:
30 Iowa Counties have social workers,
but no psychologist or psychiatrist
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Social workers provide individual
psychotherapy, which — in
coordination with psychotropic medications when necessary —is
quite cost-effective.
- Of
the four core mental health professions, social workers
comprise the largest group of practitioners nationwide
and are most readily available to practice in nursing home
settings.
- Mental
illness is a leading cause of disability in the U.S.,
and major mental disorders have a significant impact
on nursing home residents’ overall health and the costs
associated with nursing home care.
- Older
patients with depression visit doctors and emergency rooms
more often, use more medications, incur higher outpatient
charges, and stay longer in hospitals.
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About
NASW