March 31, 1997
ISSUE: On March 10, the Health Care Financing Administration (HCFA) published a proposed rule to revise the conditions of participation (COP) for Medicare’s Home Health Program. The proposed rule largely maintains the program’s current qualifications for social worker (an MSW) and social work assistant (a bachelor’s degree in social work or a related field and supervision by an MSW. However, the proposed rule omits the current requirement that a social work assistant be supervised by a social worker, suggesting that a social work assistant with no social work education and no MSW supervision could act as the primary service provider of medical social services under Medicare’s Home Health Program. NASW opposes these changes and supports the retention of current language.
SIGNIFICANCE: This proposed change, as well as HCFA’s request for public comments regarding whether the qualifications for social worker should be revised, are part of a broader effort by that agency to downgrade the requirements for social workers under Medicare programs. Publication of the proposed rule follows a lengthy internal review of the COP by HCFA, and earlier drafts of the HCFA document downgraded the definition of social worker to an individual with a BSW or "equivalent." Considerable effort by NASW and others was necessary to prevent HCFA from downgrading the social worker definition in the proposed rule.
ACTION: Send comments to HCFA in support of maintaining the current (existing) definitions and qualifications for social worker and social work assistant in the Medicare Home Health COP. (A sample letter is enclosed.) Generate similar letters of support from social work colleagues, colleagues from other disciplines, state and community-based organizations (particularly organizations representing elderly people), and related professional and trade associations.
Send copies of your letters to your representative and senators. Ask your representative and senators to write to HCFA in support of maintaining the current definitions of social workers in the Medicare Home Health Program.
TIMING: Comments on the proposed rule must be received by HCFA no later than 5:00 p.m. on June 9, 1997.
ADDRESS: Written comments (one original and three copies) must be mailed to
Bruce C. Vladeck, PhD
Administrator, Health Care Financing Administration
Department of Health and Human Services
Attention: BPD-819-P
PO Box 7519
Baltimore, MD 21207-0519
INFORMATION: Contact Sandy Harding, Government Relations Associate, at 1-800-638-8799, ext. 261, sharding@naswdc.org, or Jim Brennan, Senior Staff Associate for Health, at 1-800-638-8799, ext. 233, jbrennan@naswdc.org.
ADDITIONAL BACKGROUND INFORMATION
The Health Care Financing Administration (HCFA) is currently rewriting the conditions of participation (COP) for Medicare’s Home Health, Hospice, Hospital, and End Stage Renal Disease (ESRD) Programs. The COP serve as the federal regulations that govern these programs and define the covered benefits as well as qualified agencies and providers.
Last year NASW became aware that there was an initiative within HCFA to redefine social worker in the Home Health, Hospice, and ESRD programs as simply an individual with a BSW or "equivalent," with no expectation for clinical supervision. Through extensive effort by NASW, including the assistance of several chapter leaders, we succeeded in receiving a commitment from HCFA that the current federal definitions would be maintained in the proposed COP that would be published in the Federal Register for public comment. HCFA officials indicated, however, that the preamble to the proposed rules would specifically invite public comment regarding whether the qualifications for social worker should be revised.
Although HCFA officials promised NASW that the qualifications for social worker and social work assistant would remain the same in the proposed rule, the proposed COP have made an omission that would profoundly alter the current social work standard. The proposed rule does maintain the definition of a social worker as an individual with a master’s degree from a school of social work accredited by the Council on Social Work Education and one year of social work experience in a health care setting. The proposed rule also maintains the definition of a social work assistant as an individual with a bachelor’s degree in social work, sociology, or other field related to social work and at least one year of social work experience in a health care setting or two years of experience as a social work assistant with a satisfactory grade on a proficiency examination. However, the proposed rule omits the current requirement that a social work assistant be supervised by a social worker, suggesting that a social work assistant with no social work education and no MSW supervision could act as the primary service provider of medical social services under Medicare’s Home Health Program. NASW opposes this change.
HCFA must receive widespread response in support of maintaining the current federal definitions and qualifications for social work practice in the Medicare Home Health Program. It is difficult to overstate the importance of this issue to the profession. It is a quality care issue, a challenge to professional social work standards, and a social work practice issue. The current Medicare definitions are reflected in a variety of other federal and state programs, and a decline in the Medicare definition would likely lead to the downgrading of social work standards in other related programs.
We anticipate that the invitation to submit comments on the qualifications for social workers will generate a notable response from health care industry groups who desire greater flexibility in providing services through the Medicare programs. We also anticipate a response from non-social workers who have an interest in providing the services.
** A large volume of letters on this issue is critically important. We encourage NASW chapters, members, and related organizations to send comments to HCFA on the proposed COP. Social workers are urged to personalize their letters to HCFA.**
SAMPLE COMMENTS TO HCFA
Bruce C. Vladeck, PhD
Administrator, Health Care Financing Administration
Department of Health and Human Services
Attention: BPD-819-P
PO Box 7519
Baltimore, MD 21207-0519
Dear Dr. Vladeck:
I am opposed to the proposed changes to the definitions of social worker and social work assistant in the proposed conditions of participation for home health agencies. I urge you to maintain the current definitions for social worker and social work assistant, including the current requirement that social work assistants be supervised by social workers, in the Medicare conditions of participation for home health agencies.
As a social worker, I am very concerned that the Health Care Financing Administration is considering changing baseline qualifications for social work practice in home health (Federal Register, Vol. 62, No. 46, March 10, 1997). In my view, this is inconsistent with the expressed goal to "attain and maintain the highest practicable functional capacity for each patient in terms of medical, nursing, and rehabilitative needs as indicated on the plan of care" (page 11020). Increasingly early discharges from hospitals result in a larger number of home health beneficiaries with complex treatment and family issues. The increased needs of patients do not suggest a decreased need for qualified social work personnel.
The value of psychosocial care to persons with chronic and/or terminal illnesses is well documented. In studies that compare the effectiveness of professionally trained social workers with individuals who do not have a social work education, social workers achieved significantly better outcomes than non-social workers. General indicators are that professionally trained social workers are the preferred providers of care.
HCFA’s attempts to redefine social work qualifications and supervision are in clear opposition to the work of state licensing agencies and professional social work organizations, which clearly differentiate the appropriate roles and functions of BSW and MSW practitioners. Few provide recognition for any type of "BSW equivalent."
Medicare beneficiaries deserve quality care delivered by qualified providers. I believe that lowering the standard for social work providers in home health care is a serious mistake and would compromise the quality of care offered to beneficiaries. I also hope that HCFA does not attempt to lower social work standards in home health through the "back door" by eliminating the current requirement that social work assistants be supervised by qualified social workers.
Sincerely,
cc: Representative __________
Senator __________
INFORMATION: Contact Sandy Harding, Government Relations Associate, at 1-800-638-8799, ext. 261, sharding@naswdc.org, or Jim Brennan, Senior Staff Associate for Health, at 1-800-638-8799, ext. 233, jbrennan@naswdc.org.