Update on Clinical Social Work Reimbursement for Services to Skilled Nursing Facility Residents Under Medicare

May 29, 1998

Calls are needed immediately to HHS Secretary Donna Shalala (202/690-7000) and HCFA Administrator Nancy-Ann Min DeParle (202/690-6726), urging that they pull back the April 23rd regulations affecting clinical social workers providing services to SNF residents under Medicare Part B.  Additionally, letters can be sent, but calls are critically needed.

Over the past few months, NASW has been lobbying Congress aggressively to allow clinical social workers (CSWs) to continue to bill directly to Medicare Part B for mental health services provided to residents of skilled nursing facilities (SNFs). NASW worked with a number of members of Congress to introduce the Medicare Social Work Equity Act, H.R. 3570 and S.1864, which would specifically add CSWs to the list of excluded services that would not be subject to the new consolidated billing requirement mandated under Section 4432(b) of the Balanced Budget Act of 1997. With more members of Congress cosponsoring our bill, NASW was hopeful that Congress would approve this legislation. Unfortunately, new final regulations issued by the Health Care Financing Administration (HCFA) on April 23, 1998, will eliminate reimbursement to CSWs under Medicare Part B for services provided to residents of SNFs. It appears that this regulation will override NASW’s efforts to legislatively fix the consolidated billing issue. This regulation on "Medicare Benefits and Application of the Outpatient Mental Health Treatment Limitation to Clinical Psychologist and Clinical Social Worker Services" affects reimbursement for CSWs in many different health settings and becomes effective June 22, 1998. NASW has launched an aggressive campaign to prevent these regulations from going into effect. We have requested a meeting with Health and Human Services Secretary Donna Shalala and are also working with lead congressional cosponsors of our bill to resolve this critical issue. BUT WE NEED YOUR IMMEDIATE HELP.

For a more detailed briefing paper on this issue, please contact Phyllis Ransome at 1-800-638-8799, ext. 348. Please leave a message with your fax number or address.

Honorable Donna E. Shalala, Secretary
Department of Health and Human Services
Hubert H. Humphrey Building, Room 615F
200 Independence Avenue, SW
Washington, DC 20201

Nancy-Ann Min DeParle, Administrator
Health Care Financing Administration
Department of Health and Human Services
Hubert H. Humphrey Building, Room 314G
200 Independence Avenue, SW
Washington, DC 20201

Please send blind copies of your letters to Madeleine Golde, National Association of Social Workers, 750 First Street, NE, Suite 700, Washington, DC 20002.

• The final rule on "Medicare Benefits and Application of the Outpatient Mental Health Treatment Limitation to Clinical Psychologists and Clinical Social Worker Services," issued in the Federal Register on April 23, 1998, will eliminate reimbursement for clinical social worker services provided to residents of SNFs under Medicare Part B.
• Clinical psychologists will be permitted to continue to bill Medicare Part B directly for similar psychological services to SNF residents.
• This is discriminatory action against clinical social workers who are one of the major providers of mental health treatment and diagnosis to SNF residents.
• If this new HCFA goes into effect, thousands of clinical social workers will lose their jobs, beneficiaries will be denied access to needed critical mental health services, and the costs to Medicare for mental health services in SNFs will dramatically increase.
• HCFA must not allow those provisions pertaining to clinical social work services provided to SNF residents to go into effect. Time is critical, because the regulations are supposed to go into effect June 22, 1998.

It is important to add your own personal story: how this will affect you as a clinical social worker and the residents you serve in SNFs.