SEPTEMBER 22, 2000

ACTION ALERT UPDATE

Medicare Social Work Equity Act (MSWEA)
S 847, HR 655

 

Balanced Budget Refinement Act II

Before the 106th Congressional session ends in early October, we are anticipating a number of Balanced Budget Amendments to correct some of the cuts that were made in 1997. We are lobbying Members of Congress to be sure to include MSWEA and we need the help of the NASW membership NOW!

Under the Balanced Budget Act, Section 4432, Clinical Social Workers (CSW) were no longer able to bill Medicare directly for the provision of clinical social work services - mental health diagnosis and treatment - to residents in skilled nursing facilities (SNF). Clinical social work services prior to the Act were excluded along with psychiatrists and psychologists. The MSWEA restores this exclusion.

We maintain that medical social work services, which include case management, discharge planning, and adjustment issues for the patient and their families were the intended services properly bundled in the Prospective Payment System (PPS). These are the services provided by social workers employed by skilled nursing facilities. The services of clinical social workers, who are independent practitioners and who provide mental health diagnosis and therapy should not be bundled. CSWs should be permitted to bill Medicare directly for providing their services to residents of SNFs.

The Medicare Social Work Equity Act corrects the inequitable treatment of clinical social workers with regard to other providers of mental health services. The passage of MSWEA will ensure that clinical social workers continue to provide the mental health services to residents of SNFs. Without this remedy, nursing homes will resort to the more costly services of other mental health providers. In underserved and rural areas where clinical social workers are the primary providers and often the only provider of mental health services, residents of SNFs will not receive the mental health services they need.

NIMH designated social work as one of the four core mental health professions. CSWs are fully trained and qualified to provide mental health diagnosis and treatment. Clinical social workers are the nation’s largest providers of mental health and therapy services.

Now is the time to contact members of the Senate Finance Committee, House Ways and Means Committee, and the House Commerce Committee to urge them to include MSWEA in the BBRA II. Call or write! Below are some documents to assist you in writing a letter or to use as talking points for inclusion of our bill. Also at the end of this document are list of committee members. Let’s make sure they hear from us!

For more information on this effort, please contact Pat Gorman 1800-638-8799 x336

Attachments:

Protecting Medicare Mental Health Services A Major Concern for Social Workers: Many SNF Residents Will Lose Mental Health Services

These bills will address three issues of concern to social workers practicing in skilled nursing facilities.

  1. Prospective Payment System (PPS) - Beginning in January 1999 social workers can no longer bill Medicare for services provided to patients in skilled nursing facilities under a Part A stay. Clinical social workers can continue to bill Medicare for Part B patients, but only until Consolidated Billing (CB) is implemented (see #2). Under PPS, skilled nursing facilities receive a lump sum payment for patients, which includes clinical social work services. Chances are good that SNFs will not contract with clinical social workers to provide services since the daily PPS amount is too low to cover ancillary services. Because psychologists and psychiatrists are not subject to PPS, they can continue seeing Part A patients and then bill Medicare directly. MSWEA will address this by excluding clinical social work services from PPS.
  2. Consolidated Billing (CB) - Under CB, clinical social workers will have to submit bills to the SNF which will then bill Medicare. Implementation of this regulatory policy has been delayed until HCFA can correct the Y2K problem. MSWEA will address this problem, by excluding clinical social workers from CB, just as clinical psychologists and psychiatrists are excluded.
  3. Billing Authority for Clinical Social Workers - Because of the confusion between clinical social work and social services, many believe that the social services provided "in-house" at the SNF is the same as the service provided by clinical social workers who are providing mental health diagnosis and treatment to residents. In order to eliminate the confusion, the provision in the current law that has led HCFA to interpret social services and clinical social worker services as the same service, will be deleted.

Five Reasons to Support the Medicare Social Work Equity Act
  1. Mental Health Services were never intended to be bundled with other services in order to control costs. CSWs were inadvertently included in PPS and Consolidated Billing. A technical correction is necessary to fix the problem.
  2. Access to mental health services is critical to nursing home residents who often experience depression and adjustment difficulties.
  3. If Clinical Social Workers (CSWs) are discontinued from Medicare reimbursement for mental health services in skilled nursing facilities, nursing home residents in rural and underserved areas will suffer. CSWs are often the only mental health professionals available in these areas.
  4. As CSWs are excluded from this area of practice, more expensive providers will fill the void in non-rural areas. For example, CSWs charge 25% less than Clinical Psychologists do.
  5. In 1998 CSWs billed less than $4 million for these services.

Republicans

 William Roth, DE, Chairman, 202-224-2441

Charles Grassley, IA, 202-224-3744

Orrin Hatch, UT, 202-224-5251

Frank Murkowski, AK, 202-224-6665

Don Nickles, OK, 202-224-5754

Phil Gramm, TX, 202-224-2934

Trent Lott, MS, 202-224-6253

James Jeffords, VT, 202-224-5141

Connie Mack, FL, 202-224-5274

Fred Thompson, TN, 202-224-4944

Democrats

 Daniel Moynihan, NY, Ranking Member, 202-224-4451

Max Baucus, MT, 202-224-2651

John Rockefeller, WV, 202-224-6472

John Breaux, LA, 202-224-4623

Kent Conrad, ND, 202-224-2043

Bob Graham, FL, 202-224-3041

Richard Bryan, NV, 202-224-6244

J. Robert Kerrey, NE, 202-224-6551

Charles Robb, VA, 202-224-6551

Members of the Committee on Commerce

Majority

MINORITY

Committee on Ways and Means 106th Congress Membership

MAJORITY

MINORITY