NASW Works with Congress to Ensure Social Work Care in Skilled Nursing Facilities

WASHINGTON—U.S. Senator Barbara Mikulski (D-MD), U.S. Representative Pete Stark (D-FL), and U.S. Representative Jim Leach (R-IA) introduced legislation this week to rectify the inequity between billing provisions for clinical social workers and those for other professional mental health providers. Passage of the Clinical Social Work Medicare Equity Act S.1083 (CSWMEA) will exempt clinical social workers from the Medicare Prospective Pay System (PPS) billing requirements for Medicare Part B in the skilled nursing facility (SNF) setting.

Currently, there is no national policy on the provision of mental health services under Medicare Part B. The Center for Medicare and Medicaid Services (CMMS) delegates discretion on the matter to each individual Medicare carrier, and it is up to them to decide whether to pay for clinical social work services. Many carriers do not.

The National Association of Social Workers believes that Congress did not intend to bundle mental health services with other medical-social services, as demonstrated by the exclusion of psychiatrists and psychologists from the PPS. The result of the CSWMEA administrative change is that all SNF patients will be able to receive psychotherapy services from clinical social workers and the decision to cover these important treatments no longer rests with each individual Medicare carrier.

"It is in the best interest of the nation for clinical social workers to be treated by Medicare like their peers," adds NASW Executive Director Elizabeth Clark PhD, ACSW, MPH. "NASW heartily thanks Senator Mikulski, Representative Stark, and Representative Leach for their longstanding support of this important legislation."

"Clinical social workers are now the primary providers of mental health services to residents of nursing homes, particularly in rural and other medically under-served areas", said Representative Pete Stark. "If Congress does not fix this oversight in the law, many clinical social workers will be forced to stop serving SNF residents.  The ultimate victims are vulnerable seniors who need mental health care." 

Congressman Jim Leach said, "I am pleased to be an original co-sponsor of The Clinical Social Work Medicare Equity Act – legislation intended to ensure that residents of nursing homes have access to the critical mental health services provided by social workers."

Some studies show that up to 88% of nursing home residents have mental health problems, ranging from major depression to Alzheimer’s Disease.  Clinical social workers are highly-trained, and often work in areas where psychiatrists and psychologists choose not to practice. They hold a master’s degree in social work, complete bout 3,000 hours in supervised field instruction, and obtain a state license or state certification in order to practice.

In addition to providing diagnosis and treatment for mental illness, clinical social workers assess people’s strengths and are trained to counsel clients in the context of their family and community. For many seniors living in nursing facilities, this empowerment therapy is often the most effective strategy for coping with long-term illness. The CSWMEA will ensure that seniors and other skilled nursing facility residents will have access to mental health treatment from a provider of their choice.

The National Association of Social Workers (NASW) is the largest membership organization of professional social workers in the world, with 150,000 members. NASW works to enhance the professional growth and development of its members, to create and maintain professional standards, and to advance sound social policies. Approximately 40% of its members are mental health care providers.

For more information about the Clinical Social Work Medicare Equity Act, please contact Francesca Fierro O’Reilly in NASW Government Relations at (202) 336-8336 or the NASW Public Affairs Office at (202) 336-8236.

The National Association of Social Workers (NASW), in Washington, DC, is the largest membership organization of professional social workers with 153,000 members. It promotes, develops and protects the practice of social work and social workers. NASW also seeks to enhance the well being of individuals, families and communities through its work and through its advocacy.