Clinical Social
Work Medicare Equity Act Reintroduced Congressional Cosponsors
Needed for S. 1148/H.R. 2736
June 3, 2005
THE ISSUE AT HAND
The Balanced Budget Act of 1997, through the creation of the
Prospective Pay System (PPS) for Medicare Skilled Nursing Facilities
(SNFs), revoked the ability of clinical social workers (CSWs)
to bill Medicare directly for psychotherapy services rendered
in the SNF setting. Section 4432 failed 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.
NASW is working with U.S. Representatives Pete Stark (D-CA)
and Jim Leach (R-IA) and Senator Barbara Mikulski (D-MD) on
federal legislation that would rectify this inequity. The Clinical
Social Work Medicare Equity Act of 2005 would restore the ability
of CSWs to bill Medicare Part B directly for services furnished
to SNF patients nationwide.
ACTION NEEDED
NASW needs its members to contact their Representative and
Senators and ask them to cosponsor this legislation.
A sample letter has been posted on NASW’s Congress Web
for members to email, fax, or mail to their Members of Congress.
Your advocacy on this issue is critical to helping push this
piece of legislation through the House and Senate. To contact
your Members of Congress, you may call the Capitol Switchboard
at (202) 225-3121 or find their numbers and/ or email addresses
at www.house.gov and www.senate.gov.
Contact your Representative and Senators through NASW's Congress
Web, available on our website at: http://www.socialworkers.org/advocacy/grassroots/congressweb.asp
TIMING
The legislation was reintroduced on May 26, 2005. The sponsors
of this legislation would like to acquire bipartisan support
to show that there is a critical mass of support, but it is
especially important to get Republicans signed on in support
of the effort. Additionally, it is critical to thank the Representatives
and Senators who cosponsored the CSWMEA in the 108 th Congress
and request their continued support in the 109 th Congress.
SAMPLE SCRIPT
- "My name is __________. As a constituent, professional
social worker, and a member of the National Association of
Social Workers, I urge Senator/Representative ___________
cosponsor the Clinical Social Work Medicare Equity Act of
2005 (S. 1148/H.R. 2736), which was introduced by Representatives
Pete Stark and Jim Leach and Senator Barbara Mikulski on
May 26, 2005."
- This critical legislation will ensure that residents of
a skilled nursing facility will no longer be denied mental
health services provided by a clinical social worker, unlike
other Medicare beneficiaries who access their services in
other settings.
- IF YOUR SENATOR OR REPRESENTATIVE IS ON THE LIST OF SUPPORTERS
BELOW FROM THE 108 th CONGRESS-- "Thank you for your
support and cosponsorship in the 108 th Congress-- can I
count on your continued support this Congress?"
- Thank you.
Congressional Targets
Several members of Congress just need thank you notes from
constituents because they have already signed on the bill as
original cosponsors. These include Sens. Bingaman (NM), Cornzine
(NJ), Inouye (HI), Johnson (SD), Murray (WA), Stabenow (MI),
and Reps. Abercrombie (HI), Bordallo (GU), Hinchey (NY), Kildee
(MI), Leach (IA), McNulty (NY), Waxman (CA), and Wexler (FL).
Other members cosponsored the bill last year and need special
attention to do so again this year. These Members of Congress
need a request to cosponsor with a reminder that they did so
last year, they include:
Senate Cosponsors in the 108 th Congress
House Cosponsors in the 108 th Congress
- Rep. Ackerman, Gary L. (NY)
- Rep. Berkley, Shelly (NV)
- Rep. Christensen, Donna M. (VI)
- Rep. Davis, Susan A. (CA)
- Rep. Doyle, Michael F. (PA)
- Rep. Evans, Lane (IL)
- Rep. Frank, Barney (MA)
- Rep. Lee, Barbara (CA)
- Rep. Schakowsky, Janice D. (IL)
- Rep. Tierney, John F. (MA)
- Rep. Towns, Edolphus (NY)
BACKGROUND
Passage of the Omnibus Budget Reconciliation Act of 1989,
P.L. 101-239, provided for Medicare Part B coverage for clinical
social worker (CSW) services. Before the passage of the Balanced
Budget Act of 1997 (BBA 97), P.L. 105-33, CSWs billed Medicare
Part B directly for the diagnosis and treatment of mental health
conditions in most settings, including SNFs.
However, Section 4432 of the BBA 97 established the Prospective
Payment System (PPS) for Medicare Parts A and B, which provides
for a global per diem payment for almost all services received
by SNF residents. The per diem payment is intended to cover
those services the SNF is required to provide to all patients
in order to participate in the Medicare program, such as nursing,
dietary, and medical-social services. However, some services
are clearly excluded from the SNF PPS by the statute, such
as physician services, psychologist services, certified nurse-midwifery
services, and certified nurse anesthetist services. In the
case of CSW services, BBA 97 failed to make a distinction between
mandated medical social services and the optional psychotherapeutic
CSW services since CSW services were not explicitly excluded
from the SNF PPS. Therefore, it is often the case in many areas
of the country that CSWs may no longer bill Medicare directly
for psychotherapy services in SNFs, even though they may bill
Medicare independently in other settings.
The situation is further complicated by the fact that BBA
97 also implemented consolidated billing (CB) for all services
rendered to SNF patients, in that the SNF, and not the individual
provider, bills Medicare for all patient services as of July
1, 1998 under both Parts A and B. Year 2K issues then caused
CMS to delay CB requirements for patients in a non-covered
SNF stay, i.e. not covered by Part A, until April 1, 2001.
But Congress intervened in the meantime, Repealing most of
the CB portion of BBA 97 through passage of Section 313 of
the Benefits Improvement and Protection Act of 2000, P.L. 106-554.
CB now applies only to SNF patients during a Part A stay, and
has no impact on Part B services, except for physical, occupational,
and speech-language therapy services, which are subject to
CB requirements.
For more information, please visit http://www.naswdc.org/advocacy or
contact Jim Finley, NASW Government Relations, at jfinley@naswdc.org |
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