December 1, 2006
Medicare Payments for Clinical Social Workers Unresolved
Unless Congress acts next week to reverse it, a final rule issued by the Centers for Medicare and Medicaid Services (CMS) determining clinical social work Medicare Part B payments will cut clinical social worker payments for services delivered beginning January 1, 2007. A final CMS rule was posted on November 1, 2006 updating several components of the Medicare Part B “Physician” Fee Schedule including: the RVU (work values), practice expenses, and the SGR update (Sustainable Growth Rate). This payment schedule is the basis for all health professions that bill Part B, including clinical social workers. CMS proposed that clinical social workers receive a total payment reduction of 14 percent, comprised of a 7 percent reduction in work values, a 2 percent reduction in practice expense values, and a 5 percent SGR cut received by all Part B providers. Making matters even worse, an additional 5 percent decrease in social worker practice expense values is not fully phased in until 2010.
The Issue At Hand:
Facing a 14 percent cut, clinical social workers will receive one of the highest reductions of all covered professions this year, with additional cuts to come in future years. Congress must intervene now to stop these CMS actions. Incongruously, CMS is proposing a 10 percent increase in payments for evaluation and management codes, which will increase payments for many physicians but these codes are not available to clinical social workers and other non-physician practitioners.
The cuts in RVUs and practice expenses are also affecting psychologists, clinical nurse specialists, and a broad array of Medicare Part B providers. The RVU and practice expense adjustments respond to a five-year mandatory rebalancing of provider payments, which is budget neutral overall, but this year has created large winners and losers among various professions. In addition, Medicare adjusts its SGR payments annually according to a formula specified by statute that adjusts payment rates for the growth in Medicare spending for physician and non-physician services. The annual SGR decrease in payment rates affects all physicians and non-physicians equally.
NASW is vigorously advocating for clinical social workers who are severely affected by this year’s Medicare payment rules. Along with other health professions, we have been lobbying Congress heavily, to halt the payment cuts before they go into effect. We have made a number of specific suggestions to Congress on how to adjust payments to clinical social workers, but it is unclear if action will be taken at this time.
Action Needed:
NASW members should contact their members of Congress now and urge them to reverse these Part B payment cuts before they adjourn for the year. Senior congressional staff are meeting now behind closed doors in a last minute attempt to find a bipartisan, bicameral solution to this multi-billion dollar Part B payment shortfall. NASW will keep its members abreast of any congressional actions. Members may link to a sample letter to Congress here: Restore CSW Medicare Rates
Thank you for your advocacy!
A copy of the final rule may be found at: Physician Fee Schedule Rule
|
About
NASW