May 1, 2007
Clinical Social Work Medicare Equity Act Reintroduced Congressional Cosponsors Needed for S.1212
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. The law 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 Barbara Mikulski (D-MD) on federal legislation that would rectify this inequity that denies badly needed mental health services to nursing home residents. The Clinical Social Work Medicare Equity Act of 2007 would restore the ability of CSWs to bill Medicare Part A directly for services furnished to SNF patients nationwide.
ACTION NEEDED
Your advocacy on this issue is critical to helping push this legislation through the Senate. NASW urges its members to contact their Senators and ask them to cosponsor the Clinical Social Work Medicare Equity Act (S.1212). To contact your Senators, you may call the Capitol Switchboard at (202) 224-3121 or find their numbers and/or email addresses at www.senate.gov. Alternatively, email your Senators through NASW's Congress Web, available on our website at: http://www.socialworkers.org/advocacy/grassroots/congressweb.asp
TIMING
The Senate bill was reintroduced on April 25, 2007. Senator Mikulski and the cosponsors of S.1212 need to demonstrate broad support for the bill. To date Senators Bingaman, Cantwell, Johnson, Kennedy, and Murray have cosponsored the bill. All other Senators are targets for your advocacy. NASW is expecting to announce a House bill and strategy shortly.
SAMPLE SCRIPT
- "My name is ________. As a constituent, professional social worker, and a member of the National Association of Social Workers, I urge Senator ________ to cosponsor the Clinical Social Work Medicare Equity Act of 2007 (S.1212), which was introduced by Senator Barbara Mikulski on April 25, 2007."
- This critical legislation will ensure that residents of skilled nursing facilities will no longer be denied mental health services provided by clinical social workers, unlike other Medicare beneficiaries who may access their services in other settings.
- Thank you.
BACKGROUND
Since 1989, Medicare Part B coverage has been available for clinical social worker (CSW) services delivered independently in outpatient settings. Before passage of the Balanced Budget Act of 1997 (BBA 97), P.L. 105-33, CSWs billed Medicare Part A directly for the diagnosis and treatment of mental health conditions in 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 typically received by all residents and the discretionary psychotherapeutic CSW services provided to those residents with a specialized need. Since CSW services were not explicitly excluded from the SNF PPS, CSWs may not bill Medicare directly for psychotherapy services in SNFs, even though they may bill Medicare independently in outpatient settings.
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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