Support CSWMEA to Help Seniors
enrolled in Medicare get the Mental Health Services They Need
April 28, 2005
THE ISSUE AT HAND
Seniors are not getting the mental health services they need
because clinical social workers are excluded from billing Medicare
directly for psychotherapy services rendered in skilled nursing
facilities (SNFs).
“I was devastated . My insurance carrier
told me they would no longer reimburse social workers
under Medicare Part A for mental health services. I did
not have the money to repay the carrier for old claims.
After 20 years in private practice, I had to file
for bankruptcy and close my practice . My former clients
had to go without mental health services because I am
the only mental health therapist in the community.”
~ Clinical Social Worker in Florida |
Section 4432 of the Balanced Budget Act of 1997, through the
creation of the Prospective Pay System (PPS) for Medicare SNFs,
revoked clinical social workers' ability to bill Medicare directly
for psychotherapy services rendered in the SNF setting. Section
4432 fails 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.
Reps. Pete Stark (D-CA) and Jim Leach (R-IA), in the House
and Sen. Barbara Mikuski, in the Senate, are expected to introduce
the Clinical Social Work Medicare Equity Act. This bill would
rectify this inequity by restoring the ability of CSW to bill
Medicare Part B directly for services furnished to SNF patients
nationwide.
FACT: 30 Iowa Counties have social workers, but no psychologist
or psychiatrist |
Seniors
in Skilled Nursing Facilities need Social Workers
- Seniors who receive skilled nursing care often
have mental health needs.
- Social workers are trained and licensed to
provide mental health services.
- Social workers already work in skilled nursing
facilities.
- Social workers are more likely than psychologists
and psychiatrists to work in rural communities.
Social Workers Provide Cost-Effective Services in Skilled
Nursing Facilities
Social workers provide individual psychotherapy, which — in
coordination with psychotropic medications when necessary — is
quite cost-effective.
- Of the four core mental health professions, social workers
comprise the largest group of practitioners nationwide and
are most readily available to practice in nursing home settings.
- Mental illness is a leading cause of disability in the
U.S., and major mental disorders have a significant impact
on nursing home residents' overall health and the costs associated
with nursing home care.
- Older patients with depression visit
doctors and emergency rooms more often, use more medications,
incur higher outpatient charges, and stay longer in hospitals.
|
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