June 17, 1998
The Honorable Donna E. Shalala
Secretary
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Secretary Shalala:
We would like to request your reconsideration of a Final Rule issued in the Federal Register on April 23, 1998, that poses serious and potentially harmful consequences for nursing home residents currently receiving mental health services from clinical social workers. Specifically, as currently interpreted by your Department, the Final Rule ("Medicare Benefits and Application of the Outpatient Mental Health Treatment Limitation to Clinical Psychologist and Clinical Social Worker Services") effectively eliminates Medicare reimbursement for clinical social worker services provided residents of skilled nursing facilities, whether or not their stay is being paid by Medicare, Medicaid, or a private payer.
This means that, as of June 22, a mere five days from today, current and future mental health services for nursing home residents will cease to be provided by clinical social workers. In many rural and underserved areas of the country where clinical social workers are often the only available mental health provider, nursing home patients will be denied needed mental health treatment.
To complicate matters further, it is our understanding that carriers have not been informed of the changes that will become effective in five days. Moreover, HCFA’s interpretation in this Final Rule runs contrary to current practice. Few administrators of nursing facilities or clinical social workers are aware of these changes and will likely continue to provide services under current carrier guidelines, only to find later that payment for such services has been denied.
From a Congressional standpoint, we have serious concerns about the consequences of this regulation for our constituents. If this regulation is implemented as planned, services will be suspended with little or no explanation to nursing homes, clinical social workers and, most importantly, patients and their families. Disruption of current, on-going mental health treatment will be traumatic for these patients. In many underserved areas where there is no other available mental health providers, this disruption will be permanent.
In order to avert this crisis, our staff met today with staff from HCFA to discuss possible solutions to this problem. Based on this discussion, we have learned that there are at least two interpretations of the Medicare statute. This difference in interpretations signals the need for a review of Congressional intent. Therefore, at the very least, implementation of this Final Rule should be delayed so that this matter can be further investigated.
Although HCFA staff were sympathetic to our concerns and understood our request for a delay in implementation, they were clearly not in a position to make this decision on the Agency’s behalf. We are therefore requesting that you delay the implementation of this Final Rule so that we can avert this impending crisis.
Thank you for your time and consideration of this matter. We look forward to hearing from you.
Sincerely,
Barbara Mikulski Richard A. Gephardt Pete Stark
U.S. Senator Democratic Leader
Member of Congress
Cc: Nancy-Ann Min DeParle
NASW Government Relations
Contact:
Madeleine Golde,
Phone: (202) 336-8261 or 1-800-638-8799, extension 237
Fax: (202) 336-8311
E-mail: mgolde@naswdc.org