Improving Training Opportunities under Managed Care

Managed care has had a chilling effect on professional training, and field placements for clinical social work are in jeopardy. Agency staff are under more pressure to produce billable units and have little time for student supervision. In some settings like hospitals, social work departments have been combined with other units, and there is no longer a social work department head to encourage professional training. Increasingly, agencies are refusing students because students’ clinical work can no longer be billed to the managed care company. This Fact Sheet contains information to help students, agencies, and schools of social work in this last dilemma.

Some managed care companies have told agencies that they cannot bill for MSW student work, even when a student is under the supervision of a licensed professional. The reason cited is that accreditation standards of the National Committee on Quality Assurance (NCQA) will not allow students to provide service; only licensed professionals can provide service. NCQA accreditation has become very important to managed care companies, both for marketing and eligibility for some contracts.

NASW has questioned NCQA about this interpretation of their standards and has received written clarification that there is no such barrier to reimbursement. The NCQA response clarifies that the standards that restrict care to licensed practitioners is meant to address those who treat members outside of facility-based care. Those in agencies are covered under different standards that merely require the managed care company to have written policies and regular review to assess that the agency meets state and federal regulatory and accrediting standards. Moreover, this standard does not address use of graduate students whose work is supervised by an independently credentialed practitioner. This is left to the discretion of the managed care company. (See next page for language of the letter.)

Excerpts of Letter from Claire Sharda, Director of Policy, NCQA, January 14, 1998:

"Under CR 3.1, MBHOs [managed behavioral health organizations] must verify from primary sources a current license to practice as an independent behavioral health care practitioner . . . . The intent of the above standard is to focus on those independent practitioners who treat members outside of facility-based settings, i.e., autonomously. CR 12 addresses the credentialing of those practitioners who only treat an MBHO’s members within a facility-based setting . . . . Moreover, this standard does not address the MBHO’s use of other practitioners, such as master’s level clinicians or graduate students whose work is supervised by an independently credentialed practitioner; this is left to the discretion of the MBHO."

CR 12 states "The managed care organization has written policies and procedures for the initial and ongoing assessment of organizational providers with which it intends to contract." The standard goes on to state that

The provider, as an agency, must be in good standing with state and federal regulatory bodies.
The provider has been reviewed and approved by the accrediting body (if the provider is not accredited, the MBHO must develop and implement standards of participation).
At least every three years, the managed care organization confirms that the provider still has such accreditation and regulation in good standing.

NASW seeks to support strong clinical training and the essential partnership between agencies and schools of social work. We therefore encourage NASW chapters and other interested persons to share this clarification of NCQA policy with agencies and schools of social work. The agencies can communicate with the managed care organizations to let them know that NCQA standards do not exclude use of students properly supervised by licensed social workers.

Some NASW chapters are now working on this issue. The National Office will continue to put forth detailed information on this critical issue. For more information, call 1-800-638-8799, ext. 218.

Join NASW in Shaping Managed Care

Support managed care regulation in both Congress and in states for consumer and provider protections. The National Office has identified chapters for member mobilization.
Help in NASW’s major effort to protect social work reimbursement under Medicare for patients in skilled-nursing facilities (see latest Alert).
Support NASW’s initiative to gain representation on NCQA committees.
Seek expert technical assistance and training about how social workers can manage managed care.
Use your voice in other advocacy opportunities on managed care, such as NASW’s letter to the Justice Department about recent managed care corporate consolidation.