Clinical Social Work Practice Alert

Revised 2008 Medicare Fee Schedule for Clinical Social Workers

Mirean Coleman, LICSW, CT
Senior Policy Associate for Clinical Social Workers
September 2008

Beginning July 1, 2008, clinical social workers who are Medicare providers received an increase in reimbursement. This increase is the result of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008 (also known as HR 6331, public law number 110­-275).
 
The reimbursement changes for clinical social workers are as follows:

• On July 1, 2008, clinical social workers and other Medicare providers were scheduled to receive a 10.6 percent reimbursement decrease under the Sustainable Growth Rate (SGR) formula. The SGR formula determines payments for outpatient Medicare services. MIPPA, however, prevented this deduction.
• Instead, reimbursement was restored to the January 1, 2008 payment rate, which included a 0.5 percent fee increase above 2007 rates. Medicare's contractors are automatically reprocessing any claims paid at the lower rate to clinical social workers and other Medicare providers.
• Under MIPPA, clinical social workers will receive a five percent increase effective July 1, 2008 through December 31, 2009. This increase restores a 2007 Medicare fee reduction for clinical social workers, attributable to the Centers for Medicare and Medicaid Services' (CMS) "Five Year Review." The CMS review increased payments to Current Procedural Terminology Evaluation and Management Codes. CMS has not yet issued provisions on how the five percent increase will be implemented.
• Beginning January 1, 2009, MIPPA increases clinical social work Medicare payments by 1.1 percent.
• The law extends the Medicare Physician Quality Reporting Initiative and provides a two percent incentive payment for clinical social workers who use quality measures in 2009 and 2010.
• MIPPA eliminates copayments for Medicare outpatient mental health services. Under current law, Medicare requires a 50 percent copay for outpatient mental health services, as compared to 20 percent for most other health services.

MIPPA phases out the 50 percent copayment beginning in 2010 and expanding to 2014. At a later date, CMS plans to issue provisions on the termination of mental health copayments.

Overall, Medicare payments for clinical social workers are increasing. Total increases for 2008 include:

• January 1, 2008:  Clinical social workers received a 0.5 percent SGR increase. They also received a 1.5 percent bonus incentive payment when using quality measures while performing treatment services.
• July 1, 2008:  Clinical social workers received a five percent restoration rate. This rate is retroactive to July 1, 2008, and is effective through December 31, 2009.

Future Medicare payments also look promising. Beginning January 1, 2009, clinical social workers are scheduled to receive the following:

• A 1.1 percent Medicare payment increase
• A two percent incentive payment when using quality measures

As CMS's implementation provisions on the above changes become available, NASW will provide them to members. The Association successfully lobbied for the passage of MIPPA and will continue lobbying to retain the five percent restoration increase scheduled to terminate on December 31, 2009.

Resources
Medicare Improvements for Patients and Providers Act (MIPPA), 110th U.S.C. (2008).  Available online at http://www.opencongress.org/bill/110-h6331/show  

National Association of Social Workers (NASW). (2007). 2007 Medicare Payment for Clinical Social Workers [Practice Update].  Available online at:
http://www.socialworkers.org/practice/clinical/2007/csw020507.asp