NASW’s Response to Medicare’s Proposed 14 Percent Fee Reduction for Clinical Social Workers who are Medicare Providers

August 18, 2006

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention CMS-1512-PN
Mail Stop C4-26-05
7500 Security Boulevard
Baltimore, MD 21244-1850

RE: Proposed Notice CMS-1512-PN

Dear Sir or Madam:

On behalf of 150,000 members of the National Association of Social Workers (NASW) and the 40,000 clinical social workers who are Medicare providers, I am submitting comments to you in response to the proposed notice, “Five-Year Review of Work Relative Value Units Under the Physician Fee Schedule and Proposed Changes to the Practice Expense Methodology.”  This proposed notice appeared in the Federal Register dated June 29, 2006.

The proposed notice reveals a substantial increase for evaluation and management services which was reported as compensation for the time and effort that physicians spend with patients in evaluating their condition, advising patients, and assisting them in managing their care.  The increase is a great recognition of the value of physicians.  Unfortunately, clinical social workers and many other non-physician practitioners are unable to use the evaluation and management codes to report these services. Although clinical social workers evaluate the mental health condition of Medicare patients and advise and assist them in managing their care, they are not included in this increase. 

The Medicare increase should also include clinical social workers and other licensed professional health care providers who work just as hard as physicians to provide quality care for Medicare beneficiaries.  NASW requests that CMS fairly compensate all Medicare providers with increases or rescind CMS’s proposal to increase the evaluation and management services until all Medicare providers can receive fair and adequate increases.  To not do so creates a discriminatory payment system that devalues the work of non-physician Medicare providers such as clinical social workers. 

The proposed notice also revealed a 10% cut in RVUs across the board for all Medicare providers to pay for the increases in the evaluation and management services.  Doing so will create a 7% reduction in work value for clinical social workers beginning January 2007.  This is a significant reduction in reimbursement for clinical social workers who are already CMS’s lowest paid mental health providers.  NASW urges CMS not to subject clinical social workers to the burden of paying for the reimbursement increases for evaluation and management services.  If CMS is not budgeted to pay for increases of these services, we request that CMS delay the proposal to do so until the agency is financially able to fund the increases and develop an equitable payment system.

Also proposed is an additional 7% cut in practice expense for clinical social workers by 2010.  The proposed “bottom up” formula that CMS is recommending to calculate practice expense has a negative impact on practice expense values for clinical social workers. We request that you adopt a different formula that would achieve your goal for consistency but not penalize Medicare providers such as clinical social workers. 

A total reimbursement reduction of 14% would be devastating for clinical social workers, a profession that provides a large volume of mental health services to Medicare beneficiaries. The NASW Center for Workforce Studies established that there is currently a shortage of social workers in the gerontology field that is predicted to grow significantly. We are enclosing a copy of the study for your use. NASW is already receiving reports from members who plan to terminate their Medicare practices should the proposed notice be approved because they would be unable to continue to provide quality services to Medicare beneficiaries due the proposed reduced rate of reimbursement. A national shortage and withdrawal of clinical social work Medicare providers would definitely limit access to care for Medicare beneficiaries who seek psychotherapy services from clinical social workers. 

In summary, NASW requests CMS to:

• retain the work values of clinical social workers effective January 1, 2007;

• withdraw the proposed increase in evaluation and management services until CMS is able to develop an equitable payment system for all Medicare providers; and

• continue to explore practice expense formulas and change the proposed “bottom up” practice expense formula to one in which no Medicare provider loses.                                                                                                                                                  

Thank you for providing NASW the opportunity to submit comments on behalf of our membership and clinical social workers who are Medicare providers.   If you have any questions, please do not hesitate to contact me at 202-336-8200.

Sincerely,

Elizabeth J. Clark, PhD, ACSW, MPH
Executive Director