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Mr. McCONNELL. I say to my friend from Connecticut, what our bill is all about is really an effort to call on the President to change this policy. We should not have to offer the bill that we are offering. We are offering it, but we should not have to offer it because

[Page: S4032]  GPO's PDF

   I say to my friend from Connecticut, does he not agree, this is what this is about, to give the people, on whose behalf we are fighting this war, a chance to participate themselves?

   Mr. LIEBERMAN. The Senator from Kentucky is absolutely right. That is the purpose. The purpose is to push this option, this act which will support our objectives, objectives for which we are spending billions of dollars and already risking American lives, to push us closer to achieving those objectives and also, if I may add, to hopefully force some discussion of this option among our NATO allies.

   One of the arguments we hear about why this is not being considered by the administration is that there is opposition to it among our NATO allies. But we also hear there is opposition among our NATO allies, which I understand at this point, to the introduction of NATO ground forces. If there is opposition in NATO, as there is in Congress and in the administration, as the Senator has said, to the introduction of ground forces, including Americans, then, again, isn't it both wise militarily and powerful morally for us to as soon as possible be helping the fighters on the ground, the KLA?

   Mr. McCONNELL. In fact, I say to my friend from Connecticut, isn't it reasonable to argue that the only reason these refugees have been created is because there was no effective fighting force on the ground inside Kosovo? No way to defend your home, no way to defend your family, and what do you do when you are afraid? You run. That is what has created the refugee problem, which is presumably what our European allies care about most--the spillover into their countries.

   The only effective way, the Senator from Connecticut and I are saying, to prevent a further accumulation of refugees is for there to be some fighting force on the ground in Kosovo adequately trained and equipped in order to fight this battle where it counts.

   Mr. LIEBERMAN. The Senator from Kentucky is right, and there is a painful irony here. He is absolutely right both about our objectives on the ground and our objectives to maintain stability in the region which is being destabilized now by these large refugee flows.

   The victories, if one can call them that, that the tragic, brutal, barbaric victories that Milosevic's forces have had over the Kosovars are hollow. They are barbaric because this was an armed force fighting against unarmed, undefended people. It is a question that will hang in the air--and some later time we will come back to it--what might have been different if, in fact, the KLA had been better armed at the outset of this a month or two or three ago, because I think that might have deterred, certainly delayed the massive exodus and slaughter that has been carried out against this undefended indigenous population.

   Mr. McCONNELL. There is no question the Senator from Connecticut is correct. The good news is, it is not too late. The KLA is bigger and more committed today than it was 2 months ago when this policy also made sense.

   Mr. President, I encourage cosponsorship on behalf of our colleagues on both sides of the aisle.

   Mr. LIEBERMAN. I thank my friend from Kentucky for his leadership. We intend to pursue this and urge our colleagues to consider it as quickly as possible so that we may do something concrete and tangible that really can alter the balance of power and the balance of morality and the balance militarily on the ground in Kosovo.

   By Ms. MIKULSKI (for herself, Mrs. MURRAY, Mr. INOUYE, Mr. WYDEN, Mr. JOHNSON, Mr. HOLLINGS, Mr. REID, and Mr. BINGAMAN):

   S. 847. A bill to amend title XVIII of the Social Security Act to exclude clinical social worker services from coverage under the medicare skilled nursing facility prospective payment system; to the Committee on Finance.

   MEDICARE SOCIAL WORK EQUITY ACT OF 1999

   Ms. MIKULSKI. Mr. President, I rise today to introduce the Medicare Social Work Equity Act of 1999. I am proud to sponsor this legislation which will amend section 4432 in the Balanced Budget Act of 1997 which prevents social workers from directly billing Medicare for mental health services provided in skilled nursing facilities (SNF's). This bill will also ensure that clinical social workers (CSW's) can receive Medicare reimbursement for mental health services they provide in skilled nursing facilities. I am honored to be joined by my good friends Senators MURRAY, INOUYE, HOLLINGS, WYDEN, JOHNSON, REID, and BINGAMAN who care equally about correcting these inequities for social workers and about ensuring quality mental health services for nursing home residents.

   The Balanced Budget Act of 1997 (BBA) changed the payment method for skilled nursing facility care. Before BBA, reimbursement was made after services had been delivered for the reasonable costs incurred. However this ``cost-based system'' was blamed for inordinate growth in Medicare spending at skilled nursing facilities.

   The Balanced Budget Act of 1997 phased in a prospective payment system for skilled nursing facilities that was fully implemented on January 1, 1999, for Medicare part A services. Payments for part B services for skilled nursing facility residents are to be consolidated. This means that the provider of the services must bill the facility instead of directly billing Medicare. The consolidated billing provision has been delayed indefinitely by the Health Care Financing Administration (HCFA) while it addresses Year 2000 (Y2K) compliance issues.

   However, Congress was careful to not include psychologists and psychiatrists in this consolidated billing provision. Social workers were included, I think by mistake. Clinical social workers are the primary providers of mental health services to residents of nursing homes, particularly in underserved urban and rural areas. CSW's are also the most

   cost effective mental health providers.

   This legislation is important for three reasons: First, I am concerned that section 4432 inadvertently reduces mental health services to nursing home residents. Second, I believe that the consolidated billing requirement will result in a shift from using social workers to other mental health professionals who are reimbursed at a higher cost to Medicare. Finally, I am concerned that clinical social workers will lose their jobs in nursing homes or will be inadequately reimbursed.

   In addition, this bill ensures that clinical social workers can receive Medicare reimbursement for mental health services they provide in skilled nursing facilities. An April 1998, HCFA rule would have effectively eliminated Medicare reimbursement for clinical social worker services provided to residents of SNF's, whether or not their stay was being paid by Medicare, Medicaid, or a private payer. It would have deemed all mental health services provided to nursing home residents ``required'' services, not distinguishing between the mental health diagnosis and treatment services provided by CSW's and the required medically-related social services provided at the SNF.

   Facilities would likely bring in a psychiatrist or psychologist (if available) because services provided by them could still be billed separately This would affect seniors in many rural and underserved areas where CSW's are often the only available mental health provider and have developed relationships over time with these SNF patients. HCFA delayed this rule for two years. However, clarification is needed in the law to ensure that CSW's can be reimbursed by Medicare for the mental health services they provide to inpatients in SNF's. This bill makes that necessary change.

   I like this bill because it will correct inequities for America's social workers, it will assure quality of care for nursing home residents, and will assure cost efficiency for Medicare. This bill is strongly supported by the National Association of Social Workers, Clinical Social Work Federation, American Psychological Association, American Group Psychotherapy Association, Bazelon Center for Mental Health Law, National Mental Health Association, National Council for Community Behavioral Health Care, National Association of Protection and Advocacy Systems, Anxiety Disorders Association of America, and the Mental Health and Aging Network of the American Society on Aging. I now look forward to the Senate's support of this important legislation.

[Page: S4033]  GPO's PDF

   By Mrs. FEINSTEIN:

   S. 848. A bill to designate a portion of the Otay Mountain region of California as wilderness.

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