LEGISLATIVE ALERT

Contact Your Members of Congress and Urge Them to Cosponsor a Measure That Would Ensure the Continued Provision of Mental Health Services by Clinical Social Workers in Skilled Nursing Facilities

Recent legislation has posed a threat for clinical social workers and their ability to provide services in skilled nursing facilities (SNFs). With social workers being the largest providers of mental health services in the United States and the only professionally licensed provider of mental health services in many rural counties, this could have serious adverse affects on the residents of skilled nursing facilities.

What is the problem?

The problem begins with the Balanced Budget Act of 1997 (BBA 97) that was designed to reduce the budget deficit and included Medicare savings of $115 billion over Fiscal Years 1998-2002. One of the ways the BBA 97 achieves savings is by establishing a new payment methodology for skilled nursing facilities, including:

Prospective payment system (PPS) – As of January 1999, social workers can no longer bill Medicare for services provided to patients under Part A stays in skilled nursing facilities. Under PPS, skilled nursing facilities receive a lump sum payment for patients, including clinical social work services. Because the daily PPS amounts SNFs receive are low, chances are they will not contract with clinical social workers to provide these services. Psychologists and psychiatrists are excluded from PPS and thus can continue to see patients in Part A settings and bill Medicare directly.
Consolidated Billing (CB) –Under CB, clinical social workers will be required to submit bills for services to the SNF which in turn will bill Medicare. Currently, clinical social workers can continue to bill Medicare for Part B services until CB is implemented which has been postponed until the Health Care Financing Administration (HCFA) can resolve its Y2K problems.
Billing Authority for Clinical Social Workers – Because of the confusion between clinical social work and social services, many believe that the social services provided "in-house" at the SNF is the same as the service provided by clinical social workers who are providing mental health diagnosis and treatment to residents. In order to eliminate the confusion, the provision in the current law that has led the Health Care Financing Administration (HCFA) to interpret social services and clinical social worker services as the same service, will be deleted. [Resulted from the Omnibus Budget Reconciliation Act of 1989, not BBA 97]

The lump sum payments under PPS and the shift in billing responsibility to SNFs under CB could potentially create a burden for SNFs that ultimately will deter them from contracting with clinical social workers for mental health services. Residents of skilled nursing facilities could stand to lose their mental health services if the Medicare reimbursement requirements prove to be too cumbersome for SNFs to deal with. Additionally, social workers bill Medicare at 75% of what clinical psychologists bill, thus proving more costly if SNFs contract with psychologists rather than clinical social workers due to convenience of not having to bill Medicare for social work services.

Where do we currently stand?

Identical bills have been introduced in both the House of Representatives and the Senate to address this issue. Rep. Pete Stark (D-CA) and Jim Leach (R-IA) introduced H.R. 655 in the House of Representatives and Senator Barbara Mikulski intoduced S. 847 in the Senate. These bills are each called the Medicare Social Work Equity Act of 1999. Much work is needed for successful passage of H.R. 655/S.847.

The Medicare Social Work Equity Act essentially protects and reinstates clinical social worker’s ability to bill Medicare directly for Part A and Part B services to patients in skilled nursing facilities (SNFs). More specifically, the bill excludes clinical social worker services from Prospective Payment System and consolidated billing. It also provides a distinction between clinical social work services and social services in SNFs.

It is imperative that social workers contact and urge their members of Congress to support H.R. 655 or S.847. The fact sheet below provides some excellent points about social workers in SNFs that many people, especially members of Congress, don’t know.

Need help contacting your member of congress?

Check your local phone book for government listings (probably blue pages)
Call information (411)
Call United States Capitol switchboard at (202) 224-3121 (Ask who your Senators are [two per state] and who your Representative is [one per Congressional District]

FOR MORE INFORMATION Call The NASW Medicare Social Work Equity Act Hotline At 1-800-638-8799 X 547

Contact Wendy Royalty, Government Relations Associate At 1-800-638-8799 X 237

Facts about clinical social workers in nursing homes

Nearly 10% of clinically trained social workers specialize in working with clients in a nursing home setting.
Less that 1% of Clinical Psychologists practice in a nursing home setting.
Medicare consumers have had the opportunity to choose clinical social workers for their mental health services in nursing homes since 1989.
Clinical Social Workers bill Medicare for mental health services in skilled nursing facilities at 75% of what Clinical Psychologists bill.
Skilled nursing facilities are required to provide social services.
Social services provided in skilled nursing facilities do not necessarily include mental health services.
Social services in a skilled nursing facility include case management, admissions, community resource identification, and discharge planning.
Social services in a nursing home may or may not be provided by a professional social worker.
Nursing homes are required by HCFA to provide mental health services.

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SAMPLE LETTER

Please add your own personal story or personalize the message.

Date

The Honorable [insert name]
U.S. House of Representatives (or U.S. Senate)
Washington, DC 20515 (20510)

Dear Representative (or Senator) [insert name]:

I am a professional social worker, and I am writing to ask your help to correct a serious problem that will adversely affect the provision of mental health services to Medicare beneficiaries in skilled-nursing facilities (SNFs) and the clinical social workers that provide those services. I urge you to support and cosponsor the Medicare Social Work Equity Act of 1999 (H.R. 655), which would exclude clinical social workers from Prospective Payment System (PPS) and Consolidated Billing (CB) that resulted from the Balanced Budget Act of 1997 (BBA 97).

Currently, clinical social workers that provide mental health services to residents in SNFs can bill Medicare Part B directly, but only until the Health Care Financing Administration (HCFA) can resolve its Y2K problem. When the new consolidated billing requirement goes into effect, clinical social workers will be required to bill the SNF, which in turn will bill Medicare and then reimburse the social worker. Clinical psychologists and psychiatrists, however, are specifically excluded from the consolidated billing requirement.

Clinical social workers are one of three categories of mental health professionals that are recognized as reimbursable providers of mental health services under Medicare. Clinical social workers are the primary providers of mental health services to residents of skilled nursing facilities, particularly in underserved urban and rural areas. Clinical social workers are also the most cost-effective mental health providers billing at 75 percent of what psychologists and psychiatrists bill.

Ultimately, the new Medicare billing provisions under BBA 97 will result in:

Reduced mental health services to skilled nursing facility residents. This will be a travesty to a population that is already seriously underserved. Studies clearly show that almost 90 percent of skilled nursing facility residents suffer from some form of mental disorder and that most residents do not currently receive mental health services from a licensed provider. Where residents have received mental health services, studies demonstrate its effectiveness in terms of a higher level of functioning, reduced need for medications and hospitalization, and increased opportunities to return to the community.
Higher costs to Medicare. The new consolidated billing requirement will result in a greater shift from using social workers to other mental health professionals who are reimbursed at a higher cost to Medicare. It is anticipated that there would be increased costs to Medicare with the use of more psychotropic medications, and nursing home residents who are left untreated will require longer, more expensive hospital stays.
Loss of jobs or lower reimbursement for clinical social workers providing mental health services to skilled nursing facility residents. My employer has already told me that I may lose my job. The unnecessary and cumbersome administrative tasks under consolidated billing will create a disincentive for SNFs to contract with social workers because other mental health providers, like psychologists, can bill Medicare directly.

We do not believe that Congress intentionally created this problem. The Medicare Social Work Equity Act of 1999 addresses essential issues of fairness for social workers, quality of care for skilled nursing facility residents, and cost efficiency for Medicare. We hope we can count on your support for this important legislation.

Sincerely yours,

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The National Association of Social Workers is the largest organization of professional social workers with 155,000 members. It promotes, develops and protects the practice of social work and social workers. NASW also seeks to enhance the well-being of individuals, families, and communities through its work and through its advocacy. A professional social worker has a degree in social work and meets state legal requirements. Professional social workers practice in many settings including family service agencies, child welfare, community mental health centers, private practice, schools, hospitals, employee assistance programs, and public and private agencies. Professional social workers are the nation's largest group of mental health services providers.

The National Association of Social Workers (NASW) is located at 750 First Street, NE, Suite 700, Washington DC 20002-4241. Telephone is 202/408-8600, FAX 202/336-8311 and TTD 202/408-8396.