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CSWA keeps members apprised of all current national legislation that affects clinical social workers and the need for action to members of Congress. The Past Legislative Alerts listed here allow members to review the history of CSWA action on national bills in Congress that affect clinical social workers and the outcomes of our actions.
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Medicare Cuts Update and Background Information - 8-26-10

Act By Date: 
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Thanks to everyone who sent their letters to CMS on the proposed 5% cut to LCSW service and contacted your members of Congress.  I wanted to give you an update on this important issue, and some background information.
Some good news!  Rep. Lois Capps (D-CA), author of the "Dear Colleague" letter to CMS to prevent the cut to Medicare reimbursement for LCSWs and other mental health providers, had 22 co-signers to her letter.  I hope everyone in her district will thank her for her stellar help.  You can read the letter at the CSWA website under Legislative Topics, PolicyPapersLetters, Page 2 at www.clinicalsocialworkassociation.org .  If your representative signed on, please express your thanks to them as well.

IMPORTANT INFORMATION: Medicare rates do not only affect clinicians who are Medicare providers. They are based on two formulas which are continually updated, the Relative Value Unit (RVU) and the Medical Economic Index (MEI).  Private insurers tend to base their rates in some way on the Medicare rates; any change in Medicare rates is likely to ripple through all insurance plans. 

Some CSWA members didn't think that the Medicare posts sent last week applied to them, because they are not Medicare providers.  I want to clear this up immediately. We are all affected by Medicare reimbursement rates if we are on any insurance panels at all.  So - please respond to legislative alerts on Medicare, even if you do not see Medicare patients and/or have opted-out of Medicare.

A quick reminder - if you want to be a Medicare provider, you need to formally apply.  You can find information on the process at the CMS website.  You are then obligated to see any Medicare patient who contacts you.   All LCSWs are seen as Medicare providers, but will not be reimbursed until they have formally applied.  LCSWs should be thoughtful about whether they want to Medicare providers or not. 

Remaining in the limbo of being a provider, but not having sign on or opted-out, could lead to problems if anyone filed a complaint about your refusing to see a Medicare patient.  The URL for opting in to the Medicare system is http://www.cms.hhs.gov/MedicareProviderSupEnroll/downloads/suppliers.pdf. The URL for opting out of Medicare is http://www.cms.gov/manuals/Downloads/bp102c15.pdf .
Please let me know if you have any questions on this important topic.

Contact Congress about Medicare Cuts to LCSWs - 8-20-10

Act By Date: 
August 22, 2010

CSWA thanks all members, and affiliated society members, who have sent their comments to CMS to prevent the proposed cuts to clinical social work Medicare reimbursement, difficult though the process has been.

I am pleased to report that three members of Congress want to help prevent the cuts as well and need your help immediately.
Reps. Paul D. Tonko (D-NY), Tammy Baldwin (D-WI) and Lois Capps (D-CA) are writing a letter to Donald Berwick, M.D., the CMS Administrator, urging a careful consideration of the harm that the Medical Economic Index (MEI) revision in the proposed rule, the basis for the reimbursement cuts, will have on Medicare mental health services.  We need as many representatives to sign on to the letter as possible, which is the purpose of the "Dear Colleague" letter.

The text of the "Dear Colleague" letter and the letter to CMS ("CSWA - 'Dear Colleague' Letter to CMS - 8-20-10") can be found at the CSWA website under Legislative Topics, Policy Papers Letters, Page 2 (http://www.clinicalsocialworkassociation.org/content/dear-colleague-letter-members-congress-8-20-10) .

Call or email your Representative (D.C. phone numbers and email addresses can be located at http://www.contactingthecongress.org/ by clicking on your state) with the following message:

"I am a member of the Clinical Social Work Association and a constituent. Please sign on to a "Dear Colleague" letter from Representatives Tonko, Baldwin and Capps urging CMS not to harm Medicare mental health services in the 2011 Medicare fee schedule.  Please contact Amy Fisher in Congresswoman Capps' office to sign on."
Time is short; Representatives Tonko, Baldwin and Capps have set a sign-on deadline of 2 p.m., Tuesday, August 24th, so your messages are needed today.
Please let me know when you have sent this message to your representative, and do so as soon as possible.  This action is in addition to sending your comments to CMS. Thanks for your participation in this important campaign.

Laura Groshong, LICSW, Director, Government Relations
Clinical Social Work Association
lwgroshong@clinicalsocialworkassociation.org

CMS Cuts to Medicare Reimbursement - More Information - 8-19-10

Act By Date: 
August 24, 2010

I have received several posts from members who have tried to send comments to CMS and been unsuccessful.  This post offers some suggestions for getting your comments accepted.
1. Though it takes an extra step or two, creating a Word document and uploading it to the website seems to have worked for anyone who tried it.  I would recommend this way of sending comments.

2. A shorter version of the letter to CMS is found below which may solve the problems some people had with getting the whole letter accepted.

3. If you have trouble with the "category", keep trying.  You need to use "Health Care Professional or Association-Other Health Care Professional" which is hard to find as it is only partially visible in the categories list.  You can try typing it in as well; this has worked for some people.

4. You can also send your comments via overnight express mail to the following address (must be postmarked by August 24):

Centers for Medicare and Medicaid Services
Department of Health and Human Services
Dr. Donald Berwick, Administrator 
Attention CMS-1503-P
Mailstop C4-26-05
7500 Security Boulevard
Baltimore, MD  21244

5. DON'T GIVE UP!  If you can't get your comments accepted during the day at the website, try in the evening or the next day.  There are millions of health care providers trying to post comments and the system can get overloaded.

The revised shorter sample letter below is a version of the comments submitted by CSWA and NASW which may be easier to cut and paste (though uploading the letter as a document is probably the best plan.) Please any make adjustments that you want, using the basic information. The more letters that CMS receives from individuals, the more likely CMS will be to consider changing this proposed rule. Your comments must be cut and pasted into the Federal Register (or sent by Express Mail) no later than 11:59 PM EST, August 24, 2010, to be considered.

Directions for filing comments online:

(Go to the Federal Register website at http://www.regulations.gov/search/Regs/home.html#documentDetail?R=0900006480b182c9):

  1. You can read the rule if you wish by clicking on the "pdf" or "text" icons on the lower left side (N.B.: This rule is included with many other proposed rules and is 671 pages long. The relevant pages on changes to payment for LCSW services may be found on pp. 6-7 and p. 194.)
  2. Click on "submit comment" at the top right of the page (it is small and hard to see).
  3. The comment screen allows you to type in your comment, cut and paste, and/or upload your comments.
  4. There are several "Health Care Professional" categories, among many others, in the box for categories. The one for clinical social workers is the seventh one down, "Health Care Professional/Association - Other Health Care Professional."  Be sure to add "Clinical Social Work Association" to the box marked "Organization Name".
The revised sample letter follows:
SAMPLE CMS COMMENT LETTER (Revised)
(Must be sent by August 24, 2010 to be read!)

Donald Berwick, MD

Administrator

Centers for Medicare & Medicaid Services

Department of Health and Human Services

P.O. Box 8013

Baltimore, MD 21244-8013

RE:  Comments in opposition to "rebasing" of payment rates for mental health services as proposed in CMS-1503-P

Dear Dr. Berwick: 

Thank you for the opportunity to comment on proposed rule CMS-1503-P, Medicare Payment Policies under the Physician Fee Schedule, 75 FR 40040. This proposed rule addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice and the relative value of services.

I am a licensed clinical social worker and a member of the Clinical Social Work Association. I would like to call your attention to serious problems in two aspects of the rebasing of payment rates.

First, I am concerned that, at the most basic level, the rule penalizes health care work that is not technology-intensive, such as psychotherapy, when in fact it is the technology-intensive health expenses that are actually driving up costs. Thus the rebasing, as currently structured, is both inequitable and counter-productive for clinical social workers.

Second, I take strong exception to the reduction of payment rates for mental health services proposed in the rebasing.  I believe that such payment cuts are likely to become a tipping point causing large numbers of professionals to "opt-out" of Medicare, rather than to continue to participate as providers at payment rates that cannot sustain their practices.  This is particularly true for clinical social workers, who already receive significantly lower payments than psychiatrists and psychologists for psychotherapy diagnosis and treatment services, and who provide about 40-50% of all mental health treatment in the country. (SAMHSA, 2004)

Should Medicare panels for mental health services be severely depleted by opt-outs, many beneficiaries will be deprived of much-needed mental health services.  The importance of access to the psychotherapy services provided by LCSWs for depression as an example is supported by the Surgeon General's Report on Mental Health (1999) which documented that lack of access to mental health treatment increased medical utilization. Please note that depression costs the United States $30 to $50 billion in lost productivity and direct medical costs each year:  individuals who are depressed miss work because of illness at twice the rate of the general population, and health service costs are 50 to 100 percent greater for depressed patients than for comparable patients without depression (SAMHSA, 2006). The Veterans Administration and Department of Defense, among others, have found that a combination of medication and psychotherapy were by far the most successful treatment for depression (Journal of Clinical Psychiatry, 2001).

Finally, it is important to recognize that cuts in Medicare payment rates to mental health professionals will lead to reduced rates by private insurance, which in turn is likely to result in further erosion of already distressed insurance panels. The unintended consequence of the policy, then, could be a substantial undermining of the intended advancements of the recent federal behavioral health parity law that seeks to expand coverage for behavioral health care.

Please reconsider the proposed rebasing and its assumptions, which result in a cut of 5% for psychotherapy services provided by clinical social workers and other mental health professionals.

Thank you for your consideration of my comments.


Sincerely,

[Your Name, License, and Address]

As always, please let me know when you have sent these comments.  I appreciate your making sure that our voices are heard through this frustrating process.  Opposing this proposed CMS rule is a crucial issue for the economic well-being of LCSWs. CSWA encourages all members to send comments.  Thanks in advance for your help.

Send Comments to CMS - 8-18-10

Act By Date: 
August 24, 2010

You have probably all read the information sent yesterday regarding the proposed 5% cut to Medicare rates for LCSWs, and the letter that CSWA and NASW sent to CMS regarding this proposed rule. Now it is time for all CSWA members to help oppose this cut.
This is more complicated than most requests for CSWA member action, but also more crucial.

The sample letter below is a version of the comments submitted by CSWA and NASW. Please any make adjustments that you want, using the basic information. The more letters that CMS receives from individuals, the more likely CMS will be to consider changing this proposed rule. Your comments must be cut and pasted into the Federal Register by no later than 11:59 PM EST, August 24, 2010, to be considered.

Directions for filing comments:

(Go to the Federal Register website at http://www.regulations.gov/search/Regs/home.html#documentDetail?R=0900006480b182c9):

  1. You can read the rule if you wish by clicking on the "pdf" or "text" icons on the lower left side (N.B.: This rule is included with many other proposed rules and is 671 pages long. The relevant pages on changes to payment for LCSW services may be found on pp. 6-7 and p. 194.)
  2. Click on "submit comment" at the top right of the page (it is small and hard to see).
  3. The comment screen allows you to type in your comment, cut and paste, and/or upload your comments.
  4. There are several "Health Care Professional" categories, among many others, in the box for categories. The one for clinical social workers is the seventh one down, "Health Care Professional/Association - Other Health Care Professional."  Be sure to add "Clinical Social Work Association" to the box marked "Organization Name".
The sample letter follows:
SAMPLE CMS COMMENT LETTER
(Must be sent by August 24, 2010 to be read!)

Donald Berwick, MD
Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1503-P
P.O. Box 8013
Baltimore, MD 21244-8013
RE:  Comments in opposition to "rebasing" of payment rates for mental health services as proposed in CMS-1503-P (Medicare Payment Policies Under the Physician Fee Schedule, 75 FR 40040)
Dear Dr. Berwick: 

Thank you for the opportunity to comment on proposed rule CMS-1503-P, Medicare Payment Policies under the Physician Fee Schedule, 75 FR 40040. This proposed rule addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice and the relative value of services.

I am a licensed clinical social worker and a member of the Clinical Social Work Association. I would like to call your attention to serious problems in two aspects of the rebasing of payment rates.
First, I am concerned that, at the most basic level, the rule penalizes health care work that is not technology-intensive, such as psychotherapy, when in fact it is the technology-intensive health expenses that are actually driving up costs. Thus the rebasing, as currently structured, is both inequitable and counter-productive for clinical social workers.
Second, I take strong exception to the reduction of payment rates for mental health services proposed in the rebasing.  I believe that such payment cuts are likely to become a tipping point causing large numbers of professionals to "opt-out" of Medicare, rather than to continue to participate as providers at payment rates that cannot sustain their practices.  This is particularly true for clinical social workers, who already receive significantly lower payments than psychiatrists and psychologists for psychotherapy diagnosis and treatment services, and who provide about 40-50% of all mental health treatment in the country. (Substance Abuse and Mental Health Services Administration, 2004)
Should Medicare panels for mental health services be severely depleted by opt-outs, many beneficiaries will be deprived of much-needed mental health services.  Depression provides just one example of many demonstrating the potentially devastating impact of the proposed rebasing rule. The importance of access to the psychotherapy services provided by LCSWs for depression is detailed below:

  • Depression costs the United States $30 to $50 billion in lost productivity and direct medical costs each year:  individuals who are depressed miss work because of illness at twice the rate of the general population, and health service costs are 50 to 100 percent greater for depressed patients than for comparable patients without depression.

  • The increased costs are not caused by specialty mental health care, but by higher medical utilization. Access to mental health treatment, including the psychotherapy services provided by LCSWs for depression, has been shown to decrease medical utilization. (Mental Health: A Report of the Surgeon General, Chapter 6, 1999)
  • The most effective evidence-based treatment for moderate to severe depression is a combination of pharmacotherapy and psychotherapy, according to the definitive 2000 study by the Agency for Health Care Policy and Research, the Veterans Health Administration/Department of Defense, and the American Psychiatric Association. Any policy such as the proposed rebasing rule, which limits access to psychotherapy, is likely to have a negative impact on treatment success for depression. (Greden J., "The Burden of Recurrent Depression: Causes, Consequences, and Future Prospects," Journal of Clinical Psychiatry, 2001)

Finally, it is important to recognize that cuts in Medicare payment rates to mental health professionals will lead to reduced rates by private insurance, which in turn is likely to result in further erosion of already distressed insurance panels. The unintended consequence of the policy, then, could be a substantial undermining of the intended advancements of the recent federal behavioral health parity law that seeks to expand coverage for behavioral health care.

I urge you to reconsider the proposed rebasing and its assumptions, which result in a cut of 5% for psychotherapy services provided by clinical social workers and other mental health professionals. It is crucial that Medicare rates ensure access to quality mental health services if the emotional well-being of beneficiaries is to be sustained.
Thank you for your consideration of my comments.
Sincerely,
[Your Name, License, and Address]

As always, please let me know when you have sent these comments.  Opposing this proposed CMS rule is a crucial issue for the economic well-being of LCSWs. CSWA encourages all members to send comments.  Thanks in advance for your help.

Joint Comments on 'Rebasing' to CMS - 8-17-10

Act By Date: 
None

CSWA is working with the National Association of Social Workers (NASW) on a new threat to mental health funding has emerged in the form of a process called "re-basing."

A joint letter from CSWA and NASW to Director Berwick of the Centers for Medicare and Medicaid Services was posted in the Federal Register yesterday, expressing our concerns. This letter may be accessed at the CSWA website (http://www.clinicalsocialworkassociation.org/policy-paper-letters?page=2) as "CSWA-NASW Letter to CMS - 8-16-10" or under the Legislative Topics tab "Policy Papers Letters".

In short, this letter says that the 5% cut in reimbursement to Medicare psychotherapy services provided by LCSWs and psychologists would:

· Limit access to mental health services through Medicare;

 

· Place an economic burden on 'low-tech' psychotherapy services, when 'high-tech' services which are driving up health care costs;

 

· Potentially cause many LCSWs, who provide the majority of psychotherapy services, to opt-out of the Medicare system because of economic hardship; and

 

· Have a domino effect on reimbursement rates in already stressed private insurance plans.

This post is being sent to keep you informed on the work that CSWA is doing on behalf of all licensed clinical social workers. No action is required at this time. A Legislative Alert will be sent shortly to inform CSWA members on how to best support this effort.

FMAP Funding Promising - 8-4-10

Act By Date: 
None




 

A procedural vote on HR 1586 passed in the Senate today, 61-38, with bipartisan support.  This clears the way for passing the bill itself, which will preserve the Medicaid funding on which many states are depending to maintain mental health programs.  Many thanks to all CSWA members who called their Senators on very short notice.

It is still not too late to make your voice heard if you have not contacted your Senators.  Call 888-340-6521, x.1., followed by your zipcode at the prompt.

Please leave the following message with the staff person who answers your calls: "I am a member of the Clinical Social Work Association [if you are] and a constituent.  Please ask the Senator to vote in favor of HR 1586 to extend Medicaid funding."

As always, please let me know when you have left your messages.

HR 1586 will be sent to the House upon passage in the Senate where it is expected to pass easily next week.

Help FMAP Funding Pass Senate!

Act By Date: 
August 2, 2010
      CSWA asks for your help ASAP, by calling your Senators to extend current Medicaid funding in HR 1586.  The vote on extended FMAP funding was scheduled this morning and will occur at 5:45 EDT (2:45 PDT), so time is short. 

       The provision that will be voted on today is an amendment to HR 1586 that would provide for gradually scaled-back assistance to state Medicaid programs from Jan. 1, 2011 to June 30, 2011. The amendment is fully offset by spending reductions in other programs and will not add to the federal deficit.

        To contact your senators, call 888-340-6521, x. 1, followed by your zip code. This special Hotline is generously being shared with CSWA members by FamiliesUSA.

       Please leave the following message with the staff person who answers: "I am a member of the Clinical Social Work Association and a constituent.  Please ask the Senator to support passage of HR 1586 for extended Medicaid funding."
      Thanks for your help.  As always, please let me know when you have contacted your Senators.

Comments on DSM-V to American Psychiatric Association

Act By Date: 
None

These comments were based on feedback from CSWA members and the CSWA Government Relations Committee.  To read the letter to APA, go to "Legislative Topics" and click on "Policy Letters."

Medicare Changes

Act By Date: 
Immediate

Medicare has had some changes in provider enrollment and reimbursement for LCSWs since January 1 which CWSA would like to bring to your attention.

1.    Medicare LCSW Providers - In spite of the fact that LCSWs are ‘automatically’ Medicare providers, we must complete a Medicare provider application to be reimbursable.  This application has now changed and must be COMPLETED and RESUBMITTED by any LCSW who wants to continue being a Medicare provider.   The new system is called PECOS for Medicare “Provider Enrollment, Chain and Ownership System.”  Anyone who has not renewed their registration with CMS as a provider since 2003 must send in a new complete PECOS application by December 31, 2010.  Applications can be accessed at http://www.cms.hhs.gov/MedicareProviderSupEnroll/02_EnrollmentApplicatio...

2.    Co-Pay Changes – The Medicare Improvements for Patients and Providers Act of 2008 included a phased-in equalization of mental health co-pays and medical co-pays, which began on January 1, 2010.  LCSW clients now have to pay a 45% co-pay, which will become a 40% co-pay in 2011, and so on, until 2014 when the co-pay will be the same 20% as medical services.  CMS will now pay 55% of the reimbursable LCSW claims, which will gradually increase to 80% by 2014.   

3.    “Telehealth” Services - Medicare providers may be reimbursed for LCSW telephone services only if they occur 1) in a rural health professional shortage area or in a county outside of a Metropolitan Statistical Area; and 2) are offered from a rural health or mental health clinic, a hospital, the LCSW’s office, or a skilled nursing facility.  For more information, see http://www.cms.hhs.gov/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf

4.    Reimbursement Reduction – There will be reductions in reimbursement for “practice expenses” for all Medicare providers totaling as much as 7% by 2013. Practice expenses include direct expenses such as clinical labor, supplies, and equipment.  The 2010 decrease for LCSWs is 1%.  In some regions, Medicare administrators have cut LCSW reimbursement rates by as much as $5 due to this across-the-board reduction.

5.    Hold on Medicare Claims – Because the 21% cut to Medicare providers due to the Sustainable Growth Rate (SGR) formula could not be removed by March 1, a hold was placed on all Medicare claims for the first two weeks of March.  Congress is working on getting the cut rescinded by March 14 and pay claims submitted in the first two weeks of March without the 21% cut, retroactively.

Please let me know if you have any questions on the Medicare changes.

Medicare Cuts

Act By Date: 
None

As you know from previous alerts, in spite of furious last minute negotiations, the reimbursement cuts to LCSWs and other Medicare providers are scheduled to go into effect on Monday, March 1, 2010.

Congress, the Centers for Medicare and Medicaid Services (CMS), and provider groups, including CSWA, are working hard to again delay the proposed 21% cut, which has been delayed for the past 13 years and two months by a patchwork series of bills.   These cuts have been temporarily revoked for time periods ranging from a year to a few months, with the last delay from January 1 to February 28 of 2010.

The cuts are based on the Sustainable Growth Rate, or SGR, which was created to keep Medicare spending under control.  The unintended consequence has been that reimbursement rates for physicians and clinicians, including LCSWs, have been the ongoing target of proposed reimbursement cuts.

It appears that for the first time the SGR cuts may actually go into effect, at least until they are retroactively removed.  Partly in the hope that this can be accomplished quickly, CMS has instructed its administrators to hold claims containing services paid under the Medicare for the first 10 business days of March. The holding of these claims will only affect claims with dates of service March 1, 2010, and forward.

As hard as this cut may be, this hold should have a minimum impact on provider cash flow, if a new delay can be passed, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.

CSWA will continue to work hard on reversing this cut, a major financial blow for members who are Medicare providers, and keep members up to date as much as possible on the progress in again delaying the Medicare reimbursement cut, hopefully retroactively.  We know that this is a difficult situation for members which we are working closely with other clinical groups, Congress, and CMS, to alleviate.

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