Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY
[This document clarifies the ways that LCSWs work with Medicare beneficiaries. ]
Medicare opt-in and opt-out status for LCSWs has been a source of confusion. Previously, CSWA had been informed that all LCSWs needed to opt-in or opt-out of Medicare. This was an error. There is no requirement to opt-in as a Medicare provider if an LCSW chooses not to work with Medicare beneficiaries. LCSWS must opt-in if they wish to be paid through Medicare.
LCSWs must, however, opt-out if they want to work with Medicare beneficiaries who pay the LCSW privately. This requires a signed contract with each beneficiary the LCSW treats that confirms neither the LCSW or the beneficiary will submit any claims to Medicare for the psychotherapy services that provided. CSWA has a template which can be used for this purpose and an opt-out letter as well which should both be sent to your regional Medicare Administrative Center (MAC) if you choose to opt-out. A beneficiary may have a private contract with an LCSW while maintaining Medicare coverage with other providers if they so choose.
A good Medicare summary document can be found at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1311.pdf
CSWA has templates for private contracts with Medicare enrollees and to opt-out of Medicare in the Members Only section of the CSWA website (www.clinicalsocialworkassociation.org) .
If an LCSW decides to opt-in, the LCSW accepts “assignment” of all Medicare cases who seek treatment. If an LCSW chooses to refer a beneficiary who seeks treatment, a referral and reason for the referral should be documented. The Medicare terminology for this category is participating (“par”). There is another category for other providers, non-participating (“non-par”) which does not apply to LCSWs.
Another form of assignment is “incident to” the services of physicians, psychologists, nurse-practitioners, or physician assistants.
Here is a summary of what Medicare currently covers taken from https://www.medicare.gov/coverage/outpatient-mental-health-care.html
Medicare Part B (Medical Insurance)covers mental health services and visits with these types of health professionals:
Medicare only covers these visits, often called counseling or therapy, when they’re provided by a health care provider who accepts ">assignment[all LCSWs.]
Part B covers outpatient mental health services, including services that are usually provided outside a hospital (like in a clinic, doctor’s office, or therapist’s office) and services provided in a hospital’s outpatient department. Part B also covers outpatient mental health services for treatment of inappropriate alcohol and drug use. Part B helps pay for these covered outpatient services:
All people with Part B are covered.
LCSWs have concerns about non-mental health clinicians being allowed to provide psychotherapy or make mental health diagnostic assessments, which CMS allows. CSWA continues to work with CMS on the problems with untrained mental health clinicians providing these services.
LCSWs do not need to opt-in or opt-out of Medicare. If an LCSW wishes to be paid through Medicare, the LCSW must opt-in as a Medicare provider. All LCSWs are expected to accept assignment of any Medicare beneficiary who needs mental health treatment unless there is a reason that the beneficiary needs to be referred. If an LCSW wishes to be paid privately, the LCSW needs to opt-out of Medicare and have each beneficiary sign a contract agreeing to refrain from submitting any claims to Medicare for the LCSW’s services. Telemental health services continue to be limited to rural areas with a shortage of mental health clinicians.
Laura Groshong, LICSW, CSWA Director, Policy and PracticeClinical Social Work AssociationThe National Voice of Clinical Social WorkStrengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY
PO Box 10Garrisonville, Virginia 22463