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March 1, 2016
Good morning and welcome. My name is Margot Aronson, and I am a Licensed Clinical Social Worker. LCSWs are the backbone of our country’s mental health treatment system. We are responsible for close to half of clinical services provided in the USA: assessment and diagnosis, psychotherapy, case management, and more, in clinics, hospitals, group and private practice.
I am speaking today for the Clinical Social Work Association, which represents the interests of the 240,000 LCSWs in the US. Our Association has a strong advocacy program with a focus on mental health issues at the national level and on professional practice issues. The bill we’re discussing today – H.R. 3712 /S. 2173, the Improving Access to Mental Health Treatment Act – cuts across both those areas of interest.
This bill addresses problems Medicare beneficiaries have in obtaining mental health care. As you know, Medicare - our federal insurance program – provides health insurance to Americans over 65, and also to younger people with disabilities or ALS or end-stage renal disease, through Social Security Disability Insurance (SSDI). Overall, Medicare serves about 50 million Americans.
According to the CDC (Center for Disease Control), nearly 1 in 3 seniors do not receive treatment for an ongoing mental health condition. Seniors may be in distress or in crisis with issues of aging such as: loss of vision, hearing, mobility; with a diagnosis of major illness or Alzheimer’s; with the cognitive impairment – or death - of a life partner; with painful end-of-life decisions. Addiction to prescription medication and/or alcohol is at epidemic levels for the elderly. And in fact, substance misuse is often a factor with the younger beneficiaries, who may be dealing with debilitating depression, with an anxiety disorder, with serious mental illness, with PTSD.
Licensed clinical social workers, along with psychologists and psychiatrists, are the only providers of mental health services for Medicare beneficiaries. Surveys generally find that our LCSW treatment success and satisfaction rates - for the services provided by all three groups - are at least equal to those of our psychology and psychiatry colleagues (Consumer Reports, 2004, 2010).
CSWA spoke with leadership at CMS (the Centers for Medicare & Medicaid Services) last summer. CMS is the oversight agency for Medicare. They told us that they need LCSWs to help the vast and rapidly expanding numbers of Medicare beneficiaries (10,000 a day for the past two years).
Increasingly, however, LCSWs are saying that they cannot continue to work in the Medicare system because the current rates are so low that they cannot sustain their practices (25% less than other mental health providers for the same services). It is this disparity that The Improving Access bill seeks to begin to correct.
Part I of the Improving Access to Mental Health Act would increase Medicare reimbursement for LCSW services from 75% to 85% of the physician fee schedule rate.
While the bill will not totally resolve this problem, it is a start. The increase will bring clinical social workers up to parity with other non-physician Medicare providers – turns out we’re now the only profession at 75%. We believe that this modest financial boost, combined with the gesture of support from Congress, will go far in encouraging LCSWs to become Medicare providers.
Let me just make a quick comment about the discrepancy in pay for the same services with the same success rate: as you might expect, it is the cause of considerable resentment; and the legislative staffers we’ve met with have themselves identified and expressed concern about the fairness issue; in addition there is the fairness issue to women, as social work is primarily a female profession.
Part 2 of the bill increases access to LCSW services in skilled nursing facilities.
Since 1997, LCSWs have not been permitted as independent practitioners to provide treatment to patients in skilled nursing facilities, commonly called SNFs. What this restriction means in practice is that treatment gets derailed for the client who temporarily moves into a SNF because of an illness, or the need for rehab, or to recover from surgery. Sometimes the move is the beginning of what will be a major life change: such a patient may be feeling despair, but an independent LCSW cannot be made available to him to do a timely depression assessment or to provide therapy. This is especially painful for beneficiaries who have had an ongoing relationship with an LCSW that is interrupted while the client in a SNF. This would restore the ability of LCSWs to work within SNFs independently.
Finally, Part 3 of this bill eliminates Medicare restrictions on the right of LCSWs to do Health and Behavior Assessment and Intervention services (HBAI), helping clients cope with the social and emotional issues stemming from medical conditions (cancer, heart disease, diabetes, or Alzheimer’s, for example). HBAI services are well within the LCSW scope of practice, and our holistic, person-in-environment framework, bringing to bear biological, psychological, social and family elements, is especially relevant in the skilled nursing setting and wherever substance abuse may be an issue.
To summarize, the Improving Access to Mental Health Treatment Act is a clear, simple, practical bill. Here are its three straight-forward parts:
HR 3712/S 2173 WILL IMPROVE ACCESS TO MENTAL HEALTH THROUGH MEDICARE BY:
We know that the elderly have a significant percentage of undiagnosed and untreated mental health conditions, and that limited access to mental health providers presents a major barrier to their overall health, leaving them at risk. This bill takes very practical steps to improving their access to mental health treatment; it is a significant bill. Thank you.
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