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Changes to Medicare for LCSWs in 2017

07 Sep 2016 8:38 PM | CSWA Administrator (Administrator)

The Aware Advocate - 2016

Changes to Medicare for LCSWs in 2017

Laura Groshong, LICSW, Director of Policy and Practice

     As all CSWA members know, since 2012 LCSWs have been subject to the Physician Quality Reporting System (PQRS) which has affected reimbursement rates in a cumbersome and difficult way for the past 5 years.  While the penalties that have been given for failure to comply with PQRS measures were relatively small (1-2% a year), the challenges of keeping track of the yearly changes to measures that LCSWs were supposed to report on have been a source off anxiety and frustration. 

    The good news is that for 2017 and 2018, LCSWs will not have to continue reporting PQRS measures.  The PQRS measures are being rolled in to a new plan called Merit-Based Incentive Payment System (MIPS) which is part of the new Medicare formula for reimbursement, Medicare Access and CHIP Reauthorization ACT (MACRA) that replaced the very problematic Sustainable Growth Rate (SGR).

    Though all LCSWs are free of the new reporting systems for now, it may be helpful to understand the changes that are coming to physicians and may be applied to LCSWs in 2019.  They will apply to quality of care; cost of care; use of electronic record keeping; and activities that attempt to reduce the cost of care while improving quality in Medicaid.

  • -          Quality – measures that will be similar to PQRS measures and reported yearly
  • -          Resource Use – will require reporting on care given for high-cost conditions (including inpatient for depression) and the number of episodes required (formerly called Value-Based Patient Modifier Program, which did not apply to LCSWs, but may in future)
  • -          Advancing Care Information – encouraging the use of interoperable electronic record keeping (formerly called EHR)
  • -          Clinical Practice Improvement Activities – the least defined area, which is intended to identify ways to cut costs for Medicaid services

      The Quality measures for physicians and nurses in 2016 are currently defined as follows:

• Anti-depressant medication management

• Preventive care and screening: screening for clinical depression and follow-up plan

• Elder maltreatment screen and follow-up plan

• Dementia: cognitive assessment

• Dementia: functional status assessment

• Dementia: neuropsychiatric symptom assessment

• Dementia: management of neuropsychiatric symptoms

• Dementia: counseling regarding safety concerns

• Dementia: caregiver education and support

• Adult major depressive disorder (MDD): coordination of care of patients with specific comorbid conditions

• Adherence to antipsychotic medications for individuals with schizophrenia

• Follow-up after hospitalization for mental health conditions

It is notable that Medicare describes the covered groups (physicians, nurses, physician assistants) as the “vast majority of behavioral health providers” in Medicare ( .  There are 38,000 LCSWs that are currently Medicare providers, probably a much smaller group than the current number of primary care physicians and others providing psychotropic medication.

    Keep in mind that LCSWs are still required to submit PQRS information for 2016 and will receive a Medicare reimbursement deduction in 2018 for failure to comply with PQRS reporting; see CSWA website for 2015 measures which are the same as 2016 measures ( .  

     In the meantime, look forward to some time off next year if you are a Medicare provider from the PQRS measures.  CSWA will continue to keep you informed about other changes to these reporting requirements.  

Laura W. Groshong, LICSW, Director, Policy and Practice

Clinical Social Work Association
Seattle, WA

CSWA - "The National Voice for Clinical Social Work"

Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY

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Garrisonville, Virginia  22463

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