[Congressional Record Volume 144, Number 36 (Thursday, March 26, 1998)]
[Extensions of Remarks]
[Pages E483-E484]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              THE MEDICARE SOCIAL WORK EQUITY ACT OF 1998

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, March 26, 1998

  Mr. STARK. Mr. Speaker, I am pleased to introduce The Medicare Social 
Work Equity Act of 1998.
  The Balanced Budget Act of 1997 includes a provision that will 
discourage nursing homes from utilizing social workers. This unintended 
consequence occurs because the legislation requires social workers' 
services to be included in the consolidated billing of the nursing home 
while psychologist and psychiatrist services remain outside of the 
consolidated billing.
  Under this construction, if a nursing home utilizes social workers' 
services, those dollars come out of the nursing home payment. 
Psychologist and psychiatrist payments do not. The effect of such a 
policy will be to encourage nursing homes to avoid social workers and 
instead rely on the more expensive services of psychologists and 
psychiatrists.
  Several firms that provide mental health services to nursing homes 
across the country have already informed me that they will cease hiring 
social workers and replace them with psychiatrists and psychologists 
beginning July 1, 1998.
  Clinical social workers are the primary providers of mental health 
services to residents of nursing homes, particularly in underserved 
urban and rural areas. Without correcting legislation, mental health 
services to nursing home residents will be reduced and Medicare costs 
for these services will most likely increase.
  I do not believe that Congress intentionally crated this problem. The 
Medicare Social Work Equity Act of 1998 seeks to address these concerns 
by excluding clinical social workers from the consolidated billing 
provisions of the Balanced Budget Act of 1997 and treating them 
identically to other mental health providers.
  This bill has been endorsed by the National Association of Social 
Workers, the Clinical Social Work Federation, the American Health Care 
Association and the National Citizens' Coalition for nursing Home 
Reform. Several firms that provide mental health services to nursing 
homes across the country have also pledged their support. I am 
attaching a letter I received from one such firm, MHM/Bay Colony 
Counseling Services.
  I urge my fellow Members of Congress to join with me in passing this 
crucial piece of legislation. Together, we can ensure that social 
workers continue to provide essential mental health services to nursing 
home residents.

                                                    MHM/Bay Colony


                                          Counseling Services,

                                    Cambridge, MA, March 10, 1998.
     Representative Fortney ``Pete'' Stark, 
     House of Representatives, Cannon House Office Building, 
         Washington, DC.
       Dear Representative Stark: I am contacting you to extend my 
     enthusiastic support for your efforts in pursuing the 
     Medicare Social Work Equity Act of 1998 which excludes social 
     workers from the new consolidated billing requirement in 
     skilled nursing facilities.
       I am the Clinical Director at MHM/Bay Colony Extended Care 
     Service. We provide comprehensive mental health services to 
     the residents of about 125 nursing home facilities in the 
     state of Massachusetts, and we employ about 100 professional 
     clinicians, 60% of which are licensed social workers.
       The social workers we employ are trained, and exceptionally 
     skilled psychotherapists who have made a purposeful 
     professional career choice to provide psychotherapeutic 
     services to the medically and psychiatrically frail and 
     compromised older population. In doing so, they also provide 
     consultation and support to the nursing home staff who are 
     extremely challenged in providing front line care to this 
     needy population.
       If this consolidated billing requirement for skilled 
     nursing facilities by Medicare includes social workers, the 
     impact will have an enormously destructive effect on systems 
     and services; i.e.:
       Our services to these residents will be decimated in terms 
     of available and acceptable trained professionals.

[[Page E484]]

       60% of our case load of frail aging nursing home residents, 
     most in their last years of life will lose services. (This is 
     the population who are most intensely affected by severe 
     emotional distress, or progressive dementia and in need of 
     management consultation intervention).
       60 to 70 social workers will be unemployed from our 
     program. (I speculate about 200 to 400 additionally from 
     other services in Massachusetts).
       The assumption for this Medicare consolidated billing 
     requirement, I believe, is that it is a cost saving device. 
     In all actuality, in terms of mental health services, the 
     costs will ultimately increase for Medicare. Programs, like 
     ours, will be forced to employ only doctorate level 
     psychologists who are exempt from this consolidated billing. 
     Medicare reimburses psychologists at a higher rate than 
     social workers for the same billing code.
       In closing, I need to emphasis that our services are 
     essential for the fundamental well-being of this population 
     and that our social workers are the foundation of our 
     services.
       My staff and I thank you for your leadership in expending 
     this so rapidly. I am available for contact if further 
     efforts are needed.
           Sincerely,
                                                    Muriel Ellman,
                         Clinical Director, Extended Care Service.

     

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