[Congressional Record Volume 144, Number 36 (Thursday, March 26, 1998)]
[Senate]
[Page S2660]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. MIKULSKI (for herself, Mrs. Murray and Mr. Wyden):
  S. 1864. A bill to amend title XVIII of the Social Security Act to 
exclude clinical social worker services from coverage under the 
Medicare skilled nursing facility prospective payment system; to the 
Committee on Finance.


              THE MEDICARE SOCIAL WORK EQUITY ACT OF 1998

  Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Medicare 
Social Work Equity Act of 1998''. I am proud to sponsor this 
legislation which will amend section 4432 in the Balanced Budget Act of 
1997 which prevents social workers from directly billing Medicare for 
mental health services provided in skilled nursing facilities. I am 
honored to be joined by my good friends Senator Murray and Senator 
Wyden who care equally about correcting this inequity for social 
workers.

  Last year's Balanced Budget Act changed the payment method for 
skilled nursing facility care. Under current law, reimbursement is made 
after services have been delivered for the reasonable costs incurred. 
However, this ``cost-based system'' was blamed for inordinate growth in 
Medicare spending at skilled nursing facilities.
  The Balanced Budget Act of 1997 phases in a prospective payment 
system for skilled nursing facilities beginning July 1, 1998. Payments 
for Part B services for skilled nursing facility residents will be 
consolidated. This means that the provider of the services must bill 
the facility instead of directly billing Medicare.
  Congress was careful to not include psychologists and psychiatrists 
in this new consolidated billing provision. Social workers were 
included, I think by mistake. Clinical social workers are the primary 
providers of mental health services to residents of nursing homes, 
particularly in underserved urban and rural areas. Clinical social 
workers are also the most cost effective mental health providers.
  This legislation is important for three reasons: First, I am 
concerned that section 4432 will inadvertently reduce mental health 
services to nursing home residents. Second, I believe that the new 
consolidated billing requirement will result in a shift from using 
social workers to other mental health professionals who are reimbursed 
at a higher cost. This will result in higher costs to Medicare. 
Finally, I am concerned that clinical social workers will lose their 
jobs in nursing homes or will be inadequately reimbursed.
  I like this bill because it will correct an inequity for America's 
social workers, it will assure quality of care for nursing home 
residents, and will assure cost efficiency for Medicare. I look forward 
to the Senate's support of this worthy legislation.
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