[Congressional Record Volume 147, Number 87 (Thursday, June 21, 2001)]
[Extensions of Remarks]
[Page E1175]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  INTRODUCTION OF THE CLINICAL SOCIAL WORK MEDICARE EQUITY ACT OF 2001

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, June 21, 2001

  Mr. STARK. Mr. Speaker, today I join with Rep. Leach and Sen. 
Milkulski to introduce the Clinical Social Work Medicare Equity Act of 
2001. This bipartisan legislation would fix a technical error created 
by the Balanced Budget Act of 1997 (BBA'97) and help residents of 
skilled nursing facilities (SNFs) better access needed mental health 
care. It does this by allowing clinical social workers to bill Medicare 
directly when they provide mental health services to SNF residents.
  Clinical social workers are highly trained mental health 
professionals who have participated in the Medicare program since 1987. 
They constitute the single largest group--roughly 60 percent--of mental 
health providers in the nation. In rural and other medically 
underserved areas, clinical social workers are often the only mental 
health providers.
  Until BBA'97, clinical social workers were able to bill Medicare 
directly for providing mental health services to SNF residents, just 
like clinical psychologists and psychiatrists. But a drafting error in 
BBA'97 unintentionally stripped clinical social workers of this ability 
and created an inequity that ultimately harms beneficiaries who need 
mental health care.
  In order to contain rising healthcare costs, Section 4432 of BBA'97 
authorized a prospective payment system for Medicare SNFs. For each day 
a beneficiary spends in a SNF, the facility receives a fixed payment 
that essentially bundles together the range of services a typical 
resident requires. Yet Congress recognized that some ancillary 
services, including mental health services, are better provided on an 
individually arranged basis. Mental health providers, including 
clinical psychologists and psychiatrists, were therefore excluded from 
the SNF prospective payment system.
  Unfortunately, clinical social workers were not placed on this 
exclusion list. This was an unintended oversight arising from a failure 
to recognize that all social workers are not alike.
  Some social workers are specifically trained to provide medical-
social services, such as discharge planning from inpatient or long-term 
care settings. Because SNF residents often require this type of 
medical-social service, it makes sense to bundle it into the SNF 
prospective payment system.
  Clinical social workers, however, are specifically trained to provide 
mental health services. Clearly Congress never intended mental health 
services to be part of the SNF prospective payment system. Therefore, 
the failure to exclude clinical social workers, who are Medicare-
authorized mental health providers, makes no sense.
  If Congress does not fix this oversight in the law, many clinical 
social workers will be forced to stop serving Medicare beneficiaries in 
SNFs. The ultimate victims are vulnerable seniors who need mental 
health care.
  We must not allow this to happen. According to the 2001 DHHS report, 
``Older Americans and Mental Health: Issues and Opportunities,'' mental 
illness is highly prevalent in nursing homes. In fact, some studies 
have found that up to 88 percent of nursing home residents have mental 
health problems, ranging from major depression to Alzheimer's disease. 
The 1999 Surgeon General report on mental health further indicates that 
older people have the highest rate of suicide of any age group--
accounting for 20 percent of all suicide deaths.
  Mental health treatment works. Alzheimer's patients and their 
families can benefit enormously from psychoeducation and counseling 
around how to cope and manage behavior problems. Research trials have 
repeatedly demonstrated that psychotherapy can be as effective as anti-
depressants in treating major depression. Clinical social workers 
provide these important services and do so at a fraction of the cost of 
clinical psychologists and psychiatrists.
  This legislation is strongly endorsed by the National Association of 
Social Workers and the Clinical Social Work Federation and is included 
in a larger omnibus Medicare mental health modernization bill (H.R. 
1522) endorsed by over 30 mental health and senior citizen 
organizations.
  Again, our legislation would exclude clinical social workers from the 
prospective payment system. This small fix corrects what we believe to 
be a serious error created by BBA'97. It is time to act quickly and 
decisively to preserve access to needed mental health services for 
residents in thousands of our nation's skilled nursing facilities.

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