[Congressional Record Volume 149, Number 25 (Tuesday, February 11, 2003)]
[Extensions of Remarks]
[Page E182]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    INTRODUCING THE CLINICAL SOCIAL WORK MEDICARE EQUITY ACT OF 2003

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Tuesday, February 11, 2003

  Mr. STARK. Mr. Speaker, today I join with Representative Leach and 18 
other colleagues to introduce the Clinical Social Work Medicare Equity 
Act of 2003. Senator Mikulski is introducing the companion bill in the 
Senate. This legislation changes a provision in the Balanced Budget Act 
of 1997 that omits Certified Social Workers, CSWS, from a list of 
clinical professionals allowed to directly bill through Medicare, Part 
B for mental health services provided to Medicare beneficiaries in 
skilled nursing facilities, SNFs. As a result of this omission, CSWs 
are the only Medicare-authorized mental health providers without this 
direct billing capability within the SNF setting.
  Approximately 20 percent of seniors suffer from mental illness and 
the prevalence is higher in nursing home residents. These mental 
disorders interfere with the person's ability to carry out activities 
of daily living. They include major depression, anxiety, and severe 
cognitive impairment resulting from Alzheimer's disease. Furthermore, 
older people have the highest rate of suicide of any age group. Thus, 
access to mental health services for seniors in nursing homes is very 
important.
  Unfortunately, the inability for CSWs to bill Medicare Part B in SNFs 
has the effect of excluding these highly skilled professionals from 
providing mental health services to this population. This is 
particularly problematic in rural and other medically underserved areas 
where other Medicare-authorized mental health providers such as 
psychiatrists and psychologists are often unavailable. The National 
Association of Social Workers, NASW, strongly supports this access 
enhancing legislation.
  Clinical social workers are highly trained mental health 
professionals who have participated in the Medicare program since 1987. 
They constitute the single largest group of mental health providers in 
the nation. 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. Their 
current exclusion from this provider list is not defensible.
  The ultimate victims of the current regulations are the vulnerable 
seniors who need mental health care. Mental health treatment works. 
Alzheimer's patients and their families can benefit enormously from 
psycho-education and counseling around how to cope and manage behavior 
problems. Research trials have repeatedly demonstrated that 
psychotherapy, either alone or in combination with medication, can be 
effective in treating depression and debilitating anxiety. Clinical 
social workers provide these important services and do so at a fraction 
of the cost of clinical psychologists and psychiatrists.
  In summary, our legislation changes a billing mechanism that again 
makes it viable for CSWs to provide mental health services in skilled 
nursing facilities. As a result, our legislation helps to ensure ease 
of access to needed mental health services to the many Medicare 
beneficiaries who reside in skilled nursing facilities. The Clinical 
Social Work Medicare Equity Act is a small technical change to existing 
law, but it would have the effect of improving the lives of Medicare 
beneficiaries in nursing homes who are suffering from mental illness. 
We urge our colleagues to work with us to enact this important 
legislation this year.

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