[Congressional Record Volume 149, Number 25 (Tuesday, February 11, 2003)]
[Senate]
[Pages S2200-S2201]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. MIKULSKI (for herself, Mr. Johnson, Mrs. Murray, Ms. 
        Stabenow, Mr. Corzine, Mr. Inouye, and Mr. Bingaman):
  S. 343. A bill to amend title XVIII of the Social Security Act to 
permit direct payment under the medicare program for clinical social 
worker services provided to residents of skilled nursing facilities; to 
the Committee on Finance.
  Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Clinical 
Social Work Medicare Equity Act of 2003.'' I am proud to sponsor this 
legislation that will include clinical social workers among other 
mental health providers that are exempted from the Medicare Part B 
Prospective Payment System. This bill will ensure that clinical social 
workers can receive Medicare reimbursements for the mental health 
services they provide in skilled nursing facilities.
  Since my first days in Congress, I have been fighting to protect and 
strengthen the safety for our Nation's seniors. Making sure that 
seniors have access to quality, affordable mental health care is an 
important part of this fight. I know that millions of seniors do not 
have access to, or are not receiving, the mental health services they 
need. For example, depression affects nearly 6 million seniors, but 
only one-tenth ever get treated. This is unacceptable. Clinical social 
workers

[[Page S2201]]

may also be the only mental health providers in some rural areas. 
Protecting seniors' access to clinical social workers can help make 
sure that our most vulnerable citizens get the quality, affordable 
mental health care they need.
  Clinical social workers, much like psychologists and psychiatrists, 
treat and diagnose mental illnesses. In fact, clinical social workers 
are the primary mental health providers for nursing home residents. But 
unlike other mental health providers, clinical social workers cannot 
bill directly for the important services they provide to their 
patients. This bill will correct this inequity and make sure clinical 
social workers get the payments and respect they deserve.
  Before the Balanced Budget Act of 1997, clinical social workers 
billed Medicare Part B directly for mental health services provided in 
nursing facilities to each patient they served. Under the Prospective 
Payment System, services provided by clinical social workers are 
lumped, or ``bundled,'' along with the services of other health care 
providers for the purposes of billing and payments. Psychologists and 
psychiatrists, who provide similar counseling, were exempted from this 
system and continue to bill Medicare directly. This bill would exempt 
clinical social workers, like their mental health colleagues, from the 
Prospective Payment System, and would make sure that clinical social 
workers are paid for the services they provide to patients in skilled 
nursing facilities. The Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act addressed some of these concerns, but 
this legislation would remove the final barrier to ensuring that 
clinical social workers are treated fairly and equitably for the care 
they provide.
  This bill is about more than paperwork and payment procedures. This 
bill is about equal access to Medicare payments for the equal and 
important work done by clinical social workers. It is also about making 
sure our Nation's most vulnerable citizens have access to quality, 
affordable mental health care. Without clinical social workers, many 
nursing home residents may never get the counseling they need when 
faced with a life threatening illness or the loss of a loved one. I 
think we can do better by our nation's seniors, and I'm fighting to 
make sure we do.
  The Clinical Social Work Medicare Equity Act of 2003 is strongly 
supported by the National Association of Social Workers. I ask 
unanimous consent that a letter of endorsement from the National 
Association of Social Workers be printed in the Record. I also want to 
thank Senators Johnson, Murray, Stabenow, Corzine, Inouye, and Bingaman 
for their cosponsorship of this bill. I look forward to working with my 
colleagues to enact this important legislation.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                              National Association


                                            of Social Workers,

                                Washington, DC, February 10, 2003.
     Hon. Barbara A. Mikulski,
     U.S. Senate,
     Washington, DC.
       Dear Senator Mikulski: I am writing on behalf of the 
     National Association of Social Workers (NASW), the largest 
     professional social work organization with nearly 150,000 
     members nationwide. NASW promotes, develops, and protects the 
     effective practice of social work and social workers. NASW 
     also seeks to enhance the well being of individuals, 
     families, and communities through its work, service, and 
     advocacy.
       NASW strongly supports the Clinical Social Work Medicare 
     Equity Act of 2003 which will end the unfair treatment of 
     clinical social workers under the Medicare Part B Prospective 
     Payment System (PPS) for Skilled Nursing Facilities (SNFs).
       Section 4432 of the Balanced Budget Act of 1997 authorized 
     the creation of the PPS, under which the cost of a variety of 
     daily services provided to SNF patients is bundled into a 
     single amount. Prior to PPS, a separate Medicare Part B claim 
     was filed by the provider for each individual service 
     rendered to a patient. Congress made this change in an 
     attempt to captitate the rapidly rising costs of additional 
     patient services delivered by Medicare providers to SNF 
     patients, with the precise target being physical, 
     occupational, and speech-language therapy services. However, 
     Congress recognized that some services, such as mental health 
     and anesthesia, are best provided on an individual basis 
     rather than as part of the bundle of services. Thus, the 
     following types of providers are specifically excluded from 
     the PPS: physicians, clinical psychologists, certified nurse-
     midwives, and certified registered nurse anesthetists. 
     Unfortunately, due to an unintentional oversight during the 
     drafting process, clinical social workers were not listed 
     among the aforementioned providers in the legislation.
       In 1996, Department of Health and Human Services Inspector 
     General June Gibbs Brown published a report entitled ``Mental 
     Health Services in Nursing Facilities''. The purpose of the 
     report was to describe the types of mental health services 
     provided in nursing facilities and identify potential 
     vulnerabilities in the mental health services covered by 
     Medicare. One critical funding of the report was 70% of 
     nursing home respondents stated that permitting clinical 
     social workers and clinical psychologists to bill 
     independently had a beneficial effect on the provision of 
     mental health services in nursing facilities. The Clinical 
     Social Work Medicare Equity will maintain this beneficial 
     effect on SNF patients by ensuring the continuation of direct 
     Medicare billing by clinical social workers for mental health 
     services rendered to SNF patients.
       Your efforts on behalf of mental health patients and 
     professionals nationwide are greatly appreciated by our 
     members. We thank you for your strong interest in and 
     commitment to this important issue as demonstrated by your 
     sponsorship of the Clinical Social Work Medicare Equity Act.
       Please do not hesitate to contact Francesca Fierro O'Reilly 
     of my staff at 202-408-8600 x336 should you require anything 
     further. NASW looks forward to working with you on this and 
     future issues of mutual concern.
           Sincerely,
                                               Elizabeth J. Clark,
                               PhD, ACSW, MPH, Executive Director.
                                 ______