[Congressional Record Volume 151, Number 72 (Thursday, May 26, 2005)]
[Extensions of Remarks]
[Page E1111]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        INTRODUCING THE CLINICAL SOCIAL WORK MEDICARE EQUITY ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Thursday, May 26, 2005

  Mr. STARK. Mr. Speaker, today I am pleased to join with my friend and 
colleague Rep. Jim Leach (R-IA) to introduce the Clinical Social Work 
Medicare Equity Act of 2005. Sen. Mikulski is introducing the companion 
bill in the Senate. This simple, bipartisan bill would greatly improve 
access to mental health services for Medicare beneficiaries in skilled 
nursing facilities (SNFs) by allowing clinical social workers to direct 
bill for their services.
  This legislation seeks to correct a flaw in the Balanced Budget Act 
of 1997 with respect to Medicare coverage of clinical social work 
services to nursing home residents. The law omits Certified Social 
Workers (CSWs) from a list of clinical professionals allowed to 
directly bill Medicare Part B for mental health services provided to 
Medicare beneficiaries in SNFs. As a result of this omission, Medicare 
beneficiaries in nursing homes often go without necessary mental health 
services.
  Numerous reports suggest that mental illness is highly prevalent in 
nursing homes, with mental health problems affecting more than 80 
percent of the residents. These mental disorders--including major 
depression, anxiety, and severe cognitive impairment of Alzheimer's 
disease--interfere with a person's ability to carry out activities of 
daily living. Furthermore, older people have the highest rate of 
suicide of any age group, accounting for 20 percent of all suicide 
deaths. Thus, access to mental health services for seniors in nursing 
homes is critically important.
  Clinical social workers are highly trained mental health 
professionals and have been approved providers in the Medicare program 
since 1987. They provide 61 percent of mental health treatment in our 
country, and constitute the single largest group of mental health 
providers in the United States. Clinical social workers are also cost 
effective because they are paid less than Medicare's other mental 
health providers. They are reimbursed at 75 percent of the rate paid to 
psychologists.
  Sadly, in many cases vulnerable nursing home residents have no access 
to mental health services when highly skilled CSWs are unable to bill 
Medicare Part B for services in SNFs. Rural and other medically 
underserved areas are particularly disadvantaged because psychiatrists 
and psychologists are often unavailable.
  Before the Balanced Budget Act of 1997, 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 indefensible.
  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.
  The Clinical Social Work Medicare Equity Act of 2005 again makes it 
possible for CSWs to provide mental health services in skilled nursing 
facilities. This legislation helps to ensure access to needed mental 
health services for the many Medicare beneficiaries who reside in 
skilled nursing facilities. This bill is a small technical change to 
existing law, but would have the enormous 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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