[Congressional Record Volume 151, Number 72 (Thursday, May 26, 2005)]
[Senate]
[Pages S6042-S6043]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. MIKULSKI (for herself, Ms. Stabenow, Mr. Bingaman, Mrs. 
        Murray, Mr. Corzine, Mr. Johnson, and Mr. Inouye):
  S. 1148. 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, in honor of Older Americans' Mental 
Health Week, I rise today to introduce the Clinical Social Work 
Medicare Equity Act of 2005. I am proud to sponsor this legislation 
that will ensure that clinical social workers can receive Medicare 
reimbursements for the mental health services they provide in skilled 
nursing facilities. Under the current system, social workers may not be 
paid for services they provide. Psychologists and psychiatrists, who 
provide similar counseling, are able to separately bill Medicare for 
their services. Congressmen Stark and Leach are introducing a companion 
bill today in the House of Representatives.
  Since my first days in Congress, I have been fighting to protect and 
strengthen the safety of 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 urgently 
need. Nearly 6 million seniors are affected by depression, but only 
one-tenth ever gets treated. According to the American Psychiatric 
Association, up to 25 percent of the elderly population in the United 
States suffers from significant symptoms of mental illness and among 
nursing home residents the prevalence is as high as 80 percent. These 
mental disorders, which include severe depression and debilitating 
anxiety, interfere with the person's ability to carryout activities of 
daily living and adversely affect their quality of life. Furthermore, 
older people have a 20 percent suicide rate, the highest of any age 
group. Every year nearly 6,000 older Americans kill themselves. This is 
unacceptable and must be addressed.
  As a former social worker, I understand the role that social workers 
play in the overall care of patients and seniors. This bill protects 
patients across the country and ensures that seniors living in 
underserved urban and rural areas, where clinical social workers are 
often the only available option for mental health care, continue to 
receive the treatment 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 and also seniors residing in rural 
environments. But unlike other mental health providers, clinical social 
workers cannot bill directly for the important services they provide to 
their patients. 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 and deserve. 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 
billis about equal access to Medicare payments for the equal and 
important work done by clinical social workers. It is about making sure 
our Nation's most vulnerable citizens have access to quality, 
affordable mental health care. The overarching goal we should be 
striving to achieve for our seniors is an overall improved quality of 
life. 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 2005 is strongly 
supported by the National Association of Social Workers and the 
Association for Geriatric Psychiatry. I also want to thank Senators 
Stabenow, Bingaman, Murray, Corzine, Johnson, and Inouye for their 
cosponsorship of this bill. I look forward to working with my 
colleagues to enact this important legislation.
  Mr. President, I ask unanimous consent that the text of the bill and 
letters of support be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

         National Association of Social Workers--Political Action 
           for Candidate Election,
                                     Washington, DC, May 25, 2005.
     Senator Barbara Mikulski,
     Hart Senate Office Building,
     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 over 153,000 
     members nationwide. NASW promotes, develops, and protects the 
     affective 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 2005, 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

[[Page S6043]]

     provider for each individual service rendered to a patient. 
     Congress made this change in an attempt to capitate 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 finding 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 
     professional social workers 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. NASW looks forward to working with you 
     on this and future issues of mutual concern.
           Sincerely,
                                                    David Dempsey,
     Manager, Government Relations and PACE.
                                  ____

                                          American Association for


                                         Geriatric Psychiatry,

                                       Bethesda, MD, May 25, 2005.
     Hon. Barbara Mikulski, 
     U.S. Senate,
     Washington, DC.
       Dear Senator Mikulski: On behalf of the American 
     Association for Geriatric Psychiatry (AAGP), I am writing to 
     endorse the ``Clinical Social Work Medicare Equity Act of 
     2005.''
       AAGP is a professional membership organization dedicated to 
     promoting the mental health and well-being of older people 
     and improving the care of those with late-life mental 
     disorders. AAGP's membership consists of 2,000 geriatric 
     psychiatrists, as well as other health professionals who 
     focus on the mental health problems faced by senior citizens.
       This legislation would permit direct payment under the 
     Medicare program for clinical social worker services provided 
     to residents of skilled nursing facilities. The numbers of 
     mental health professionals available to treat older adults, 
     including residents of nursing homes, are already inadequate, 
     and as the baby boom generation ages, the needs will only 
     increase. Clinical social workers constitute a crucial 
     component of the team of mental health professionals who are 
     able to deliver this care, and assuring that they are able to 
     bill for their services in the same way as psychiatrists and 
     psychologists is not only fair but also necessary if nursing 
     home residents are to have access to the mental health care 
     they need.
       AAGP commends you for your introduction of this important 
     legislation, and we look forward to working with you towards 
     its enactment.
           Sincerely,
                                            Christine M. de Vries,
                                               Executive Director.

                                S. 1148

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Clinical Social Work 
     Medicare Equity Act of 2005''.

     SEC. 2. PERMITTING DIRECT PAYMENT UNDER THE MEDICARE PROGRAM 
                   FOR CLINICAL SOCIAL WORKER SERVICES PROVIDED TO 
                   RESIDENTS OF SKILLED NURSING FACILITIES.

       (a) In General.--Section 1888(e)(2)(A)(ii) of the Social 
     Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by 
     inserting ``clinical social worker services,'' after 
     ``qualified psychologist services,''.
       (b) Conforming Amendment.--Section 1861(hh)(2) of the 
     Social Security Act (42 U.S.C. 1395x(hh)(2)) is amended by 
     striking ``and other than services furnished to an inpatient 
     of a skilled nursing facility which the facility is required 
     to provide as a requirement for participation''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to items and services furnished on or after the 
     date that regulations relating to payment for physicians' 
     services for calendar year 2005 take effect, but in no case 
     later than the first day of the third month beginning after 
     the date of the enactment of this Act.
                                 ______