[Congressional Record Volume 153, Number 67 (Wednesday, April 25, 2007)]
[Senate]
[Pages S5098-S5099]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. MIKULSKI (for herself, Ms. Stabenow, Mr. Inouye, Ms. 
        Cantwell, and Mrs. Murray):
  S. 1212. 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. MIKULSI. Mr. President, acknowledging the social workers' 
presence on Capitol Hill this week for their Annual Leadership Meeting 
Lobby Day, I rise today to introduce the ``Clinical Social Work 
Medicare Equity Act of 2007.'' I am proud to sponsor this legislation 
that will ensure clinical social workers receive Medicare 
reimbursements for the mental health services they provide in skilled 
nursing facilities. Under the current system, social workers are not 
paid for the services they provide. Psychologists and psychiatrists, 
who provide similar counseling, are able to separately bill Medicare 
for their services.
  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

[[Page S5099]]

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 receive treatment. 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 carry out 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 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 seniors residing in rural 
environments. Unlike other mental health providers, clinical social 
workers cannot bill Medicare directly for the important services they 
provide to their patients. Protecting seniors' access to clinical 
social workers ensures that our most vulnerable citizens get the 
quality, affordable mental health care they need. 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 they 
provided in nursing facilities for 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 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 2007 is strongly 
supported by the National Association of Social Workers. I also want to 
thank Senators Stabenow and Inouye for their co-sponsorship of this 
bill. I look forward to working with my colleagues to enact this 
important legislation.
  I ask unanimous consent that a letter of support be printed in the 
Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:
                                              National Association


                                            of Social Workers,

                                   Washington, DC, April 25, 2007.
     Senator Barbara Mikulski,
     Washington, DC.
       Dear Senator Mikulski: I am writing on behalf of the 
     National Association of Social Workers (NASW), the largest 
     professional social work organization in the world with 
     150,000 members nationwide. NASW promotes, develops, and 
     protects the effective practice of social work services. NASW 
     strongly supports the Clinical Social Work Medicare Equity 
     Act of 2007, which will improve mental health care to nursing 
     home residents and end the unfair treatment of clinical 
     social workers under the Medicare Prospective Payment System 
     (PPS) for Skilled Nursing Facilities (SNFs).
       The Balanced Budget Act of 1997 authorized the creation of 
     the PPS, under which the cost of a variety of routine 
     services provided to SNF patients is bundled into a single 
     amount. Prior to adoption of the PPS, a separate Medicare 
     claim was filed by providers for individual services rendered 
     to a patient. However, Congress recognized that some 
     services, such as mental health and anesthesia, are provided 
     on an individual as-needed basis rather than as part of the 
     bundle of services. Thus, the following types of providers 
     were excluded from the PPS: physicians, clinical 
     psychologists, certified nurse-midwives, and certified 
     registered nurse anesthetists. Unfortunately, due to an 
     oversight during the drafting process, clinical social 
     workers were not listed among the PPS excluded providers.
       In 1996, the DHHS Inspector General issued a report 
     entitled ``Mental Health Services in Nursing Facilities,'' 
     which described the types of mental health services provided 
     in nursing facilities and identified their potential 
     vulnerabilities. One critical finding of the report was that 
     70 percent of respondents stated that permitting clinical 
     social workers and clinical psychologists to bill Medicare 
     independently had a beneficial effect on the provision of 
     mental health services in SNFs. Your legislation will improve 
     care for SNF residents by restoring Medicare payments for 
     specialized clinical social work services rendered to SNF 
     patients.
       Your tireless efforts on behalf of consumers of mental 
     health services and professional social workers nationwide 
     are greatly appreciated by our members. We thank you for your 
     strong interest in and commitment to these important issues 
     as demonstrated by your sponsorship of the Clinical Socia1 
     Work Medicare Equity Act. NASW looks forward to working with 
     you on this and future issues of mutual concern.
           Sincerely,
                                               Elizabeth J. Clark,
                                               Executive Director.
                                 ______