[Congressional Record Volume 157, Number 39 (Tuesday, March 15, 2011)]
[Senate]
[Pages S1680-S1681]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. MIKULSKI (for herself and Mr. Inouye):
  S. 583. 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 World Social Work Day, I 
rise today to introduce the Dorothy I. Height and Whitney M. Young, Jr. 
Social Work Reinvestment Act and the Clinical Social Work Medicare 
Equity Act of 2011. I am proud to introduce legislation that will 
reduce the shortage of social workers in our nation and properly 
reimburse social workers for the services they provide.
  Social workers play a crucial role combating the social problems 
facing our nation and are essential providers in our health care 
system. Our health care and social service needs have drastically 
increased over the past decade and will continue to do so in the next 
decade. We must have the workforce in place to make sure that our 
returning soldiers have access to mental health services, our elderly 
maintain their independence in the communities in which they live, and 
abused children are placed in safe homes. Social workers provide mental 
health therapy, caregiver and family counseling, health education, 
program coordination, and case management. In these tough economic 
times, social workers have an essential role in keeping communities 
together and helping individuals and families cope with the stresses 
they are facing. Social workers are vital to America's social safety 
net.
  The Dorothy I. Height and Whitney M. Young, Jr. Social Work 
Reinvestment Act provides grants to social workers, identifies 
workforce challenges and resource needs, and determines how any 
workforce shortage will affect the communities social workers serve. I 
am honored to introduce this bill named after two social visionaries, 
Dorothy I. Height and Whitney M. Young. Dorothy Height, who passed away 
last year, was a pioneer of the civil rights movement. Like me, she 
began her career as a case worker and continued to fight for social 
justice. Whitney Young, another trailblazer of the civil rights 
movement, also began his career transforming our social landscape as a 
social worker. He helped create President Johnson's War on Poverty and 
has served as President of the National Association of Social Workers.
  This bill is about continued investment in social work. It provides 
grants for social work education, research, and training. These grants 
will fund community-based programs of excellence and provide 
scholarships to train the next generation of social workers. This bill 
addresses the recruitment and retention of social workers and will 
result in a renewed focus on improving social worker workplace safety. 
According to the National Association of Social Workers, 44 percent of 
social workers surveyed have faced personal safety issues when on the 
job. In addition, this bill will help identify and disseminate 
evidence-based best practices in social work interventions. This bill 
also establishes a national coordination center that will allow social 
education, advocacy and research institutions to collaborate and work 
together. The coordination center will facilitate gathering and 
distributing social work research to make the most effective use of the 
information we have on how social work service improves our social 
fabric. This bill also creates a media campaign that will promote 
social work. This bill gives social work the attention it deserves.
  As a social worker, I understand the critical role social workers 
have in the overall care of our populations. Social workers can be 
found in every facet of community life--in hospitals, mental health 
clinics, senior centers, and private agencies that serve individuals 
and families in need. Social workers are there to help struggling 
students, returning soldiers, and the chronically ill. Oftentimes, 
socials workers are the only available option for mental health care in 
rural and underserved urban areas. Yet there are not enough social 
workers to meet these needs. By 2018, it is estimated an additional 
100,000 social workers will be needed. We need to get our workforce in 
place today so that we can meet the needs of our population, 
particularly our aging Americans. The first of the baby boomers turn 65 
this year. The aging tsunami will hit us. We must be prepared.
  I believe that social work is full of great opportunities, both to 
serve and to lead. Social work is about putting our values into action. 
Social workers are among our best and brightest, our most committed and 
compassionate. They are at the frontlines of providing care, often 
putting themselves in dangerous and violent situations. Social workers 
have the ability to provide psychological, emotional, and social 
support--quite simply, the ability to change lives. I think we can do 
better by our constituents including our servicemembers, seniors, and 
children. We must make sure we have the social workers in place to meet 
their needs. I'm fighting to make sure we do.
  I also stand on the Senate floor today to introduce the Clinical 
Social Work Medicare Equity Act of 2009. This bill ensures that 
clinical social workers receive Medicare reimbursement for the mental 
health services they provide in skilled nursing facilities. Under the 
current system, social workers cannot

[[Page S1681]]

bill Medicare directly 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 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. Five million seniors are affected by depression, yet few ever 
receive treatment. According to the American Psychological Association, 
20 percent of people over the age of 55 have a mental health disorder 
and 2/3 of nursing home residents have a mental or behavioral health 
issue, but less than 3 percent receive treatment. These mental health 
disorders, which include severe depression and debilitating anxiety, 
interfere with a person's ability to carry out activities of daily 
living and adversely affect their quality of life. Furthermore, older 
people account for 20 percent of suicide deaths in the U.S., and white 
men age 85 or older have the highest suicide rate of any age group. 
Every year nearly 5,000 older Americans kill themselves. This is 
unacceptable and must be addressed.
  This bill helps residents of skilled nursing facilities across the 
country get the mental health and psychosocial services they need. It 
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, diagnose and 
treat 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 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.
  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 improved quality of life. 
Without clinical social workers, many nursing home residents would 
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. I am fighting to make sure we do.
  As a social worker, I have been on the frontlines of helping people 
cope with issues in their everyday lives. I started off fighting for 
abused children, making sure they were placed in safe homes. I will 
continue to fight every day for our children, seniors, and families on 
the floor of the United States Senate.
  The Dorothy I. Height and Whitney M. Young, Jr. Social Work 
Reinvestment Act and the Clinical Social Work Medicare Equity Act of 
2011 are both strongly supported by the National Association of Social 
Workers. I also want to thank Senator Inouye for his cosponsorship of 
the Clinical Social Work Medicare Equity Act of 2012 and thank Senator 
Begich, Senator Cardin, and Senator Inouye for their cosponsorship of 
the Social Work Reinvestment Act. I look forward to working with my 
colleagues to enact these two important pieces of legislation.
                                 ______