clinical social work association

The Aware Advocate: Focus on 2022 Medicare Changes 

December, 2021  
Laura Groshong, LICSW, CSWA Director, Policy and Practice

There are a number of issues that are affecting LCSW practices in the waning days of 2021, particularly in the area of Medicare (which we know affects commercial insurance heavily). These issues are:  1) giving patients a “Good Faith Estimate” of what the treatment we provide will cost; 2) elimination of 2022 cuts to Medicare reimbursement; 3) telemental health coverage; and 4) DCEs. Discussion of each of these follows.

Good Faith Estimates

This rule requires us to give a “good faith estimate” (GFE) to a patient of what our services will cost and how long they may last.  While this policy is part of most of our informed consent forms, signed by the patient already, it is prudent to review what the GFE is more formally requesting we include in our information to the patient. The main difference about past practices and the GFE is that it applies to private pay patients as well as insured patients and uninsured patients.

For more information and a template of what belongs in a GFE, go to the CSWA website under “Templates” in the Members Only section.

Medicare Cuts Stopped

LCSWs can take a deep breath as Congress has acted to prevent the trio of Medicare payment cuts that were set to take effect at the beginning of 2022—a 3.75% cut due to scheduled changes in the Medicare Physician Fee Schedule (“PFS”), a 2% cut for Medicare sequestration, and a 4% Statutory Pay-As-You-Go Act (“PAYGO”). These Act cuts would have slashed Medicare payments by nearly 10% during a tumultuous time for healthcare. Instead, tThe Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) was approved by the U.S. House of Representatives on December 7 and passed the U.S. Senate on December 9, 2021.  The bill has been sent to President Biden’s desk for his signature.

The Protecting Medicare and American Farmers from Sequester Cuts Act includes:

• A one-year increase in the Medicare PFS of 3%;
• A delay in resuming the 2% Medicare sequester for three months, followed by a reduction to 1% for three months;
• Erasure of the 4% Medicare PAYGO cut; and
• Prevention of additional PAYGO cuts through 2022

This is the second year that a last-minute change stopped a substantial reimbursement cut for LCSWs.  CSWA will be encouraging CMS and Congress to stop these attempts to balance the Medicare budget on the backs of clinicians moving forward.

Telemental Health Coverage

As you know, CMS issued a new rule last month to expand telemental health and audio only psychotherapy through 2023. You also know we are still unable to practice across state lines unless we are licensed in the state where the patient resides and/or there is still increased reciprocity in the state where the patient resides.  CSWA is still working with Department of Defense and the Council of State Governments to create a “Compact” that will make it much easier to work across state lines; it should be ready to begin implementing in early 2023.

The requirement that LCSWs see patients in person every 6 months has been extended to every 12 months. This is a still a hardship for some patients and LCSWs who have given up a physical office.  CSWA will be working to eliminate this requirement.

For more information go to the CSWA website under “Legislative Alerts”.

Medicare Direct Contracting Entity

Over the past decade, over 50 models of delivering health care through Medicare have been explored, with the goals of lowering costs for dual-eligibles; eliminating access to care, based on economic disparities; and, moving away from a fee for service (FFS) payment model.  The last goal has an impact on LCSWs in private practice who have used the FFS model for some time.

A new model has been emerging called the Medicare Direct Contracting Entity (MDCE).  It is similar to the Accountable Care Organizations that have been in use for the past five years, but is run by commercial for-profit agencies. CMS has started to ‘assign’ beneficiaries who are in traditional Medicare to MDCE plans without consent.  There is concern that this could lead to the privatizing of Medicare which would have the same difficulties that commercial insurance for-profit plans have, i.e., the focus on profit leads to diminished health care services.

Surgeon General Report on Youth Mental Health

U.S. Surgeon General Vivek Murthy, MD, released an advisory statement on December 7 to highlight the urgent need to address the nation’s youth mental health crisis. “Protecting Youth Mental Health” (PDF, 1.01MB) . This excellent document outlines the COVID-19 pandemic’s harm to the mental health of America’s youth and families, as well as the mental health challenges that had accumulated before the pandemic began. CSWA is delighted to see the Surgeon General paying attention to this increasingly difficult situation.

CSWA wishes you a happy and healthy holiday season!

Laura Groshong, LICSW, Director, Policy and Practice  
Clinical Social Work Association   
lwgroshong@clinicalsocialworkassociation.org