clinical social work association

I know many of you have been hearing about changes to Medicare payments and the SGR, and you may be wondering what it all means for LCSWs. Given the fact that the 158-page bill, HR 1470, now HR 2, Medicare Access and CHIP Reauthorization Act (MACRA), was created last week and released yesterday, this preliminary analysis of the bill should not be considered complete. More information will be coming but this will give you a summary of what HR 2, will and will not do, if passed.

First an important note: Without some action by Congress in the next week, all Medicare providers, including LCSWs, will receive a 21% cut in reimbursement as of April 1. That's when the SGR regulations - the ones that have been "kicked down the road" 17 times - will go into effect. Something needs to happen: the SGR cuts finally happen, an 18th postponement, or perhaps HR 1470, which looks like a real possibility.  

There are five major parts to HR 2 that are important to LCSWs as follows: 1) a new Medicare reimbursement formula; 2) a continued implementation of Medicare services based on quality measures (including PQRS); 3) an increase in premiums for higher income Medicare beneficiaries; 4) a two-year continuation of the CHIP program to provide Medicaid services for children; and 5) a more restrictive abortion policy.

Obviously the last two are not directly connected to Medicare policy, but as often happens in Congress, issues which would have difficulty passing on their own are often attached to bills that are likely to pass.

Here is what is meant by each of the five points above:

1. Medicare Reimbursement Formula - the Sustainable Growth Rate would be eliminated. The 21% cut that is looming would be handled by "splitting" the cut between providers and beneficiaries, meaning approximately a 10% cut to LCSWs and other providers and a 10% raise in premiums to higher income beneficiaries. All providers would also receive a .5% reimbursement increase for the next five years.  
   
2. Quality Measures (Merit-based Incentive Payment System) - the move from "quantity" to "quality", from fee-for-service to pay for performance, from small provider groups to large groups, from paper records to EHRs, has been in effect for the last 9 years. HR 2 integrates all these goals into Merit-based Incentive Payment System, or MIPS. This direction can be expected to continue, though CSWA will do everything possible to preserve the ability of LCSWs to be reimbursed as sole practitioners. HR 2 includes four ways to measure the ways that providers comply with the above including quality incentives (including PQRS); adequate use of resources for each condition and episode; meaningful use (does not apply to LCSWs); and use of alternate payment methods like Accountable Care Organizations (ACOs) and health homes. The last item would result in a bonus of 5%.
   
3. Higher Premiums for Higher Income Beneficiaries- this is one area where there is little debate, though the income level at which beneficiaries would need to pay higher premiums is still to be determined.
   
4. Continuation of CHIP- this inclusion of the Children's Health Insurance Program, which provides health care coverage for all children, has been a point of disagreement. The two-year inclusion is only half of what many progressive members of Congress sought, a four-year extension. This is already being challenged by the Senate.
   
5. Continuation of Abortion Limitations in Medicaid- this is an unexpected part of HR 1470 which continues the "Hyde amendment" which was due to expire this year. Many pro-choice members of Congress are opposing this provision.
   

Getting this bill passed will require enormous effort. CSWA believes that the current ambiguity of the bill makes it difficult to actively support it. As the form of the bill becomes clearer, we may be able to support or oppose the bill, or weigh in on parts of it, based on how it affects LCSWs.

CSWA hopes this summary is helpful in understanding what is a complicated, potentially helpful, bill.