clinical social work association

HR 4302 passed the Senate this evening and is very likely to be signed by the President shortly.  I sent you a summary of the bill on March 26, the day before it passed the House of Representatives. 

There are two main parts of this bill that affect LCSWs positively  The first is the short term delay of a cut to Medicare reimbursement of 24%, the 17th time that the Sustainable Growth Rate cut to these payments has been stopped.  The second is a long term improvement of mental health services, the Excellence in Mental Health Care Act, long promoted by Sen. Debbie Stabenow (D-MI) and included in this bill.  Additionally, implementation the ICD-10-CM codes have been delayed until October 1, 2015.

Below is a summary of the bill's main points: 

Sustainable Growth Rate Formula (SGR) Delay - The SGR calculation is intended to update rates to maintain budget neutrality, and reduce Medicare reimbursement rates to stay within budget. HR 4302 continues the Congress's avoidance of the automatic Medicare reimbursement cuts. CSWA supports this delay as Congress works toward a more realistic reimbursement formula. 

ICD-10-CM Delay - This bill delays the ICD-10-CM implementation from October 1, 2014 to October 1, 2015. One reason is the significant cost of upgrading EHRs involved.  Another is the recent CMS survey which showed that only 40% of all providers would be "ready" to use the ICD-10-CM codes by the original date.  CSWA supports the delay which would allow more time for LCSWs to be included in incentive funding for EHRs, currently not available.

Medicaid DSH Modifications Delay- The bill will delay the start of funding cuts to the Medicaid Disproportionate Share Hospital (DSH) program from FY 2016 to FY 2017. This program offers funding to hospitals with high levels of uncompensated care.  CSWA hopes that the funding will be restored to 2016. 

Demonstration Pilot for "Certified Community Behavioral Health Clinics" - The bill would start a four-year, eight-state demonstration program in which community behavioral health organizations that meet certain criteria (to be published by September 1, 2015) would be eligible for enhanced Medicaid reimbursement. This new type of mental health provider will be called a "certified community behavioral health clinic", and planning grants for the demonstration program will be awarded by January 1, 2016, for implementation by September 1, 2017.  This plan was initially proposed by a social worker, Sen. Debbie Stabenow (D-MI) as the Excellence in Mental Health Act.  CSWA congratulates our fellow social worker on this achievement. 

Assisted Outpatient Treatment Grant Program For Individuals With Serious Mental Illness - The bill includes an assisted outpatient treatment (AOT) grant program for individuals with serious mental illness, and authorizes grant awards of up to $1 million to no more than 50 grantees. AOT has raised great controversy, as it appears to make forced hospitalization/treatment easier to accomplish.  CSWA is reviewing the details of AOT, designed to prevent the violence which has occurred as a result of mental illness.

Skilled Nursing Facility Value-Based Purchasing - The bill establishes a skilled nursing facility value-based purchasing program starting in 2019 - based on an "all-cause all-condition hospital readmission measure".  CSWA continues to work toward independent Medicare Part A coverage for LCSWs, eliminated in 1997 when SNF services were 'bundled.' 

CSWA is generally pleased with the results of this bill and will be continuing to work for better access to LCSW mental health services.