March 23, 2014

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.

March 11, 2014

Please visit the CSWA Position Papers page to view the CSWA/NASW Response to Rep. Tim Murphy.

January 26, 2014

The Commission on Medicare and Medicaid Services and the Department of Health and Human Services have asked us to provide our patients and clients with information about how to sign up for the new health care plans which are available in the Affordable Care Act Exchange, now known as the Marketplace.

The summary of information about how to access the plans is on the CSWA website under the tab "Legislation and Advocacy". Click on "ACA Marketplace Information". This information will help anyone who wants to compare the plans at the four health care levels (Platinum, Gold, Silver, Bronze) of the Marketplace in any state.

CMS and DHHS ask us to print off some copies to keep in our waiting rooms and give to patients.

In spite of the problems with the start up of the Affordable Care Act, the value this will have to all of our citizens will be in the best interests of our patients, our practices, and the health of all citizens in our country.

November 8, 2013

The Federal Final Interim Parity Rules for the Mental Health Parity and Addiction Equity Act (MHPAEA) will be made Final Rules today when they are published in the Federal Register at 11:15 am EST. This is a victory for the five years of work that CSWA and many other organizations have devoted to getting these rules in place, the key to enforcement of MHPAEA.

This is not the complete victory that CSWA had hoped for to the extent that enforcement has been delegated to state insurance commissioners. Variation in state laws and rules can make enforcement complicated and uneven. It will be interesting to see how the state insurance commissioners assume responsibility for self-insured, i.e., ERISA, plans which had previously been overseen by the Department of Labor.

CSWA will be tracking enforcement and pursue further legislation if the insurance commissioners are unwilling/unable to make the Final Parity Rules create the equal coverage that they are untended to provide.

The main positive impact of the parity laws and final rules are that the coverage of health plans' co-payments, deductibles and limits on mental health visits to licensed clinicians are not more restrictive or less generous for mental health benefits than for medical and surgical benefits for visits to licensed medical clinicians. However, the 'non-quantitative' limits, i.e., requiring pre-authorizations for psychotherapy, different levels of coverage in for in-network/out-of-network, and determining what 'parity' means in comparing frequency and length of psychotherapy to medical/surgical treatment remain to be defined.

Coincidentally, Medicare co-pays will reach the same level as medical co-pays - 20% - on 1/1/14 after 4 years of gradually decreasing mental health co-pays from 50%. The rules do not cover Medicare or Medicaid.

While the rules do not apply to Medicare and Medicaid specifically, though past CMS guidance to states has been that parity should be a goal in Medicaid plans.

While there is more work to do, this rule implementation is a good step forward.

October 15, 2013

Many LCSWs have been stymied by the fact that there is so little correlation between the PQRS measures and our diagnostic codes (DSM/ICD). The only measures that mention a diagnostic code are #106 and #107 for major depression. However, ALL diagnostic codes we use can be linked with whether people smoke, drink, use substances and several other behaviors that CMS is tracking. Use the QDCs that apply to them if you are sending in information for other diagnoses, which you can find on the CSWA website at www.clinicalsocialworkassociation.org under "Clinical Practice" and then "PQRS Options". Scroll down to find the PQRS Measures and QDCs for those Measures.

There is NO deadline today for LCSWs who send in their QDCs on the CMS-1500.  You can wait until February 28, 2014 to do so, though getting it out of the way sooner is a good idea. You should continue to send QDCs for Medicare patients on every claim.

I know what a difficult task this has been and hope that this information is useful in navigating these rough waters.

September 2013

Please visit the CSWA Position Papers page to view the Report on Online MSW Programs.