Medicare Reimbursement
Improving Access to Mental Health Act (S. 838/H.R. 1638)
NASW leads sign on letter of 64 diverse national organizations in support of the Improving Access to Mental Health Act (S. 838/H.R. 1638) (11/2/2023)
Download the 2023 Medicare Reimbursement Issue Brief
Background
Across the country, millions of Medicare beneficiaries experience significant
health and mental health challenges. The beneficiary population is rapidly
increasing in size, changing demographically, and coping with issues such
as functional limitations, multiple chronic conditions, social isolation,
economic insecurity, and ageism. Our health care system must be able to
meet beneficiaries’ health and mental health needs.
Clinical social workers (CSWs) are the largest group of mental health service
providers in the United States and are among the professions that can bill
Medicare Part B for mental health services. They have a graduate degree
(master’s or doctorate) in social work, two years of postgraduate supervised
experience in a clinical setting, and a clinical license in their state or
jurisdiction of practice. They use a holistic approach in providing services,
focusing on biological, psychological, and social factors. CSWs are currently
able to bill Medicare Part B for the diagnosis and treatment of mental illness.
However, they are not able to bill Medicare Part B for psychosocial services
provided in skilled nursing facilities (SNFs) or for Health and Behavior
Assessment and Intervention (HBAI) services, even though they are within
CSWs’ scope of practice.
The National Academies of Sciences, Engineering, and Medicine in its
September 2019 Consensus Study, Integrating Social Care Into the Delivery
of Health Care, recommends that federal agencies expand the scopes of
practice of social workers in order to build the workforce to address the
social (e.g. non-medical) factors that play a key role in health outcomes.
These factors, also called the social determinants of health, include stable
housing, reliable transportation and economic security. There is consistent
and compelling evidence that addressing the social factors in health is
critical in improving the prevention and treatment of acute and chronic
illnesses. The study also calls for the adequate payment of social workers to
ensure a sufficient social care workforce.
Legislative Solution: Support the Improving Access to Mental Health Act, S. 838/H.R. 1638
NASW urges Members of Congress to cosponsor and advance the Improving
Access to Mental Health Act (S. 838). This legislation was introduced in a
bipartisan manner by Senators Debbie Stabenow, MSW (D-MI), and John
Barrasso, MD (R-WY). The House companion bill (H.R. 1638) was introduced by Representatives Barbara Lee, MSW (D-CA-12) and Brian Fitzpatrick
(R-PA-01). The legislation enhances Medicare beneficiaries’ access to the
valuable services of independent CSWs in two scenarios:
- While residing in SNFs, even if they are accessing Medicare Part A
- While experiencing a psychosocial concern arising due to medical
condition
Further
The Improving Access to Mental Health Act increases the
Medicare reimbursement rate for CSWs from 75% to 85% of the physician
fee schedule, thereby mitigating reimbursement inequity.
Overview of Provisions
Increase Medicare Beneficiaries’ Access to Mental Health Services in Skilled Nursing Facilities (SNFs):
Mental health concerns, such as
depression and anxiety, are common among SNF residents, and SNFs
frequently address these concerns by arranging for services from an
independent mental health provider. However, beneficiaries who receive SNF
services under Medicare Part A cannot simultaneously receive services from
an independent CSW under Part B. This limits the pool of practitioners who
can serve SNF residents, which is problematic given the high incidence of
mental health conditions among SNF residents, and the high ratio of 120
residents to every medical social worker (who may not actually have received
a social work degree). This access barrier exists because when SNF
consolidated billing was implemented, psychiatrists’ and psychologists’
services were excluded from the Prospective Payment System, but CSW
services were not. Medicare beneficiaries who transfer from a setting in
which they receive mental health services from an independent CSW under
Medicare Part B to a SNF, where they cannot receive such services,
experience a disruption in care. Such care transitions can occur even if the
beneficiary is moved within the same building or remains in the same bed.
The reimbursement restriction also limits the pool of Medicare providers
available to meet newly identified mental health needs of beneficiaries
during a SNF stay. Correcting this will enhance beneficiaries’ access to
mental health services in SNFs.
Increase Medicare Beneficiaries’ Access to Health and Behavior Assessment and Intervention (HBAI) Services:
HBAI services help
Medicare beneficiaries with emotional and psychosocial concerns that arise
because of a medical condition (such as a diagnosis of cancer or an exacerbation of multiple sclerosis) and are unrelated to a mental health
condition. Although beneficiaries can access Medicare Part B–reimbursed
HBAI services from psychologists and psychiatrists, they cannot access them
from independent CSWs. This access barrier exists because Medicare Part B
reimbursement for independent CSW services is restricted to the diagnosis
and treatment of mental illness. Expanding this definition to include HBAI
services will remove the access barrier for beneficiaries.
Increase Medicare Reimbursement for Independent Clinical Social Workers:
CSWs are among the few mental health professions that provide
psychotherapy services for Medicare beneficiaries. Medicare reimburses
CSWs at only 75% of the physician fee schedule. Psychiatrists and
psychologists are reimbursed 100% of the physician fee schedule. The
CSW rate is even lower than the 85% rate at which some non-physician
practitioners (nurse practitioners, physician assistants, clinical nurse
specialists, occupational therapists, physical therapists, speech language
pathologists, registered dieticians) are reimbursed. Mitigating this
reimbursement inequity by increasing CSWs’ rates to 85% of the physician
fee schedule will increase recruitment and retention of CSWs in the
Medicare workforce, thereby expanding provider options for beneficiaries.
- Centers for Medicare & Medicaid Services. (n.d.). Mental health care: Outpatient. Retrieved from www.medicare.gov/coverage/mental-health-care-outpatient
- National Academies of Sciences, Engineering, and Medicine. (2019, September). Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health. Retrieved from http://nationalacademies.org/hmd/Reports/2019/integrating-social-care-intothe-delivery-of-health-care