Some clinical social workers have requested 100 percent reimbursement comparable to the psychologists and psychiatrists.
ISSUE
Fall 2017
PracticePerspectives
The National Association of Social Workers
Mirean Coleman M S W, L I C S W, C T
750 First Street NE
Clinical Manager
Suite 800
[email protected]
Washington, DC 20002-4241 SocialWorkers.org
Advocating for Clinical Social Workers: A Look at 2017 One of the most frequently asked questions from NASW members is, “What are you doing to advocate for clinical social workers?” NASW
Practice Perspectives Fall 2017
engages in a multitude of advocacy efforts for clinical social workers, especially areas in which members have identified specific concerns. For the year 2017, NASW’s advocacy efforts on behalf of clinical social workers are described in this document.
750 First Street NE, Suite 800 Washington, DC 20002-4241 SocialWorkers.org
Mental Health Parity
©2017 National Association of Social Workers. All Rights Reserved.
Members have expressed concerns that not all third-party payers have implemented mental health parity policies with medical services. NASW is a committee member of the ClearHealth Quality Institute, Mental Health Parity Accreditation Standards Committee. ClearHealth Quality Institute is a newly formed accreditation organization that develops and offers accreditation and certification programs. The committee is representative of payers, providers, and consumer advocates and is developing mental health parity accreditation standards for use by third-party payers. When completed, these accreditation standards will provide guidelines for all
payers to use and will help to ensure that mental health parity policies are consistently administered across payers and their patients.
Social Security Disability Eligibility Determinations Clinical social workers have expressed concerns that they are unable to determine eligibility determinations for persons with a disabling mental illness applying for Social Security disability benefits. For several years, NASW has been advocating for clinical social workers to become “medical sources” and on several occasions have submitted requests to Social Security to reconsider this matter. NASW last submitted a request during the fall of 2016 for clinical social workers to become medical sources beginning in 2017. The request was denied with one of the rationales being that there was not a consistent definition among state statutes of what services clinical social workers performed. NASW will continue to advocate for clinical social workers to become medical sources.
ICD-11 The World Health Organization (WHO) is working on the International Classification of Diseases-Eleventh Edition (ICD-11) and proposed to transfer all of the diagnoses of dementia from the Mental or Behavioural Disorder chapter into the chapter on Diseases
NASW engages in a multitude of advocacy efforts for clinical social workers, especially areas in which members have identified specific concerns.
of the Nervous System. NASW objected to this proposal because it would have prevented clinical social workers and other mental health professionals from providing necessary mental health treatment to patients with dementia. Along with other associations, NASW made a written request to the WHO to retain the diagnoses of dementia in the chapter of Mental or Behavioural Disorders in the ICD-11. The request was granted, and as a result, clinical social workers will be able to continue to perform services for neurocognitive disorders such as dementia when the ICD-11 is implemented in the United States.
with the Centers for Medicare and Medicaid Services (CMS) and reminders to them through proposed rule comments on the Physician Fee Schedule. NASW continues to advocate for this issue through Congress. The Improving Access to Mental Health Act of 2017, H.R. 1290 has been introduced and ensures skilled nursing facility residents access to clinical social work services by excluding their services from consolidated billing. Additional information on this subject is available at: SocialWorkers.org/ Advocacy/Policy-Issues/Medicare-Reimbursement
CPT Codes
Clinical social workers have expressed concerns about low reimbursement rates. To address their concerns, NASW is advocating through the Improving Access to Mental Health Act of 2017, for clinical social workers to receive 85 percent of the physician fee schedule. This is a 10 percent increase in reimbursement that clinical social workers would receive. Some clinical social workers have requested 100 percent reimbursement comparable to the psychologists and psychiatrists. Because the MSW is a terminal degree, it would be difficult to obtain 100 percent. Many insurance companies recognize the value of a doctorate in clinical social work and have voluntarily chosen to reimburse those with a doctorate in clinical social work and a clinical license at the same rate as psychologists and psychiatrists.
Each quarter NASW sends two representatives to the Current Procedural Terminology (CPT) Editorial Panel Meeting to provide input to procedural codes to identify services developed for use by clinical social workers and others providers. Through this process psychotherapy codes are created, revised, or deleted. The Health and Behavioral Assessment and Intervention codes were also developed through the process and are currently under revision. NASW advocates for new and revised codes for clinical social workers continuously.
Work and Practice Expense Values NASW also sends two representatives each quarter to the Health Care Professional Advisory Committee (HCPAC) of the Relative Value System Update Committee (RUC) of the American Medical Association. This committee determines the work and practice expense values of CPT codes based on provider surveys. The cost of providing services is divided into three components: work, practice expense, and professional liability insurance. The work component consists of 50.9 percent of the code value. The practice expense value consists of 44.8 percent of the code, and the professional liability insurance consists of 4.3 percent of the value of the code. NASW represents clinical social workers on this advisory committee and advocates for the best values for clinical social workers.
Skilled Nursing Facility In 2002, enforcement of the Consolidated Billing Act of 1997 prevented clinical social workers from receiving reimbursement of psychotherapy services within a skilled nursing facility. NASW has been advocating to restore payment of these services to private practitioners through meetings
Reimbursement
Health and Behavioral Assessment and Intervention Codes Clinical social workers have requested NASW to assist them in acquiring reimbursement for emotional, behavioral, and psychosocial services related to a health condition. To access payment to the Health and Behavioral Assessment and Intervention (HBAI) Codes requires a change in the Social Security statute that defines the services that clinical social workers are allowed to perform for reimbursement. NASW is addressing this issue also in the Improving Access to Mental Health Act of 2017. Although a limited number of Medicare Administrative Contractors are reimbursing clinical social workers for these services, NASW is advocating for clinical social workers to be reimbursed for the HBAI codes at the national level.
Quality Measures Use of measures in health care has become a standard of practice to determine whether quality services are being performed. Health plans are expecting clinical social workers and others to use quality measures. NASW is advocating for patient-centered, integrative measures for use by clinical social workers and has been actively involved with CMS and its designated contractors to create relevant measures. For 2017, NASW is participating in measure development in areas such as depression screening, elder maltreatment, substance use, alcohol and tobacco screening, attention deficit hyperactivity disorder, and documentation in the medical record. NASW advocated for clinical social workers who received 2017 PQRS negative payment adjustments from CMS. NASW requested CMS
to review for errors clinical social work feedback reports it received from members. CMS honored the request, and discovered errors had been made on feedback reports submitted to NASW from members in Pennsylvania. Those negative payment adjustments from Pennsylvania were reversed.
Other Advocacy Areas NASW’s advocacy efforts for clinical social workers are just a few highlights of what the association is doing to help the social work community. NASW also advocates for other specialty areas of social workers and those efforts can be found on NASW’s advocacy website at SocialWorkers.org/Advocacy For additional information on other clinical social work issues, visit NASW at SocialWorkers.org/Practice/ClinicalSocial-Work.
NASW also sends two representatives each quarter to the Health Care Professional Advisory Committee (HCPAC) of the Relative Value System Update Committee (RUC) of the American Medical Association.
NASW engages in a multitude of advocacy efforts for clinical social workers, especially areas in which members have identified specific concerns.
of the Nervous System. NASW objected to this proposal because it would have prevented clinical social workers and other mental health professionals from providing necessary mental health treatment to patients with dementia. Along with other associations, NASW made a written request to the WHO to retain the diagnoses of dementia in the chapter of Mental or Behavioural Disorders in the ICD-11. The request was granted, and as a result, clinical social workers will be able to continue to perform services for neurocognitive disorders such as dementia when the ICD-11 is implemented in the United States.
with the Centers for Medicare and Medicaid Services (CMS) and reminders to them through proposed rule comments on the Physician Fee Schedule. NASW continues to advocate for this issue through Congress. The Improving Access to Mental Health Act of 2017, H.R. 1290 has been introduced and ensures skilled nursing facility residents access to clinical social work services by excluding their services from consolidated billing. Additional information on this subject is available at: SocialWorkers.org/ Advocacy/Policy-Issues/Medicare-Reimbursement
CPT Codes
Clinical social workers have expressed concerns about low reimbursement rates. To address their concerns, NASW is advocating through the Improving Access to Mental Health Act of 2017, for clinical social workers to receive 85 percent of the physician fee schedule. This is a 10 percent increase in reimbursement that clinical social workers would receive. Some clinical social workers have requested 100 percent reimbursement comparable to the psychologists and psychiatrists. Because the MSW is a terminal degree, it would be difficult to obtain 100 percent. Many insurance companies recognize the value of a doctorate in clinical social work and have voluntarily chosen to reimburse those with a doctorate in clinical social work and a clinical license at the same rate as psychologists and psychiatrists.
Each quarter NASW sends two representatives to the Current Procedural Terminology (CPT) Editorial Panel Meeting to provide input to procedural codes to identify services developed for use by clinical social workers and others providers. Through this process psychotherapy codes are created, revised, or deleted. The Health and Behavioral Assessment and Intervention codes were also developed through the process and are currently under revision. NASW advocates for new and revised codes for clinical social workers continuously.
Work and Practice Expense Values NASW also sends two representatives each quarter to the Health Care Professional Advisory Committee (HCPAC) of the Relative Value System Update Committee (RUC) of the American Medical Association. This committee determines the work and practice expense values of CPT codes based on provider surveys. The cost of providing services is divided into three components: work, practice expense, and professional liability insurance. The work component consists of 50.9 percent of the code value. The practice expense value consists of 44.8 percent of the code, and the professional liability insurance consists of 4.3 percent of the value of the code. NASW represents clinical social workers on this advisory committee and advocates for the best values for clinical social workers.
Skilled Nursing Facility In 2002, enforcement of the Consolidated Billing Act of 1997 prevented clinical social workers from receiving reimbursement of psychotherapy services within a skilled nursing facility. NASW has been advocating to restore payment of these services to private practitioners through meetings
Reimbursement
Health and Behavioral Assessment and Intervention Codes Clinical social workers have requested NASW to assist them in acquiring reimbursement for emotional, behavioral, and psychosocial services related to a health condition. To access payment to the Health and Behavioral Assessment and Intervention (HBAI) Codes requires a change in the Social Security statute that defines the services that clinical social workers are allowed to perform for reimbursement. NASW is addressing this issue also in the Improving Access to Mental Health Act of 2017. Although a limited number of Medicare Administrative Contractors are reimbursing clinical social workers for these services, NASW is advocating for clinical social workers to be reimbursed for the HBAI codes at the national level.
Quality Measures Use of measures in health care has become a standard of practice to determine whether quality services are being performed. Health plans are expecting clinical social workers and others to use quality measures. NASW is advocating for patient-centered, integrative measures for use by clinical social workers and has been actively involved with CMS and its designated contractors to create relevant measures. For 2017, NASW is participating in measure development in areas such as depression screening, elder maltreatment, substance use, alcohol and tobacco screening, attention deficit hyperactivity disorder, and documentation in the medical record. NASW advocated for clinical social workers who received 2017 PQRS negative payment adjustments from CMS. NASW requested CMS
to review for errors clinical social work feedback reports it received from members. CMS honored the request, and discovered errors had been made on feedback reports submitted to NASW from members in Pennsylvania. Those negative payment adjustments from Pennsylvania were reversed.
Other Advocacy Areas NASW’s advocacy efforts for clinical social workers are just a few highlights of what the association is doing to help the social work community. NASW also advocates for other specialty areas of social workers and those efforts can be found on NASW’s advocacy website at SocialWorkers.org/Advocacy For additional information on other clinical social work issues, visit NASW at SocialWorkers.org/Practice/ClinicalSocial-Work.
NASW also sends two representatives each quarter to the Health Care Professional Advisory Committee (HCPAC) of the Relative Value System Update Committee (RUC) of the American Medical Association.
ISSUE
Fall 2017
PracticePerspectives
The National Association of Social Workers
Mirean Coleman M S W, L I C S W, C T
750 First Street NE
Clinical Manager
Suite 800
[email protected]
Washington, DC 20002-4241 SocialWorkers.org
Advocating for Clinical Social Workers: A Look at 2017 One of the most frequently asked questions from NASW members is, “What are you doing to advocate for clinical social workers?” NASW
Practice Perspectives Fall 2017
engages in a multitude of advocacy efforts for clinical social workers, especially areas in which members have identified specific concerns. For the year 2017, NASW’s advocacy efforts on behalf of clinical social workers are described in this document.
750 First Street NE, Suite 800 Washington, DC 20002-4241 SocialWorkers.org
Mental Health Parity
©2017 National Association of Social Workers. All Rights Reserved.
Members have expressed concerns that not all third-party payers have implemented mental health parity policies with medical services. NASW is a committee member of the ClearHealth Quality Institute, Mental Health Parity Accreditation Standards Committee. ClearHealth Quality Institute is a newly formed accreditation organization that develops and offers accreditation and certification programs. The committee is representative of payers, providers, and consumer advocates and is developing mental health parity accreditation standards for use by third-party payers. When completed, these accreditation standards will provide guidelines for all
payers to use and will help to ensure that mental health parity policies are consistently administered across payers and their patients.
Social Security Disability Eligibility Determinations Clinical social workers have expressed concerns that they are unable to determine eligibility determinations for persons with a disabling mental illness applying for Social Security disability benefits. For several years, NASW has been advocating for clinical social workers to become “medical sources” and on several occasions have submitted requests to Social Security to reconsider this matter. NASW last submitted a request during the fall of 2016 for clinical social workers to become medical sources beginning in 2017. The request was denied with one of the rationales being that there was not a consistent definition among state statutes of what services clinical social workers performed. NASW will continue to advocate for clinical social workers to become medical sources.
ICD-11 The World Health Organization (WHO) is working on the International Classification of Diseases-Eleventh Edition (ICD-11) and proposed to transfer all of the diagnoses of dementia from the Mental or Behavioural Disorder chapter into the chapter on Diseases
