Rep. Lee’s Bill Expands Clinical Social Workers Roles in Medicare

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Congresswoman Barbara Lee (D-CA-13), chair of the Congressional Social Work Caucus, introduced a bill last week addressing several critical issues confronting clinical social workers providing mental health services to Medicare recipients. The Improve Medicare Beneficiaries’ Access to Mental Health Services Act of 2015, if it becomes law, would add clinical social workers to qualified service providers for Medicare recipients in skilled nursing facilities. It would increase the Medicare reimbursement rate for clinical social workers from its current rate of 75 percent to 85 percent. And, it would also allow clinical social workers to be reimbursed for Health and Behavior Assessment and Intervention (HBAI) services that may not be directly related to mental health treatment. Senator Debbie Stabenow, one of two social workers serving in the Senate, introduced a companion bill.

The National Association for Social Workers (NASW) has been working to remove these regulatory barriers that have limited Medicare recipients’ access to quality services provided by clinical social workers—the nation’s largest group of mental health service providers. There are about a quarter million licensed clinical social workers in the United States. Rep. Lee’s bill addresses the three areas of concern by amending language in Title 18 of the Social Security Act. According to NASW, in order to be certified as a Medicare provider, a social worker must have a Master in Social Work (MSW) degree or doctorate from an accredited school of social work and two years or 3,000 hours of supervised post-graduate clinical experience. She or he must have a clinical license or certification from the state of practice, must obtain a National Provider Identifier Number, and have malpractice insurance.

Rep B Lee

The Clinical Social Work Association (CSWA) points out that participation in Medicare can be confusing for clinical social workers. Once CSWs sign up as Medicare providers they must accept all referrals unless they “opt out” which would allow them to privately contract with Medicare beneficiaries. According to the CSWA, the “opt out” period is generally for two years. There are a number of reasons CSWs may decide to “opt out” of being a Medicare Provider. One reason is the Medicare reimbursement rate for CSWs is just 75 percent that of psychiatrists and psychologists. Increasing the rate to 85 percent, increases the likelihood more clinical social workers will participate in Medicare.

Currently clinical social workers are reimbursed through Medicaid Part B and cannot be reimbursed for services provided to beneficiaries in skilled nursing facilities (SNF) under Medicaid Part A. This limits Medicare beneficiaries’ access to mental health services provided by clinical social workers including services that could be interrupted if the beneficiary is transferred to a SNF while receiving treatment from a clinical social worker. The bill would amend language in Title 18 of the Social Security Act to include clinical social workers among providers of services in skilled nursing homes.

The bill would also fix another problem. While the Social Security Act provides reimbursement for the diagnosis and treatment of mental health problems, it does not specify reimbursement for behavioral health services covered by the Health and Behavior Assessment and Intervention (HBAI) codes such as emotional and social problems that may occur due to medical conditions such as diagnoses of cancer or Alzheimer’s disease. Currently payments to CSWs are left to the discretion of each local Medicare Administrative Contractor. Rep. Lee’s bill would include HBAI code services in those that can be provided by clinical social workers.

As the nation’s population ages, it is critical that licensed clinical social workers participate as Medicare providers and have the widest possible latitude to provide billable services. For more information regarding the Improve Medicare Beneficiaries’ Access to Mental Health Services Act of 2015 and issues related to clinical social workers and Medicare, contact Dina Kastner at NASW (

Written By Charles E. Lewis Jr., Ph.D

Rep. Lee’s Bill Expands Clinical Social Workers Roles in Medicare was originally published @ Congressional Research Institute for Social Work and Policy » Charles Lewis and has been syndicated with permission.

Photo by Glyn Lowe Photoworks.


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