NASW Health Care Roundup – Nov 10, 2009

Nov 10, 2009

House Passes Health Care Reform Legislation

In an historic vote, the House passed major health care reform legislation on November 7, with a vote of 220-215. NASW strongly supports the health care reform bill (H.R. 3962), which included a Medicare provision allowing clinical social workers to bill independently for serving certain nursing home residents. A copy of NASW’s endorsement letter highlighting provisions of great concern to social workers is linked here.

Abortion Emerges as Major Controversy in Reform

During negotiations leading up to passage, a new unsettled question arose over whether consumers who buy insurance without any government subsidy will be able to obtain insurance that covers abortion services through the federal insurance exchange established in the bill.

Abortion rights advocates and opponents agree the House language spearheaded by Bart Stupak, D-MI, would restrict access to abortion procedures for consumers who receive subsidies to buy insurance in a reconfigured health care system. Anti-abortion groups say the amendment explicitly bars private insurers from including abortion coverage in plans they sell in the exchange to consumers who pay the premiums out of pocket, but pro-choice organizations are very concerned the new language goes much further and threatens the availability of private insurance coverage for these services. NASW opposes the Stupak amendment and is working with pro-choice groups to eliminate it in the Senate and final bill. The Senate will begin consideration of health reform legislation next week, and differences between the House and Senate version will ultimately be worked out in a conference committee.

NASW Acts on New Medicare Provider Enrollment Barrier

NASW plans to join with a large coalition of medical and health care practitioner groups to urge the Centers for Medicare and Medicaid Services, (CMS) to halt implementation of a new payment policy affecting clinical social workers and other health professionals that bill independently under Medicare Part B. The new administrative barrier concerns PECOs, a database that clinical social workers will soon be required to enroll in as a condition of participation in Medicare Part B. In 2003, Medicare switched to the new PECOS database for Medicare providers.  Recently Medicare claims have been denied for any provider who is not in the PECOS system, although practitioners were not told they needed to re-enroll as Medicare providers so they could be in the PECOS system.  There are nearly 800,000 Medicare providers, but only over 500,000 have enrolled in PECOS up to the present.  The remaining 300,000 providers must re-enroll and get revalidated.  This process is similar to many insurance company processes and is long and cumbersome.  Claims by these 300,000 providers are now being denied and electronic claims are being denied immediately.  Those submitting paper claims are not being paid, but without explanation.

FTC Red Flags Rule Enforcement Delayed

The FTC has announced that it is again delaying enforcement of the “Identity Theft Red Flags” Rule” until June 1, 2010. The rules would have directly affected clinical social workers in small private and group practices. One of the controversial aspects of the Rule was its applicability to health care professionals, particularly small or solo practitioners.  The Rule has been delayed previously on two separate occasions.  NASW provided information about the identity theft regulations in the June 2009 LDF Legal Issue of the Month and the article may be accessed here.

As the regulatory situation has grown more difficult, a number of health and other professionals have approached Congress seeking a legislative solution. Congress has responded with quick movement on a bill, H.R. 3763, which would exclude licensed health practitioners with fewer than 20 people in a practice from reporting under the Fair Credit Reporting Act and from the Red Flags Rule. The bill was introduced in the House and passed the floor a brief three weeks after introduction. It is now pending before the Senate where momentum could slow down in response to the FTC’s action postponing implementation of the regulation. More information is available at an FTC website here.

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