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NASW Advocacy: News from the Hill – December 2009

Employment Non-Discrimination Act

NASW continues to work diligently on the Employment Non-Discrimination Act (H.R.3017/S.1584).  With 194 sponsors in the House of Representatives and 44 in the Senate, E.N.D.A. has begun to attract enormous attention.  The Employment Non-Discrimination Act is dedicated to the principle that every worker should be judged solely on his or her merits.  Further, hardworking Americans should not be kept from supporting their families and making a positive contribution to the economic life of our nation due characteristics that have no bearing whatsoever on their acumen to do a job.  The Association remains allied with traditional civil rights groups who affirm that inequality and discrimination subvert the principles of Democracy.

Political Climate
Despite the many twists and turns health care reform has taken in the past several months, we are not necessarily closer to a solution in mid-December than we were in mid-September.  The Senate still has not completed its own bill, and is trying to write legislation that can earn 60 votes.  Once they do so, a conference between House and Senate negotiators will have to occur in order to send a single bill to President Obama.  At this point, no one can guarantee when such a conference will take place.  The cause of this delay is simple: for all the attention rightfully placed on abortion-related aspects of the discussion, there is still no agreement on the fundamental way in which more Americans would receive health care coverage.  Many reasonable approaches have been mentioned in the Senate, including expansion of Medicare and a public option.  But one week before Christmas Day, there is still no single plan that has garnered the support of 60 Senators.  Until that happens, there can be no conference with the House and thus no bill for President Obama to sign into law.NASW has called on its members to contact their Senators to support the bill (H.R. 3590), and a link to our most recent action alert is here. NASW has written to Majority Leader Reid supporting the Senate reform bill, and a copy may be viewed on the NASW Web site.

Reinvestment for Educators
NASW President Jim Kelly, Baccalaureate Social Work Program Directors President Freddie Avant, and Action Network for Social Work Education and Research Chair Jeane Anastas, recently filmed a video regarding “Reinvestment for Educators” to discuss why the Social Work Reinvestment Initiative is important for social work educators. The bill will support recruitment of new social work students, retain experienced social workers, and fund social work education and research. To view the full legislation, please click here. After viewing the video, please send a letter of support to your Representative and Senators.

Social Work Medicare Equity Act in Health Care Reform
Section 1307 of the House health care reform bill (H.R. 3200) authorizes clinical social workers eligible to participate under Medicare Part B to bill independently for services to Medicare Part A covered residents of Skilled Nursing Facilities (SNFs). The provision removes Part B-eligible clinical social work services from the Medicare SNF per diem rate and alternatively authorizes them to bill for them separately. This is a long-sought change by NASW that will expand the availability of clinical social work services to SNF residents covered by Medicare Part A and provide parity recognition for the profession in a SNF setting. The Senate version of health care reform legislation (H.R. 3590) does not contain a similar provision, and this difference must be ironed out in conference committee on the legislation. NASW is working with House and Senate offices to support the provision when conference committee consideration begins.

SWRA Provisions Advance on Health Care Reform
There are several provisions within Health care reform legislation, H.R. 3590, which advance the Social Work Reinvestment Act (SWRA).  Related provisions are contained in the House-passed measure, H.R. 3200. The Senate bill includes the following key provisions addressing social work professional education and training needs:

  • Sec. 3508 – Establishes a demonstration program to integrate quality improvement and patient safety training into clinical education of health professionals. Schools of social work are among the eligible grantees.
  • Sec. 5101 – Creates a National health care workforce commission tasked with reviewing health care workforce and projected workforce needs. The needs of the social work profession are among those that would be considered by the Commission and schools of social work also have representation.
  • Sec. 5102 – Creates state health care workforce development competitive grants to s. enabling State partnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the State and local levels. All health professions are eligible for state planning attention, including social work.
  • Sec. 5203 – Establishes health and behavioral health workforce loan repayment programs for pediatric subspecialists and providers of mental and behavioral health services to children and adolescents who are or will be working in a Health Professional Shortage Area, Medically Underserved Area, or with a medically underserved population.
  • Sec. 5305 – Authorizes funding for geriatric education and training; career awards; comprehensive geriatric education to advanced practice nurses, clinical social workers, pharmacists, and psychologists.
  • Sec. 5306 – Awards to mental and behavioral health education and training grants to schools for the development, expansion, or enhancement of training programs in social work, graduate psychology, professional training in child and adolescent mental health, and pre-service or in-service training to paraprofessionals in child and adolescent mental health.
  • Section 756 of the Public Health Services Act is amended to include language regarding the qualifications of institutions eligible for these training grants and that at least four will go to Historically Black Colleges and Universities (HBCU) or Minority Serving Institutions (MSI).  Authorization for up to $8 million in funds is provided for social work.

Medicare MD & MSW Fee Schedule Update
Clinical social workers that participate in Medicare Part B will have their payment rates temporarily protected against large cuts scheduled for 2010 because Congress acted on a short-term bill to delay the cut required by the flawed sustainable growth rate (SGR) formula, which determines outpatient payment rates in Medicare and TRICARE. The SGR formula is frequently inappropriately described as the Medicare “physician fee” formula, but it actually sets the rate of increase or decrease for all Medicare Part B independent practitioners, including clinical social workers. NASW supports legislation that would halt scheduled cuts in Medicare payments to clinical social workers and other health professionals and has urged Congress to adopt legislation to recalibrate how these payments are set each year. See NASW’s letter to Congress here.

Correcting the problem before the rate cuts go into effect on Jan. 1, each year is politically difficult due to the multi-billion dollar costs of correcting the formula. Current law requires large annual reductions in Medicare SGR determined fees, which include rates paid to clinical social workers. Congress rejected several earlier SGR bills this fall, but then passed an eight week extension into February, enabling it to address the payment problem once it finishes work on health care reform. NASW is continuing to work with coalition partners in support of an SGR remedy.

Appropriations Bill Funds Study on Mental Workforce Issues

During the week of December 9, Congress finished the annual appropriations bill for the federal FY 2010, Labor-HHS-Education spending bill, which is available on the House Appropriations website. One item of special interest to the social work profession is the inclusion of $900,000 for the Institute of Medicine (IOM) to study mental health workforce needs focused on (1) a systematic analysis of the current and projected mental and behavioral healthcare needs of the American people, particularly for aging and growing ethnic populations; and (2) developing policy recommendations for achieving a competent and well-trained mental health workforce to address those needs.  Congressional authors justified the study as necessary in light of the projected doubling of the aged population by 2030, new evidence of the importance of addressing mental health needs as part of effective chronic disease management, increased numbers of veterans with post traumatic stress disorder, improved diagnostic techniques, and implementation of the new federal mental health parity law. The study expands on IOM’s 2008 broader study on the geriatric workforce, which did not explore mental health workforce needs in depth. NASW worked with other mental health professional groups to support this funding in the new law, and will advocate vigorously for the representation of the social work profession in the work of the IOM.

Health Legislation Prospects for 2010
At the start of the new year, Congress is not expected to consider major new health legislation, but congressional committees will consider routine health legislation, particularly those bills that were set aside last year to make time for health reform legislation. These include the 21st Century Cancer ALERT Act, reauthorization of HHS/Public Health Service programs under the jurisdiction of the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA). Furthermore, congressional oversight of new federal programs to promote the use of health information technology (HIT) and to protect confidential patient information is expected to be a priority. NASW will represent clinical social worker interests to ensure the profession is included for all Medicare HIT incentive payments and that psychotherapy notes are protected in federal privacy regulations.
Congress also faces a variety of funding challenges to implement health care reform, particularly programs that support the education and training of the health professions. NASW will aggressively pursue expanded federal support for the social work profession in these federal initiatives. As in past years, Congress has not settled on a long-term solution to the Medicare physician payment formula, which also determines the payment rate for clinical social workers and all the health professions that directly bill Medicare Part B.  NASW will continue to advocate for adequate payment rates for the profession during this protracted debate. NASW members who wish to stay informed about health and behavioral health developments in the new Congress should follow NASW’s webpage.

NIH Approves New Stem Cell Lines
On December 2, the National Institutes of Health (NIH) approved 13 new human embryonic stem cell lines for use by NIH funded researchers. Another 96 embryonic stem cell lines are undergoing NIH review. In March, President Obama expanded the number of such cell lines beyond those available under a policy set by President George W. Bush, which permitted research to begin only with lines already available on Aug. 9, 2001. To read more, go to the NIH press release.

Needle and Syringe Exchanges Ban Lifted
On December 13, the Senate passed the Consolidated Appropriations Act of FY2010 by a vote of 57 – 35.  The President is expected to sign the bill before the continuing resolution expires.  Among many other important provisions, the bill removes the federal funding ban on syringe exchange. The provision allows the distribution of syringes through syringe exchange as long as local public health or local law enforcement authorities do not object to a specific location as being inappropriate for distribution.

NASW Supports Child Welfare Workforce Improvement Act
On November 30, NASW sent a letter to Senator Blanche Lincoln (AR) thanking her for introducing S. 2837 the Child Welfare Workforce Improvement Act. The bill will help ensure a workforce that can accurately assess the strengths and needs of children and families, connect children and their families to services, monitor their progress, and improve outcomes for children. NASW sent an alert to the Advocacy Listserv looking for cosponsors.

Immigration Bill Introduced in House
Representative Luis Gutierrez (IL-4) introduced immigration legislation, Comprehensive Immigration Reform for America’s Security and Prosperity (H.R. 4321), in the House on December 15. Congress is beginning to shape the immigration debate with the introduction of this bill and NASW is developing our strategy. You can view the bill here. Immigration will be an important issue tackled in 2010.

Veteran’s Affairs
Recently, we heard from a member of NASW who is an MSW student and a veteran who recently returned from Afghanistan.  He hoped to find a mental health counselor who was both a veteran and a social worker.  While he strongly supports the work of all social workers, he wanted to find one who could directly relate to his experience in war.  The Veterans Administration in his area was unable to locate such a person for him, and other non-VA efforts came up empty as well.

This is a clear connection between member needs and NASW advocacy.  Veterans represent a constituency who may choose to enter social work to benefit both their peers and other members of society, but only if there is a distinct path for them to do so.  Thus, NASW has intensified its focus on veteran’s issues.  This improvement is meant to benefit not just veterans, but the field of social work as well.

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