Social Work Blog Social work updates from NASW
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September 25, 2019
The Centers for Medicare and Medicaid Services (CMS) has proposed two reductions in reimbursement for clinical social workers (CSWs) who are Medicare providers. These proposed cuts include a four percent cut in 2020 for code revisions or a seven percent cut in 2021 to increase reimbursement for evaluation and management (E/M) services which are provided by physicians, nurse practitioners, and physician assistants. The National Association of Social Workers (NASW) strongly opposes these cuts.
The proposed reductions are included in the proposed rule issued by CMS, File Code CMS-1715-P; CY 2020 Revisions to Payment Policies under the Physician Payment Schedule and Other Changes to Part B Payment Policies.
CSWs are already only reimbursed at 75 percent of the physician fee schedule, lower than any other mental health provider in Medicare Part B. NASW’s congressional champions have introduced legislation in the House and Senate to increase this rate to 85 percent.
If CSWs cannot afford to remain in Medicare, then millions of Medicare beneficiaries, including older adults and persons with disabilities, will lose access to essential mental health services. The nation can ill afford to implement these disincentives to CSW participation in this major federal program.
Even if you are not a Medicare provider, it is important to note that private insurance often follows Medicare’s lead when updating payment rates and policies. In other words, this proposal may affect all CSWs.
We urge you to reach out to CMS by Friday, September 27 to make your voice heard. Simply click on the link below to send a pre-completed email to CMS Administrator Seema Verma expressing your opposition to the proposed payment cuts.
NASW has submitted comments on the proposed rule: NASW submits comments to CMS on the CY 2020 Revisions to Payment Policies under the Physician Payment Schedule and Other Changes to Part B Payment Policies (Sept. 24, 2019)
Thank you for your engagement in this critically important advocacy effort. Contact CMS today!
CSWs are already only reimbursed at 75% of the physician fee schedule, lower than any other mental health provider in Medicare Part B. NASW’s congressional champions have introduced legislation in the House and Senate to increase this rate to 85%.
If CSWs cannot afford to remain in Medicare, then millions of Medicare beneficiaries, including older adults and persons with disabilities, will lose access to essential mental health services. The nation can ill afford to implement these disincentives to CSW participation in this major federal program.
With COVID the psychological needs of support for all citizens is critical. We have only begun to see those in the health care field and other essential employees to inquire about therapeutic services. They and the rest of the population is in severe emotional distress with the pandemic, economic struggles, holding onto their jobs and residences. Medicare has always provided access to these essential services and CSS’s perform the majority of telehealth services. They are uniquely equipped to address the entire person and their communities.
Please do not diminish the support for social workers as they make themselves available to these critical needs.
This is another big pharma move since these individuals (MD, ARNP, and PA’s) primary role in the mental health system is prescribing medications, but not providing therapy, counseling, or crisis intervention services as social workers do across many medical and social setting in this country. So social workers are being through under the bus in a rob Peter to pay Paul move, which will weaken and already fragile system and hurt seniors and veterans in the process. Many VA and non-VA services that veterans and their family members receive are funded either directly or secondarily by Medicare. For example: Veterans that receive services by the VA directly or under a VA contract outside the system, which VA then turns around and bills the veteran’s Medicare coverage to recoup 80% to 100% of that cost, which is a major offset in the VA’s annual budget. Both seniors and veterans (sometimes one in the same – 18.2 million veterans in the US) will be hurt by this change. This would be ironic given the Congressional and National claims of concern for veterans mental health and the rising suicide rates across the nation of both veterans and the elderly.
The hard and dedicated work that Social Workers
do deserves more reimbursement not less.
For the sake of the medicare clients, do not reduce the fee for the strong assistance that Social Workers perform.
I agree. It is time for social workers to get a financial thank you. This is no different than the fight to increase pay for teachers. Clinical Social Workers are one of three mental health professions that provide psychotherapy services to Medicare beneficiaries, and the largest mental health provider group in Medicare.
This is terrible. First you say we need more LCSW’s to provide services to the clients in AR adequately because NO other license will count. My clients were devastated when insurance demanded they switch therapist due to a license/ insurance demand. I had been treating some of them in day treatment setting for 7 years. They felt betrayed. Its unacceptable. Now You want to cut their rates of pay. What kind of terrible horse crap is this…. How will the clients we serve be impacted when no one bothers to get the LCSW license because the pay rates are just not worth the extra time, energy, money it takes to license up. It will not longer be worth it to bother getting the LCSW.
So bottom line are LCSW special or not. If you demand they are the only people to provide certain services, then why will you not recognize them an asset and pay the higher rate.
The proposed cuts for LCSW’s should not happen. Social work is a hard field and social workers often go above and beyond the typical work day to assist their clients. A huge percentage of individuals with mental illness utilize medicare or medicaid due to their often debilitating disease. It is not ok to make cuts for medicaid or medicare payments to those who are working with them to recover and potentially get them back in the workforce.
We need to invest more in mental health, not less
Cutting the Reimbursement will impact many lives that need mental health services! LCSW can off therapy which a MD can not do they are not licensed to do so! LCSW can also have a private practice NPs must be back by an MD i think that shows we are pretty much the most qualified for diagnosing and treating mental illness and are trained in assessing needs not to mention higher levels of case management to connect our clients to needed services! We hold a masters degree both LMSW and LCSW should have the right to continued to service rehabsclients as well!
I cannot even believe this. With the amount of money that I had to spend to be able to be a licensed to be able to provide therapy I cannot stay working at terrible rates. It is ridiculous to think anyone can. We have families to feed too. We have bills too. We want to help people, but that doesn’t mean we can afford to live on nothing.
I strongly oppose cuts for reimbursement for Medicare recipients. It will reduce the availability of resources because clinicians will opt for higher paying cllients. I am also a Medicare subscriber and from that point of view, we want all available resources. Social workers have fought long and hard for equality of reimbursement rates in general and it would be a huge step backwards.
Social Workers are imperative to our health care system. Medicaid/Medicare individuals are at an even higher risk and require support for ongoing struggles just as those who can afford private insurance. We are in demand as it is with high education costs, higher client loads and average pay now. If you cuts pay even more then what???
ABSOLUTELY NO CUTS TO ANY MENTAL HEALTH INSURANCE PAYMENTS. CUTS WILL FORCE THE MENTAL HEALTH PORFESSONALS OUT OF THE FIELD DUE TO INABLITY TO PAY THEIR BILLS. THESE HIGHLY TRAINED AND EDUCATED PROFESSIONALS MUST REIMBURSED FAIRLY. OTHERWISE, IF THIS HAPPENS AND PROFESSIONALS LEAVE THIER PRACTICE, THE COUNTRY WILL BE EVEN MORE VULNERABLE TO FATALITIES OF SUICIDE, RANDOM SHOOTINGS, CHILDREN AND ADOLESCENT MENTAL HEALTH OCCURENCES WHICH WILL PLACE THEM AT GREATER RISK IN AND OUTSIDE THE HOMES. IF THERE ARE LESS MENTAL HEALTH PROFESSIONALS TO PROTECT THE ADULT AND CHILDRENS POPULATIONS WE WILL PUT OUR ENTIRE NATION AT MORE RISK FOR HARM.
Okay, 45 posts here, but how many of you have commented to CMS?
I perused the 808 pages of the proposed payment changes. The onus on Social Work is to supply quantitative data demonstrating the Value Of Clinical Social Work in comparison to other medical professions. Merely saying we are the largest provider of mental health services in the country does not demonstrate actual value.
Medicare is a financial black hole with finite resources. Fraud is rampant among Medicare providers. We must promote our profession in a rational manner, not just “we are the best, pay us more”.
Beth…how about some concrete suggestions instead of scolding
Carol, I made two suggestions:
1. Please post your comments to the CMS link provided in the article.
2. In your comments, I suggested quantitative proof of the value of Clinical Social Work interventions in comparison with the utilization data of other professions in the proposal.
I am not scolding anyone here. For the past 30 years, I have urged the profession to engage in proof of value through research. We need a more business focused approach to gain funding from a variety of payer sources. Evidence shows the profession remains weak and salaries have remained stagnant for decades.
Please don’t shoot the messenger who is trying to help.
Please do not cut our services! This saddens me as we are in high need to help those who are not mentally well or suffering.
Many social work colleagues refuse to take Medicare services due to the already low reimbursement rates. In rural states such as Maine, reducing reimbursement rates for assessment and counseling services provided by licensed social workers will reduce access and impact the overall health of millions of Americans.
Mental health providers are in short supply. The need for LCSW is higher than ever before especially for Medicare and Medicaid clients, by cutting the rates you are telling us to leave the field for other more financial rewarding career path and outting a culnerable ever growing population at risk. Socisl workers have stidents loansvand other financial onligations that we would not be able to fullfill. As it dtands we are at the bottom of thevreimbursement food chain. Do not cut SW reinbursement rate, we actually could use a raise!
No cuts in Medicaid or Medicare payments for LCSW
Social workers are the largest contingent of community mental health providers in community mental health with specialized knowledge and skills to provide treatment to a wide range of diverse populations. These proposed cuts are not only an affront to our profession, these cuts would severely limit access to much needed programs and services to those in need.
No cuts for underpaid social workers! Their service is vital!
No more pay cuts. These services are very necessary.
Please no pay cuts for social workers!
No. No cuts. This is ridiculous. Stop it, already. This is not a destitute nation.
As a BASW student, I’m having to now realize that CMS doesn’t care about the lack of mental health providers across all parts of the U.S., especially in rural areas. This is just awful!
This is very sad.
Why pay cuts when the supply of licensed mental health providers is not adequate to provide for the needs?. LCSW providers are required to have a Masters Degree in Social Work and also be tested for a license. The mental health aspects are very focused and internships in various areas provide even more focus. If you cut the reimbursement for medicare and medicaid, the LCSW will quit providing for this population which would be a loss for everyone.
No cuts to payments for social workers.
NO CUTS in Medicaid or Medicare paymentin CSW & LCATs.
CSW work is vital to identifying needs, acquiring services, and maintaining patient care. Please don’t pass this legislation which will further demean this important work and limit those who have a passion for helping others in need.
As a LCSW and member of the NASW, I strongly oppose the proposed cuts to clinical social workers who are Medicare providers. CSWs are already reimbursed at a much lower rate than any other mental health provider. This proposal will affect all clinical social workers.
We need MORE funding, not less, for human services.
Social work services are a needed service for many individuals with Medicaid and Medicare.
I am a LCSW who has worked in Behavioral Healthcare for over 45 years People who have Medicate deserve to have quality services like anyone else. The cost of healthcare is already very high. Please no more cuts We need LCSW ‘s working and providing care that no one else can provide .
I oppose this cut as it will gravely impact millions of vulnerable and marginalized segments of our country.
As an LCSW this is absolutely not ok. We are already grossly underpaid and have student loans to pay off.
I am opposed to these cuts as a Medicare recipient and a Social Worker.
We cannot afford to have more social worker s drop out of Medicare. My practice has a three month waiting list. There is a shortage of mental health providers in my area.
I strongly opposed the suggested cuts to medicare. In a time when mental health providers are needed these cuts will put lives at risk!
Cutting reimbursement rates has the potential to reduce the number of mental health providers to senior citizens and people on disability at a time when the numbers of Baby Boomers on Medicare is growing. This is particularly true in rural and other underserved areas. NO CUTS.
Will this also be lowering reimbursement rates for LPC”s too? Therapy is clearly not valued for it’s long term effects if done properly by this commission. I strongly urge you to reconsider this proposition.
I AM OPPOSED TO PAY CUTS OF ANY KIND FOR CLINICAL SOCIAL WORKERS! We already work LONG hours with NO OVERTIME trying to keep up with ALL the RIDICULOUS REQUIREMENTS of MEDICAID and MEDICARE! -ENOUGH IS ENOUGH! -IF ANYTHING, CSWS DESERVE A PAY RAISE!! IT IS NOT RIGHT THAT WE ARE NOT ALLOWED TO CLAIM OVERTIME FOR TRYING TO KEEP UP WITH THE INCREASINGLY STRINGENT AND RIDICULOUS REQUIREMENTS OF GOVERNMENT HOOPS! CAN WE PLEASE GET BACK TO QUALITY INSTEAD OF QUANTITY ?!!.. ONE DAY YOU TOO WILL NEED A CLINICAL SOCIAL WORKER.. I HOPE THE ONE YOU GET IS QUALITY-FOCUSED AND PAID A FAIR WAGE.
I am in complete opposition of these pay cuts! Social workers pay to go to school for years and years to be able to put something into society. PAY THEM WHAT THEY DESERVE. I am currently a social work student and am constantly seeing bills proposing budget cuts and pay cuts and eliminating loan forgiveness and tuition reimbursement and it is ridiculous! If individuals lose access because of the this country will be taking a step backwards. Medicare and Medicaid access are the only way many at risk individuals can get medical care, so if places stop accepting it because of this it will be so tragic. NO NO AND NO!
And great post Kelly. Totally agree with you.
Please do not reduce social worker reimbursement. These services are vital for millions.
I urge you to prevent any cuts as this will negatively impact clients.
Do not cut payments for social workers. Social workers do incredible work and help to keep healthcare costs down.
Clinical social workers are needed more than ever. Cutting our reimbursement is unjustified. We are already paid below the CMS fee schedule. With our ever growing Baby Boomer generation and immigrant populations, it is social workers who will work directly with them.
If this decrease in reimbursement occurs I will no longer be able to be a provider for Medicare and I would have to stop seeing my elderly and disabled clients who desperately need therapy. It would be a great disservice to put money towards physician evaluation when there would not be professionals available to then treat these people.
Please reconsider the proposed cuts in reimbursement rates.
In order to continue to be able to provide competent, needed services, social workers need to be fairly compensated for the services they provide, which require a higher level of education and skill level.
This will lead to less social workers getting paneled with Medicare, leading to less people getting treatment who need it, most likely leading to people’s care getting compromised and more and more social workers getting burned out.
I’m in private practice and I will probably never bill Medicare because I need to pay my bills and make a living.
Pay social workers more! We do just as much work as MDs (probably more) and we get paid nothing. Show the rest of the industry how much we need to be valued. Shameful that you would even consider this.
Social worker do the majority of the therapy with clients and spend the most time, why would they even think of cutting our pay! We are licensed clinicians! we actually deserve more pay not less! We no longer, because we are licensed to have our assessment signed my a doctor.
Without social workers the aging population will continue to be stigmatized without advocacy.
Social workers all have advanced degrees. Pay for licensure. CE and ethics certification on a regular basis. Do you? All the while, we make a fraction of what most people make with masters or PhD level education. We work overtime without the benefits. We work with folks who no one else has the bandwidth to. What you’re doing is a grave mistake.
Mental health is an issue in this world and Social worker services are a vital need. The elderly in need of resources and have no clue how to access them need social workers. Increase out pay not cut our pay. We are just as important as the nurse. We are a team. Medical and Psychosocial, they go hand in hand. .
Please do not reduce reimbursement rates to clinical social workers! I urge you to understand that CSW’s provide extremely important services to the most vulnerable populations. Our training and education offer an extremely unique- and evidence-based- approach to assisting people who experience some of the most complex trauma and mental health challenges. CSW’s are already some of the lowest paid professionals. If you reduce reimbursement rates many will have to turn clients away (simply out of necessity to keep up with student loans and cost of living). This will negatively impact individual people and society as a whole! Please reconsider this!!!
Please do not cut Medicare payments to Social Workers. Our jobs are hard enough as it is. If you disincentivize our involvement in Medicare you will be jeopardizing the health and well being of already marginalized and vulnerable populations we currently serve through this federal program.
If this reduction in reimbursement goes through it will negatively impact hundreds of thousands of Americans on Medicare and dramatically reduce the number of professionals willing to take Medicare.
As a social worker I’ve seen discrimination in private practice against clients who have Medicaid. Many mental health care providers REFUSE to accept clients with Medicaid insurance due to low reimbursement rates. This will only further restrict access to mental health care for individuals on Medicaid. Furthermore, social workers are SEVERELY underpaid. Clinical social workers require a master degree. We are a growing field and jobs are plentiful however, most of them do not pay enough considering the amount of student loans we have had to take out to earn our master degree.
I am writing this to let you know I am opposed to the cuts from CMS for clinical Social Workers. This will effect the populations we as Social Workers serve, older adults and the disabled specifically. They will lose access to mental health services. Private insurance often follows the lead of Medicare when updating payment rates and policies, which can effect all Social Workers. Please reconsider these proposed cuts based the aforementioned reasons given above.
Sincerely concerned Social Worker,
Nicole Buchanan, LCSW-C
This is important to handle the senior population!
Please do not further limit access to care.
I strongly support the idea that we need to be paid more as a therapist. Please do not decrease CMS payments for social workers. In the long run this will result in fewer and fewer therapist available 2 Medicare patients.
It will end up costing the system MORE money if they cut therapeutic services to Medicare beneficiaries. CSW help people stay motivated to care for themselves, emotional support for caregivers, and help people stay out of the hospital. It is a much needed benefit!
We’ve spent our entire education working towards becoming successful Social Workers. My education cost me well over $100,000. In what way is it right to suggest reducing Medicare/Medicaid rates for Social Workers?
I oppose the pay cuts. Social workers are already grossly underpaid, assist the disadvantaged, and need stability in order to continue this career.