Congratulations to NASW’s Advocacy Network,� on August 1, 2007 the U.S. House of Representatives passed a key component of NASW’s SWRI agenda, the� Clinical Social Work Medicare Equity Act along with an across the board� 5%� increase in CSW payments under Medicare Part B.� Your advocacy was a huge help!

ACTION REQUESTED

The House and Senate will return next week from a month-long recess to begin a difficult conference over Medicare and child health insurance legislation (CHAMP, HR. 3162). NASW members should contact their Senators now to urge their support for critical provisions for clinical social workers in this conference on CHAMP. NASW has prepared a suggested message to send your Senators, click here to send your message today.

PROSPECTS

CHAMP must still be reconciled with the Senate’s child health insurance proposal and signed by the President, two very high hurdles.� The Senate supports a narrower bill that does not include� any Medicare� provisions. NASW seeks retention of Sections 606, 610 and 203 from HR. 3162 in the final conference agreement, but it is unclear how these two very different bills will be reconciled. The President has pledged to veto either the House or Senate bills, but Democratic leaders and NASW anticipate an eventual political accommodation that enacts much of the CHAMP legislation. It is therefore vital that NASW support our provisions during the conference process.

BACKGROUND

The House of Representatives passed crucial legislation on August 1, 2007 for clinical social workers, the Children’s Health and Medicare Protection Act (CHAMP, H.R. 3162). NASW scored a major early victory for its Social Work Reinvestment Initiative (SWRI) by attaching our legislation to CHAMP. This bill both increases Medicare payment rates for all clinical social workers billing Part B and restores clinical social workers’ ability to bill Medicare independently for services provided to Part A skilled nursing facility residents. One key SWRI component, the Clinical Social Work Medicare Equity Act (S. 1212 sponsored by Sen. Mikulski) has long been sought by NASW was included in CHAMP. Additionally, NASW has recently sought relief for CSW payments under Part B, which were cut 9% late last year by federal administrative action. CHAMP will increase CSW payments by 5% above their current level beginning on January 1, 2008. This special payment increase applies only to psychotherapy and behavioral services that were cut on January 1, 2007. In addition to the increase in 2008, CSWs will receive the same percent payment update that CHAMP authorizes for all physician services in the program, currently a positive .5% payment update under CHAMP.

NASW has been working aggressively with its advocacy network and behind the scenes to secure these crucial social worker payment increases.� CHAMP is the necessary vehicle for our changes, and it contains many different components. Other key provisions include a significant expansion of the State Children’s Health Insurance Program (SCHIP), increases in physician payments, and other benefit improvements in both Medicare and Medicaid. These improvements are offset by cuts in managed care payments for Medicare, nursing home rates and a substantial increase in tobacco taxes. NASW strongly supports passage of CHAMP to protect the Medicare program and expand child health insurance coverage.

The following CHAMP provisions are NASW’s top priorities in the upcoming CHAMP/child health insurance (HR. 3162) conference:

• Retain Section 606: Removes clinical social worker services from coverage under the Medicare SNF prospective (consolidated) payment system, permitting CSWs to bill� Medicare separately, the same as psychiatrists and psychologists services� for Medicare Part A beneficiaries served in skilled nursing facilities.
• Retain Section 610: Increases Medicare Part B payments to CSWs and psychologists by 5% starting on January 1, 2008.� This increase will partially restore a CMS� cut for these professional services that occurred� on the first of this year. This “bump up” is limited to four years, after which, another administrative rebalancing will occur� among payments for Part B professional services.� Additionally, CSWs will receive the same SGR payment update as physicians, now a positive .5% in the bill.
• Retain Section 203: Corrects Medicare’s current discriminatory co-payment on outpatient mental health services from 50/50 beneficiary cost sharing to the standard 80/20 coverage for other Part B services. This “Medicare parity” provision would go into effect on January 1, 2008.

THANKS FOR YOUR ADVOCACY!

For further information, contact Jim Finley at NASW: jfinley@naswdc.org.

The House and Senate have both passed higher education student loan bills that include language on loan forgiveness for child welfare workers. There is an important difference between these two bills in the loan forgiveness section. Both bills provide long term loan forgiveness for public service employees after 10 years of work. The House bill (H.R. 2669, the College Cost Reduction Act of 2007), provides loan forgiveness of $1,000 per year up to $5,000 (five years) if a person works in one of eight areas of national need, including public and private child welfare workers. This provision in the House bill is in addition to a provision that provides loan forgiveness to an individual that has been employed in public service for 10 years.The Senate bill only provides the 10-year provision, not the additional $5,000 loan forgiveness for child welfare workers found in the House bill and is limited to social workers in public service. While the 10 year loan provision will help some areas of workforce need, the limitations around public agencies will impact child welfare since many of the services in child welfare, as well as child care, are provided by non-profits and charitable agencies. Congressional staff are working right now to resolve the differences between the two versions. Call right away while Congress is at home and tell them to keep the House section in any final agreement!

Let them know that loan forgiveness is an important step in addressing the shortage of child welfare workers. Repayment is particularly challenging for social workers whose salaries continue to be among the lowest for professionals in general, and for those with master’s level education, in particular. In 2001, 22 percent of social workers earned under $30,000 and 20 percent earned between $30,000 and $39,999. The median salary for social workers with two to four years experience was $35,600. A recent survey by the Council on Social Work Education found that the average loan debt of social work students graduating in 2004 with a master’s degree in social work was $26,777. Those with bachelor’s degrees in social work faced repayment of $18,609 in loans and those with doctoral degrees in social work were $32,841 in debt.

The social work workforce issue must be addressed because we know that a quality child welfare workforce is essential to promoting good outcomes for children in the child welfare system. No issue has as great effect on the child welfare system’s capacity to serve at-risk and vulnerable children and families than the shortage of competent, stable workforce.

ACTION

Please call your member with the following message: “As a member of your constituency and as a member of the National Association of Social Workers, we urge you to keep the House provision on loan forgiveness (Section 131) that is in the College Cost Reduction Act of 2007 (HR 2669), in the final conference report. The country’s social services delivery system depends on social workers who are willing and able to commit to long-term service in the public and private sectors. However, too many social work graduates are unable to pursue human service careers due to the overwhelming burden of their student loan debts. The provision of loan forgiveness through the College Cost Reduction Act of 2007 would be a very important step in addressing these workforce issues. Thank you.”

CALL

Call your Representative and Senator right away while they are at home by contacting the U.S. Capitol Switchboard at 1-800-828-0498 and ask for the Washington, D.C. office to get their local number

Legislative Update | August 2, 2007

Congratulations to NASW’s Advocacy Network, the U.S. House passed on August 1, 2007, key components of NASW’s SWRI agenda, including the Clinical Social Work Medicare Equity Act along with an across the board 5% increase in LCSW payments under Medicare. Your advocacy was a huge help! Specifically, the following provisions were passed within the Children’s Health and Medicare Protection Act (CHAMP, HR. 3162):

• Section 606: Removal of clinical social worker services from coverage under the Medicare SNF prospective (consolidated) payment system, permitting LCSWs to bill Medicare separately, the same as psychiatrists and psychologists services for Medicare beneficiaries residing in skilled nursing facilities.

• Section 610: Increases Medicare Part B payments to LCSWs and psychologists by 5% starting on January 1, 2008. This increase will partially restore an Administration cut for these professional services that occurred on the first of this year. This “bump up” is limited to five years, after which, another administrative rebalancing will occur among payments for Part B professional services. Additionally, LCSWs will receive the same SGR payment update as physicians, now a positive .5% in the bill.

• Section 203: Increases Medicare’s current discriminatory co-payment on outpatient mental health services from 50/50 beneficiary cost sharing to the standard 80/20 coverage of other Part B services. This “Medicare parity” provision would go into effect on January 1, 2008.

BACKGROUND

The House of Representatives considered on August 1, 2007, crucial legislation for clinical social workers within legislation known as the Children’s Health and Medicare Protection Act (CHAMP, H.R. 3162). NASW scored a major early victory for its Social Work Reinvestment Initiative (SWRI) by attaching legislation to CHAMP that will both increase Medicare payment rates for all clinical social workers billing Part B and restore clinical social workers’ ability to bill Medicare independently for services provided to skilled nursing facility residents. One key SWRI component, known as the Clinical Social Work Medicare Equity Act (S.1212 sponsored by Sen. Mikulski) has long been sought by NASW. Additionally, NASW has recently sought relief for LCSW payments under Part B, which were cut 9% late last year by federal administrative action. The new and fast moving CHAMP legislation will increase LCSW payments by 5% above their current level beginning on January 1, 2008. This special payment increase applies only to psychotherapy and behavioral services that were cut on January 1, 2007. In addition to the 5 percent increase in 2008, LCSWs will receive the same percent payment change that Congress will authorize for all physician services in the program, currently a positive .5% payment update under CHAMP.

NASW has been working aggressively with its advocacy network and behind the scenes to secure these crucial social worker payment increases. CHAMP is the vehicle for our changes, and it contains many different components. Other key provisions include a significant increase in the State Children’s Health Insurance Program (SCHIP), increases in physician payments, and other benefit improvements in both Medicare and Medicaid. These improvements are offset by cuts in managed care payments for Medicare, nursing home rates and a substantial increase in tobacco taxes. NASW strongly supports passage of CHAMP as necessary to protect Medicare and expand child health insurance coverage.

PROSPECTS

CHAMP must be reconciled with the Senate and signed by the President, two very high hurdles. The Senate is now debating a far narrower SCHIP bill that does not include any Medicare provisions. NASW advocacy must secure provisions similar to Sections 606, 610 and 203 in the Senate, but it is unclear how these two very different bills will be reconciled. Furthermore, the President has pledged strongly to veto either the House or Senate bills. Democratic congressional leaders and NASW anticipate an eventual political accommodation that enacts much of the CHAMP legislation. It is therefore vital that NASW continue its legislative advocacy through the Senate conference stage.

NEXT STEPS

The House and Senate plan to take a month long recess starting tomorrow. After the Senate has cleared its SCHIP bill, NASW members will be asked to contact their Senators over the recess to urge their support for these critical CHAMP provisions in a conference on these very different bills. Watch for our advocacy materials and keep up the great work. We are winning!

THANKS FOR YOUR ADVOCACY!

For further information, contact Jim Finley at NASW: jfinley@naswdc.org.