As the debate for health care reform continues in Congress, there are many resources available from many organizations.  On the NASW Health care reform page, you will find informative documents including a one-pager from Health Care for America Now entitled, Five Immediate Benefits to Health Care Reform.  Go to the resources section of the health care reform page to read more.

Consistent with First Lady Michelle Obama’s campaign to confront the issue of childhood obesity, the Senate Committee on Health, Education, Labor and Pensions heard testimony on March 4, 2010, about the prevalence of obesity among America’s youth. Panelists included Dr. Regina Benjamin, U.S. Surgeon General; Dr. Joseph Thompson, Director of the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity; Dr. Sandra Hassink, Chair of the American Academy of Pediatrics Obesity Leadership Workgroup; and Pittsburgh Steelers Running Back Rashard Mendenhall.

NASW recognizes childhood obesity as an major public health concern, with significant implications for future U.S. health care costs. Obese children are being diagnosed with health problems previously considered to be “adult” illnesses, such as Type II diabetes, hypertension, high cholesterol, sleep apnea, and fatty liver disease. Overweight and obese children are at risk for a host of serious future illnesses, including heart disease, stroke, and certain types of cancer. Obesity and related complications disproportionately affect racial and ethnic minority children and children living in poverty.

NASW applauds Congress’ acknowledgment of this multi-dimensional issue and its efforts to address it. To view the hearing’s video and for more information, go to http://help.senate.gov/hearings/hearing/?id=059b63ce-5056-9502-5d89-33fed050a9f3.

Last week Congress halted the so-called Medicare “physician fee cut” that set Part B payment rates for clinical social workers and all independent Medicare outpatient providers with passage of an extension of Medicare physician payments at last year’s level through March 31.  On Wednesday, March 10, the Senate passed a critical extension of these  provisions (H.R. 4213).  Eight Republicans voted with Democrats to defeat a GOP filibuster of this measure. Similar legislation passed the House in December and a conference to reconcile their differences  is now required to enact this legislation.

H.R. 4213 extends the SGR component of the physician fee only through September 30. More importantly for CSWs, the bill retroactively restores a separate five-percent cut that hit Medicare psychotherapy rates on the first of this year. The proposed restoration of Medicare psychotherapy rates would apply to services delivered from January 1, through December 31. Since many private insurance plans pay social workers based on Medicare psychotherapy rates, this will benefit many clinical social workers in private practice.

The new Senate bill also includes a host of provisions unrelated to Medicare, including tax cut extenders and unemployment measures. Federal fiscal relief to help states with their escalating Medicaid expenditures is also included. This provision, called Medicaid FMAP extension, provides $25 billion in emergency Medicaid funds sought by President Obama and supported by NASW.

NASW expects to begin work on new legislation making a long-term correction of Medicare psychotherapy rates as soon as H.R. 4213 is signed into law.

For background on the complex issues involving clinical social fees, see NASW’s advocacy blog posts here.

On March 2, over 80 congressional staff and interested organizations participated in the 6^th annual Public Health Briefing 101 entitled, Building Capacity to Meet America’s Mounting Health Needs hosted by the Coalition for Health Funding.   The briefing provided information about the public health continuum and its needs.  NASW was a cosponsor of the briefing.  To view the presentation of the briefing speakers, go to: http://www.aamc.org/advocacy/healthfunding/congressionalbriefing.htm

Secretary of Health and Human Services Kathleen Sebelius is scheduled to testify before the Senate Labor-HHS-Education Appropriations Subcommittee on Wednesday, March 10 at 2 p.m. in Room 124 of the Dirksen Senate Office Building. The hearing can be viewed live via webcast from the Senate Appropriations page.  Additional information is available at: http://appropriations.senate.gov/news.cfm?method=news.view&id=16c07802-c2f8-4485-9315-640f25ea7a81

2009 Rates extended until March 31

Earlier this week the White House released a summary of its $950 billion plan to reconcile the House and Senate versions of comprehensive health reform legislation. Release of the plan marks a new phase of more direct presidential involvement in the legislative negotiations. The President’s plan largely favors the Senate’s bill and clarifies use of a legislative strategy known as budget reconciliation, which could pass the bill through Congress with 51 votes. Democrats on Capitol Hill reacted in a receptive manner to the proposal, although leaders are expected to flesh out many important details as the plan is worked into legislative language.

On Thursday, February 25, the President will meet with Democratic and Republican congressional leaders at Blair House in an attempt to reach compromises on comprehensive legislation. However, Republicans have not accepted the President’s premise for the meeting, which is to bring forward their own plans to address comprehensively the major coverage and costs problems that plague the U.S. health system. Absent a breakthrough at the talks this week, Democratic leaders are expected to attempt to pass final legislation without Republican votes. The President’s proposal generally follows NASW principles for health reform, and we expect to support the compromise legislation as it moves toward House and Senate consideration.\

The Kaiser Family Foundation created a side-by-side chart comparing the health care proposal unveiled by President Obama on February 22 and the previously passed House and Senate health care bills.  To view the full chart, please go here.

Urgency for State Medicaid Relief Grows

A new report by Families USA, an NASW coalition partner, documents a large number of states facing Medicaid cutbacks unless Congress quickly increases temporary funding for state Medicaid programs. Families USA reports that States are dealing with unprecedented budget shortfalls as a result of declining tax revenues, high levels of unemployment, increasing poverty and declining wages.  They concluded that at least 30 state legislatures are contemplating cutbacks to Medicaid, beginning this July.

In addition to protecting funding for current services to Medicaid recipients, the report shows that increased federal funding will improve state economies while expanding and protecting jobs. The Families USA report is available here: States in Need: Congress Should Extend Temporary Increase in Medicaid Funding.

President Obama’s federal budget proposal released earlier this month called for maintaining current Medicaid services during the economic downturn with an additional $25 billion in federal fiscal relief for state Medicaid programs. NASW has joined with Families USA and other advocacy groups in pushing for the funds in new legislation. The proposal would include a 6.2 percent increase in the amount of money states receive for Medicaid, and those with higher unemployment rates would receive more. Our coalition urges passage at the earliest opportunity as most state legislatures are already well along in the development of their budgets for their new fiscal year.

Essential Medicare Legislation Still Delayed

Partisan gridlock is continuing to stall legislation extending expiring Medicare provisions that establish provider payment rates. Congress had hoped to use the comprehensive health reform bill as a vehicle to address Medicare provider payment extensions, but the cost of the Medicare provisions and confusion on the health reform bill led to their being temporarily set aside for another legislative vehicle. Earlier this month the Senate Finance Committee attempted to again pass the Medicare “extenders package,” but the vehicle, a large jobs bill, was rejected by party leaders before coming to the floor. Currently, leaders know the Medicare package is urgent to pass now, but they have not found an acceptable vehicle for the multi-billion dollar package.

The expiring Medicare provisions include large rate cuts that directly impact payments to clinical social workers billing Medicare independently under Part B. Clinical social workers face two large rate cuts under expiring law. These include the physician payment provision in Medicare law that leads to a 21 percent cut in all Medicare Part B rates due to the Sustainable Growth Rate (SGR) formula that affects all practitioners. For more than a decade, all Medicare Part B payment rates have been set by the SGR formula, which by statute annually expire, cutting payments to providers. Each year Congress has intervened to postpone the SGR cut, but due to the costs of a permanent repeal, Congress has not agreed to a solution to the underlying flaws in the formula. NASW supports a permanent change in the Medicare formula (see our letter HYPERLINK “http://capwiz.com/socialworkers/utr/1/AURAMBWPUD/FHCOMBWQIV/4723954896“here). In late December Congress agreed to postpone the SGR cut for two months, but on March 1, 2010, the SGR cut will again go into effect. That agreement leaves Congress only a few days to enact another extension to correct the SGR formula.

In addition to the SGR reduction, Medicare psychotherapy rates already received a five percent cut on January 1st due to a CMS five-year rate review implemented in 2008. Clinical social workers and psychologists are working together to ensure the psychotherapy rate cut is restored in any bill delaying the larger SGR cut.  An increase for psychotherapy billing codes was included in the House version of health care reform (H.R. 3590), but not the Senate version (S. 3962). Again, with the delay in enacting comprehensive reform, a new legislative vehicle must be found to delay this cut. NASW is working very aggressively with a coalition of health practitioner groups to pressure Congress to attach the psychotherapy rate provision in the larger SGR legislation.

County of Residence Impacts Personal Health

A new project undertaken by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute ranks county health status in every state in the nation. The project found that the health of a community depends on many different factors - ranging from individual health behaviors, education and jobs, to quality of health care, to the environment. The project has recently released a collection of 50 state reports designed to help community leaders demonstrate that where people live influences how healthy they are and how long they live. For information on health by county in any state, see HYPERLINK “http://capwiz.com/socialworkers/utr/1/AURAMBWPUD/GCWDMBWQIW/4723954896“here.

A new report by federal actuaries shows government programs will pay for more than half of all U.S. health care spending by 2012. The health care spending projection data can be found on the CMS web site at http://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp

With the election of Senator Scott Brown (R-MA), there were concerns that health care reform would take a back seat to other congressional priorities such as jobs and the economy. Congressional leaders are still committed to passing health care reform legislation this year.  Congress believes that the status quo of health care is no longer acceptable and the impact of not reforming health care could be worse than doing nothing.  Many congressional members and health care advocates are supporting the following strategies to move the health care legislation forward.

1. The House would pass the Senate health bill (HR. 3590) with at least 218 votes. Currently, there are not enough votes for this option because many House democrats have differences with certain provisions in the Senate bill.
2. The Senate would then pass a reconciliation bill to include the items that are germane to the budget. The reconciliation measure would also include any provisions negotiated with the White House and Senate leaders. With the reconciliation bill, the Senate would only need 51 votes for passage.
3. The final option is to draft a compromise bill. The measure would change the massive Senate-approved health bill to what bargainers from the White House, Senate and House agreed to in December.

These negotiations are ongoing with an uncertain timetable for completion. NASW will continue to press for its legislative priorities as Congress debates its next steps as well as additional health issues that are of interest to social workers.
NASW Cosponsored Health Action 2010 Conference

Families USA held its 15th Annual Grassroots Meeting Health Action 2010 on January 28-30, 2010 in Washington, DC.  NASW was a cosponsor of the conference.  Some of the presenters included White House Senior Advisor Valerie Jarrett, Secretary of Health and Human Services Secretary Kathleen Sebelius, Sen. Al Franken, Reps. Donna Edwards and Chris Van Hollen, NAACP President Benjamin Todd Jealous, and U.S. Surgeon General Dr. Regina Benjamin. To view, their presentations and more from the conference, go to: http://www.familiesusa.org/conference/health-action-2010/webcast.html

Feds Issue Parity Rules

Federal officials with the departments of Health and Human Services, Labor and Treasury jointly issued interim final rules on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), signed into law by President Bush in October 2008. The rules implementing the new law require that mental health and addiction benefits in group health insurance plans be equal to most medical and surgical benefits. It will take effect this July 1. The new rules prohibit group health insurance plans from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits.

The interim final rules were based on a review of more than 400 comments, officials said. NASW joined with a 44-member coalition of mental health groups last year in commenting on the “Request for Information” in a letter linked here. The coalition’s letter urged the federal government to interpret the intent of the legislation in the most consumer-favorable manner possible. Co-signers are very pleased the new rules appear to have done so. Among the most significant interpretations, the rules require that group health plans that choose to offer mental health and addiction benefits along with medical and surgical benefits “must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review.” The regulations were published Tuesday, February 2, 2010, with a comment period extending until May 3. The effective date for the rules will be for plan years beginning on or after July 1. NASW is working now on comments for the proposed rules.

MHPAEA contains several significant limitations. One is the absence of a mandate that mental health and addiction benefits be offered by every plan, and the law does not specify which conditions have to be covered, a major point of contention during congressional debate. At this early time, mental health groups report they have seen no significant trend of employers eliminating coverage for behavioral health benefits as a way to avoid implementing parity requirements. A second major limit of the law is that it applies only to public or private employers with 50 or more workers, including both self-insured and fully insured entities. Group health plans for companies with fewer than 50 employees are exempt, and the law does not apply to issuers who sell plans to individuals. Federal officials said that about 160 million residents are covered in large employers’ group health insurance plans.

The rules greatly expand an earlier law, the Mental Health Parity Act of 1996, which required parity only for aggregate lifetime and annual dollar limits between the categories of benefits. Another major benefit of the new law is that it extends protections to substance use disorder benefits. NASW and other advocacy groups spent years advocating for the legislation along with a large coalition of mental health and substance abuse treatment advocacy organizations. Its long-time congressional champions included the late Sen. Edward M. Kennedy, D-MA, Sen. Pete Domenici (R-NM) now retired, Rep. Patrick J. Kennedy, D-R.I. and Rep. Jim Ramstad (R-MN) also now retired.

Resources for social workers

NASW’s January 2009

Federal Fact Sheet summarizing the law

New interim final rules

Legal summary of the rules

President Backs Medicaid Relief for the States

President Obama’s new federal budget proposal tops $3.8 trillion, and it includes many programs that directly impact social workers and their clients. One proposal is particularly critical to maintaining current Medicaid services during the economic downturn. The President’s budget backs an additional $25 billion in federal fiscal relief for state Medicaid programs. NASW had joined with other advocacy groups in pushing for additional Medicaid state fiscal relief in new legislation. Advocates and the states support the additional federal funds to help maintain state Medicaid services during the current economic crisis that has depleted funds for care. The President’s budget includes a 6.2 percent increase in the amount of money states get for Medicaid, and those with higher unemployment rates would get even more assistance. Large states with generous Medicaid programs such as California and New York stand to benefit most from the plan. Advocates of the funding also argue that it protects unrelated state jobs and activities by allowing states to avoid shifting funds to maintain critical Medicaid services.

House to Vote on Antitrust Exemption for Health Insurers

House Democratic Leaders plan to vote on the floor within days on a partial repeal of the health insurance industry’s exemption from antitrust laws (H.R. 3596). The legislation would eliminate a long-standing federal law that excludes the insurance industry from federal antitrust regulation. Under the Constitution, regulation of interstate commerce is a federal responsibility. However, in 1945 the McCarran-Ferguson Act authorized states, in the absence of federal law or regulation, to regulate all insurance products, including health, leading to the state insurance regulatory system in place today. This Act also exempted the insurance industry from federal antitrust law. Therefore, the Justice Department cannot now enforce federal antitrust law on the insurance industry. Some advocates believe that eliminating this restriction may boost competition among insurers and thereby help reduce prices to consumers. Other analysts believe the change will not impact insurance company practices. NASW is tracking this legislation and more background appears in a prior issue of the Health Care Reform Roundup.

Passing the measure now begins a new House Democratic Leadership strategy of moving popular but narrow bills that will be split off from the House’s comprehensive version of health care reform. Support for antitrust legislation is widespread in the House, and it is expected to draw some Republican support. However, prospects in the Senate appear much dimmer as the measure failed to reach the 60 vote threshold for passage last December. Other popular provisions in comprehensive health care bill, including banning insurers from denying coverage for pre-existing medical conditions, are not candidates for splitting off for separate enactment.

Democrats hope to score political points by supporting a bill aimed at the insurance industry while Republicans could risk appearing as though that they are trying to protect them. Democrats also believe that passage of several small provisions from the larger health reform initiative could help revive some momentum for passage of the comprehensive bill.

Key Medicare Provisions up in the Air

A major legislative problem was created by the delay in passing comprehensive health care legislation; that is, how to pass expiring Medicare provisions that require immediate congressional action. The expiring Medicare provisions include large rate cuts that directly impact payments to clinical social workers billing Medicare independently under Part B. Clinical social workers face two large rate cuts under expiring law. These include the physician payment provision in Medicare law that leads to a 21 percent cut in all Medicare Part B rates due to the Sustainable Growth Rate (SGR) formula that affects all practitioners. For more than a decade, all Medicare Part B payment rates have been set by the SGR formula, which by statute annually expire, cutting payments to providers. Each year Congress has intervened to postpone the SGR cut, but due to the costs of a permanent repeal, Congress has not agreed to a solution to the underlying flaws in the formula. NASW supports a permanent change in the Medicare formula (see our letter HYPERLINK “http://capwiz.com/socialworkers/utr/1/GGWSLZNPUF/GECOLZPYYB/4637793656“here). In late December Congress agreed to postpone the SGR cut for two months, but on March 1, 2010, the SGR cut will again go into effect. That agreement leaves Congress only this month to enact another extension to correct the SGR formula. Congress had hoped to use comprehensive health reform as a vehicle to address the Medicare SGR correction.

In addition to the SGR reduction, Medicare psychotherapy rates already received a five percent cut due to a CMS five-year rate review implemented in 2008. Clinical social workers and psychologists have worked together for several years to ensure the psychotherapy rate cut also does not go into effect.  An increase for psychotherapy billing codes was included in the House version of health care reform (H.R. 3590), but not the Senate version (S. 3962). Again, with the delay in enacting comprehensive reform, a new legislative vehicle must be found to delay this cut. NASW is working very aggressively with a coalition of health practitioner groups to pressure Congress to include this provision in the SGR legislation.

HYPERLINK “http://capwiz.com/socialworkers/utr/1/GGWSLZNPUF/GNJULZPYYC/4637793656“Health Reform Essential for Reducing Deficit

Rising health care costs represent the single largest cause of the federal government’s long-term budget deficit making passage of comprehensive health reform legislation essential to any effective action on long-term deficit reduction. According to the Congressional Budget Office, the Senate and House health reform bills would reduce deficits both over the decade from 2010 through 2019 and after that. Both bills also contain a wide range of measures to restructure the U.S. health system and slow the growth of health care costs, particularly Medicare costs.

A new analysis by the Center on Budget and Policy Priorities describes the problem and how the pending legislation would address it HYPERLINK “http://capwiz.com/socialworkers/utr/1/GGWSLZNPUF/LFADLZPYYD/4637793656“here.

U.S. Government to pay more than half of U.S. health costs by 2012

A new report by federal actuaries shows government programs will pay for more than half of all U.S. health care spending by 2012. The health care spending projection data can be found on the CMS web site at

HYPERLINK “http://capwiz.com/socialworkers/utr/1/GGWSLZNPUF/JKIJLZPYYE/4637793656“http://www.cms.hhs.gov/NationalHealthExpendData/03_NationalHealthAccountsProjected.asp

U.S. Surgeon General Report on Obesity

On January 28, First Lady Michelle Obama, HHS Secretary Kathleen Sebelius, and Surgeon General Dr. Regina Benjamin announced initiatives to help Americans lead healthier lives through better nutrition, regular physical activity, and improving communities to support healthy choices. To read the Surgeon General’s Report, go to:

HYPERLINK

Democrats Regroup on Strategy for Health Care Reform

Democratic congressional leaders are currently developing a new strategy to pass health care reform after the stunning loss of a Senate seat in Massachusetts. Although their new strategy will be finalized after some days have elapsed and is not yet final, several conclusions are apparent from their public comments. First, Democrats fear that failing to enact the health care bill now could increase voter anger later in this election year. Second, many legislative strategists prefer what is described as a two-bill strategy, one immediately following the next.

Under the two-bill strategy, the first step would require House passage of the Senate health bill (HR. 3590). Getting to majority House support for this bill (at least 218 votes) is extremely difficult because many Democrats have important differences with provisions in the Senate bill. Democratic House leaders say they do not now have the necessary votes to pass the Senate measure. The second bill would be necessary to secure the necessary votes in the House for the first bill. The second bill would be considered under procedures known as budget reconciliation.  This bill would include many compromises and changes to the Senate bill. The reconciliation measure would also include any provisions negotiated with the White House and Senate leaders. The two-bill option has important legislative advantages. Most importantly, any bill taken up under reconciliation procedures may move under fast-track floor procedures in the House and Senate, and passage requires 51 votes in the Senate, instead of a filibuster-proof 60 votes.

Another strategy would involve going back to the drawing board and breaking the bill into smaller components, passing those where there is more agreement. Given this highly fluid political environment, NASW will continue to press for its legislative priorities as Congress debates a new approach. Our current Action Alert is here, and we urge members to track our actions here.

Mental Health and Substance Abuse Parity Update

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) became effective for most private health plans on January 1, 2010, but federal agency regulations defining how it will be interpreted have not been cleared by the Administration. Thus health insurance carriers, which must have their 2010 plan benefits in compliance in the absence of any regulations, may be uncertain or confused about exactly what mental health and substance abuse benefits are required to be equivalent to medical and surgical benefits they offer.

According to a HHS/CMS website here, the now current federal law applies to two different types of coverage:

• 1) Large group self-funded group health plans (CMS has jurisdiction over self-funded public sector (non-federal governmental) plans, while the Department of Labor has jurisdiction over private sector self-funded group health plans.

• 2) Large group fully insured group health plans.

Some state’s insurance regulations may also contain additional coverage protections for fully insured group health plans or individual coverage. MHPAEA is designed to prevent large group health plans from imposing financial requirements and treatment limitations on mental health and substance use disorder (MH/SUD) benefits that are more restrictive than financial requirements and treatment limitations on medical/surgical benefits.  MHPAEA also prevents large group health plans from placing annual or lifetime dollar limits on mental health and substance abuse benefits that are lower than annual or lifetime dollar limits for medical/surgical benefits offered under the plan.

The law does not apply to small group health plans or health insurance coverage in the individual (non-employment based) market, but individual state law may require mental health parity in such cases. MHPAEA defines large group health plans as those with more than 50 workers and does not apply to group health plans sponsored by employers with fewer than 51 workers. Federal summary information about the law is available here and NASW has prepared its own summary, posted here and shown under January 2009.