Recently, we were doing some research in the archived editions of the NASW News.  We came across a copy of this telegram sent from NASW to President Kennedy on May 25, 1962:

“The National Association of Social Workers through its Board of Directors meeting today commends the president for your personal leadership in taking the case for health care for the elderly through social security directly to the voters.  We believe the American people will accept your word that the program embodied in the King-Anderson bill is not a sinister effort to bring about socialized medicine but a natural step forward in the physical and social development of this country.  We believe it actually represents the minimal program which should be offered to meet the needs of the ill and aging and support its adoption without further amendment or change.  In many cities social workers have actively participated in the meetings and rallies to encourage its adoption. ” 

Unfortunately, President Kennedy did not live to see the measure enacted.  Over three years later, President Johnson signed the Medicare legislation into law on July 30, 1965. 

Today is the 45th anniversary of this momentous and popular government program.  NASW was there at the beginning and continues today to advocate for a strong and quality Medicare system.

Faced with several more days of congressional debate, the Centers for Medicare and Medicaid Services (CMS) has begun processing payments for Medicare Part B claims for services delivered beginning June 1, 2010 and afterward, including those of physicians and clinical social workers. For the third time this year, Congress has been stymied in its efforts to pass legislation that would prevent a scheduled Medicare Part B fee reduction of 21 percent. Medicare payments to clinical social workers during this period will reflect a 21 percent cut below the amount paid in May.

Congress is well aware of the fee confusion and frustration of Medicare providers and is making progress toward completion of a short-term solution. On Thursday, June 17, 2010, the Senate passed a six-month agreement to reverse the 21 percent cut in outpatient provider fees paid by Medicare. This new bill will be considered and likely  passed on Tuesday, June 22. To speed Senate passage, this new Medicare measure was removed from larger extenders legislation (H.R. 4213); see our recent extender alert here. The now separated Medicare fee provision will be considered in the House as H.R. 3962.

The new Medicare bill provides $6.4 billion to undo the 21 percent cut in Part B payments that has already gone into effect. When passed, the fee reversal will require CMS to reprocess all reduced claims at the fully restored amount. The new Medicare bill is fully offset by savings in Medicare billing regulations, anti-fraud provisions and the tightening of some pension rules, thus overcoming Republican objections that it would put the federal government deeper into debt. Meanwhile the Senate remains deadlocked on the larger extenders bill, H.R. 4213, which still contains Medicaid, Unemployment Insurance, and TANF Emergency Funds supported by NASW.

Political Climate

The primary season began in earnest on Tuesday, May 18 and we learned several important lessons that night.  For one, voter turnout was not particularly high, defying the expectations of many observers who believed voter anger would voice itself loudly at the first opportunity.  Second, the night clearly went better for Democrats than it did for Republicans.  The hard fought special election in PA-12 was decisively won by Democrat Mark Critz over Republican Tim Burns.  Rep. Joe Sestak, who polling has shown to be the stronger candidate in a November general election matchup, toppled longtime Sen. Arlen Specter.  In Kentucky, we saw progressive state Attorney General Jack Conway advance to take on staunch conservative Rand Paul in the race to succeed retiring Sen. Jim Bunning (R).  Moderate Sen. Blanche Lincoln (D) will have to confront progressive challenger Lt. Gov. Bill Halter in a runoff, since Lincoln was unable to cross the 50% threshold necessary to win the primary outright.

Less than 24 hours after the conclusion of these primaries, we saw general election foes confronting one another with negative attacks.  Republicans are trying to contain any impression that Tuesday’s results don’t bode well for their long term prospects this year, while Democrats are basing their narrative on the idea that voters evidently still support them.

While we certainly can’t speculate on what this all means for the remaining 5+ months of this year’s election cycle, we can say one thing for sure: this year’s midterm elections will continue to be spirited, intense, and hard fought, right through to November 2.

President Obama Unveils the 2010 National Drug Control Strategy

On May 11, President Obama unveiled the 2010 National Drug Control Strategy.  The strategy was developed by the White House Office of National Drug Control Policy (ONDCP) with input from Federal, State and local partners.  Highlights of the strategy include:

• Strengthen efforts to prevent drug use in communities including a focus on inhalants, pain killers, “study drugs” and steroids and curtailing drugged driving.
• Seek early intervention opportunities in health care especially by increasing the knowledge of healthcare providers in screening and brief intervention techniques.
• Integrate treatment for substance use disorders into health care, and expand support for recovery.
• Break the cycle of drug use, crime, delinquency and incarceration, including supporting alternatives to incarceration such as drug- and problem-solving courts.
• Disrupt Domestic Drug Trafficking and production with attention to domestic methamphetamine production and criminal distribution of prescription medications for nonmedicinal purposes
• Strengthen international partnerships.
• Improve information systems for analysis, assessment and local management.

For more information on the Strategy, go to http://www.whitehousedrugpolicy.gov/strategy/

DC Voting Rights Act Stalled

The D.C. Voting Rights Act attempts to enfranchise over 550,000 District of Columbia residents through the addition of one House seat for our Nation’s Capitol and another for the Republican-leaning state of Utah, which is the next state scheduled to pick up a seat according to the census count.  However, despite the efforts of NASW as well as its coalition partners, H.R.175 was stalled due to significant alterations to the controversial gun amendment orchestrated by Reps. Childers (D-Miss.) and Souder (R-Ind.).  NASW will continue to pursue enactment of the D.C. Voting Rights Act since social workers seek equality for all.

Congress Struggles over Medicare Rate Legislation

This legislation is active and we will post a blog about any developments later today, May 28, 2010. (more…)

Urgent action on a bill that includes a provision postponing the scheduled payment rate cuts to Medicare Part B providers, known as the SGR formula, has been delayed due to opposition to the high cost of the item. The Centers for Medicare and Medicaid Services (CMS), which administers the program, announced today that it will delay payment of claims to all Medicare Part B providers, including clinical social workers, effective with claims for services occurring June 1 and after.

Advocacy groups for Medicare beneficiaries and Part B providers, including NASW, have lobbied the House and Senate to avert a 21 percent cut in Medicare payment rates slated for June 1, 2010. Unfortunately, the provision contained in H.R. 4213 ran up against congressional plans for their Memorial Day recess. Before leaving today, House leaders are holding a vote on the bill, also known as the “extenders package,” but the Senate has already recessed and action on the bill cannot be completed until Congress returns on June 7. By then current SGR payment rates will have already expired. Furthermore, a final compromise package has not been reached and opposition from GOP members and many fiscally conservative Democrats remains strong. The controversy has prevented congressional leaders from assembling the majorities necessary for passage. 

To avoid disruption of services to beneficiaries and payment of claims to Medicare Part B practitioners, CMS today instructed its Medicare contractors to hold claims containing services for the first 10 business days of June.  The payment hold will affect Part B claims with dates of service June 1, 2010, and later.  CMS expects the hold will have a minimum impact on provider cash flow because clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt. Congress has previously delayed scheduled rate cuts in January, March and April of this year, (see NASW background here) 

The underlying extenders bill is a target of political confrontation. H.R. 4213 is intended to address a wide variety of economic needs beyond Medicare payments, including unemployment insurance extension, extended COBRA benefits for the unemployed, Medicaid fiscal relief for the States and other high profile tax items. A revenue source to pay for the delay of the SGR formula cut is just one disputed item in the bill. Disagreements over increasing the deficit and the tax and spending provisions have each generated controversy in the legislation. The Senate is expected to quickly consider its own version of H.R. 4213 when it returns on June 7^th.

Political Climate

With the health care debate now behind us, Capitol Hill and the Obama Administration have moved on to other things.  Issues of great significance include a pending Supreme Court nomination, fluctuating news on employment, and several Congressional primary races that will give shape to the November general election.  At this point in the year, many Members of Congress are focused on both a wide range of policy issues as well as their reelection prospects.

While Democrats are expected to suffer losses this year, experts widely disagree on the number (House seat estimates have ranged from 25 all the way to 60).  That said, it’s important to remember one thing about any election in which the minority party is trying to overwhelm the majority party: only in the summer and fall are the challengers truly tested, in both fundraising and campaigning.  Those Republican candidates trying to defeat entrenched Democrats will have to maintain a significant fundraising pace and avoid gaffes on the campaign trail.  Any error in either category could cost the GOP potential seats.

These remarks are not meant to be partisan in nature because the Democrats were in a similar position in 2006 as well as 2008.  In each of those years some Democratic challengers were unable to defeat Republican incumbents due to either lackluster fundraising, a disappointing campaign, or both.  At the same time, the Democrats won a significant number of seats in the House and the Senate, eventually taking over the majority.  The GOP is likely to repeat that pattern this year, enjoying a sizeable number of wins, but not necessarily as many as their most optimistic supporters would like.

Remembering Dr. Dorothy I. Height

NASW and the social work community were devastated by the loss of Dr. Dorothy I. Height on April 20, 2010. One of the world’s most important social workers, Dr. Height was a civil rights legend who spent a lifetime advocating for the rights of women and people of color. Dr. Height worked on five continents for four major national organizations during her lifetime. Dr. Height was the only female team member in the United Civil Rights Leadership which included Dr. Martin Luther King, Jr.,  Whitney Young, A. Philip Randolph, James Farmer, Roy Wilkins and John Lewis. She received the Presidential Medal of Freedom in 1997, the Congressional Gold Medal in 2004, and was inducted into the Democracy Hall of Fame International. NASW was honored to award Dr. Height with the 2009 Lifetime Achievement Award.

The most comprehensive piece of federal legislation ever introduced to address social work workforce challenges was named after Dr. Height and fellow social worker Whitney Young. NASW Executive Director Dr. Elizabeth Clark penned a tribute to Dr. Height and discussed her support of the legislation bearing her name. Honor the legacy of Dr. Height today by contacting your Representative and Senators in support of this critical legislation.

NASW Joins Young Invincibles In Support of Early Dependent Coverage

NASW joined 65 state and national groups on a letter asking insurance companies to start dependent coverage early.  The letter was generated by Young Invincibles, a national youth advocacy group focused on health reform.  (more…)

Take Action Today!

Action Requested

Contact your Representative today about signing on as a cosponsor to H.R. 5040, the “HIT Extension for Behavioral Health Services Act.”

Background

Rep. Patrick Kennedy (D-RI) has introduced bi-partisan legislation along with Rep. Tim Murphy (R-PA), a clinical psychologist, called the Health Information Technology Extension for Behavioral Health Services Act of 2010 (H.R. 5040). The bill, introduced on April 15, 2010, would extend the new Medicare and Medicaid “meaningful use” incentive payments established under the HITECH Act within the American Recovery and Reinvestment Act (ARRA) to clinical social workers and other mental health and substance abuse providers and facilities.

ARRA provides $20 billion in incentives and grants to health care providers and hospitals to establish interoperable electronic health record (EHR) systems throughout the nation. Medicare and Medicaid ARRA payment incentives are available to most physicians, chiropractors, dentists, optometrists, podiatrists and hospitals.  However, Congress excluded from eligibility behavioral health providers, as well as most non-physician practitioners, because of cost concerns when the law was enacted in 2009. Among those providers who would be eligible for the payments under Rep. Kennedy’s H.R. 5040 are clinical social workers, clinical psychologists, psychiatric hospitals, substance use treatment facilities and mental health treatment facilities.

As enacted, ARRA establishes a vast national EHR system that excludes the electronic patient records of clinical social workers’ and other behavioral health providers. If the current law’s deficiency is not corrected, the behavioral health records of many consumers will likely remain in paper form and therefore less accessible to other health care providers. Nevertheless, there is a high risk that excluded providers would be compelled to use electronic health records systems to participate within commercial provider networks and to obtain EHR information from covered physicians and facilities. NASW is a supporter of strong patient privacy protections established within ARRA, and also believes that quality of care will likely be seriously compromised if the records of clinical social workers and other behavioral health providers remain excluded from developing EHR systems.

Details on H.R. 5040

NASW believes it is essential to integrate care delivered by clinical social workers with other behavioral health and medical providers, and this legislation will be an important priority for enactment. The Health Information Technology Extension for Behavioral Health Services Act would:

• Clarify the definition “health care provider” throughout the HITECH/ARRA Act to include clinical social workers and psychologists, substance abuse professionals, psychiatric hospital, behavioral and mental health clinics, and substance use treatment facilities.
• Establish grants for those mental health treatment facilities not eligible for meaningful use incentives through the HITECH/ARRA Act. The grants allow for purchasing certified EHRs, training medical staff in the use of EHRs, and improving the exchange of health information between mental health providers and other health care providers.

Extend Medicare and Medicaid payment incentives for meaningful use of EHRs to clinical social workers and psychologists, psychiatric hospitals, mental health treatment facilities, and substance abuse treatment facilities.

Last evening, April 15, 2010, President Obama signed into law the “Continuing Extension Act of 2010.”  The new law extends through May 31, 2010 the zero percent update to the Medicare “Physician” Fee Schedule (MPFS) which was in effect for claims with dates of service from Jan. 1, 2010, through March 31, 2010. The new law is retroactive to April 1, 2010 and will remain in force until the end of May. Without this new stopgap measure, physicians, clinical social workers and other health professionals that bill Medicare Part B independently faced a scheduled rate cut of 21 percent on claims for service delivered after April 1.

The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare contractors to immediately resume processing claims under the new law for services provided by physicians, and non-physician practitioners (NPPs) such as clinical social workers, who are paid under the MPFS. Most claims with dates of service April 1 and later were held by Medicare in anticipation of yesterday’s congressional action. If Congress had not acted, payment rates for claims occurring after April 1, by practitioners who are paid under the MPFS would have been reduced by 21 percent, as required by a formula specified in the Medicare law.

The Medicare MPFS cut was originally scheduled to go into effect for claims paid on or after Jan. 1, 2010, but it was first postponed until March 1 by a provision in the Defense Appropriations Act of 2009, and again until April 1, in the Temporary Extenders Act of 2010. This latest Act extends last year’s payment levels until the end of next month, May 31, at which time Congress plans to again have reached agreement on a longer-term formula solution. For background information on this matter, please see NASW’s website here.

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