House Gives Fast Victory to NASW Medicare SWRI Agenda

Aug 9, 2007

Legislative Update

Thanks in part to NASW’s Advocacy Network, the U.S. House passed on August 1, 2007, key components of NASW’s Social Work Reinvestment Initiative (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.


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.


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!

strong>Thanks for your advocacy!

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