Legislation supports reimbursement for HBAI services

Aug 4, 2016

Most Medicare beneficiaries go without an emotional support system when there is a change in their health status.

A provision in the Improving Access to Mental Health Act (S.2173; H.R.3712) aims to fix that problem by allowing clinical social workers across the nation to bill Medicare Part B for health and behavior assessment and intervention (HBAI) services.

HBAI services help Medicare beneficiaries with the emotional and social concerns that arise because of a change in medical condition, explained Kate Krajci, coordinator of Health and Aging at Rush University Medical Center in Chicago.

An example would be a person who is newly diagnosed with a degenerative condition such as ALS, she said.

“As that disease is progressing and getting worse, people’s needs — both emotional and practically — start to change,” Krajci said. “These codes will allow social workers to be able to bill for these services when these people are going through these kind[s] of circumstances.”

NASW helped develop the HBAI codes in 1999 through 2001. However, in 2002 the Centers for Medicare & Medicaid Services stated it would not reimburse social workers for the HBAI codes, asserting that HBAI services are not included in the Medicare statute’s definition of “clinical social worker services”: diagnosis of and treatment for mental illness.

At the same time, CMS agreed with NASW that the services reflected in the HBAI codes were within the scope of clinical social workers’ day-to-day practice.

Since 2002, CMS has left the question of whether to reimburse clinical social workers for HBAI services to the discretion of each local Medicare Administrative Contractor, or MAC. Over the past decade, various MACs have approved payments of the HBAI codes, but such reimbursement is inconsistent across regions and states.

The Improving Access to Mental Health Act eliminates this problem by expanding the Medicare definition of “clinical social worker” services to include HBAI services.

Such a change would allow a person who has a new medical diagnosis or a change in their condition to talk with a social worker right away, Krajci said.

From the July 2016 NASW News. NASW members can read the full story here.

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