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Health Care Payment Reform

There are several major mental health advancements for clinical social workers and patients in the Massachusetts Health Care Payment Reform Legislation signed into law by Governor Patrick on August 6, 2012. NASW MA Chapter and its mental health colleagues have been actively engaged in advocacy and lobbying to ensure that the best interests of social workers, other mental health professionals, and our clients and patients were included in the final bill…

The key components:

  • Accountable Care Organizations (ACOs) must integrate or contract out for behavioral health services. Since doctors will be rewarded for keeping patients well, behavioral health services will be a necessity, creating many new opportunities for behavioral health providers like social workers.
  • Insurance companies and managed care organizations will now have to provide their "medical necessity criteria sets” for review by the Department of Public Health Office of Patient Protection. And, for the first time, these criteria sets must be made available to providers, including social workers, and consumers either through posting on their website or, for criteria sets defined as "proprietary,” upon request.
  • ACOs must comply with federal and state Mental Health Parity. The Division of Insurance will have the power to regulate this requirement and reporting to the Attorney General will be required. In addition, if a behavioral health provider is removed from an ACO, that provider will have the ability to appeal.
  • There will be access to $30 million in federal grants for behavioral health providers to move to electronic medical records.
  • There will be a new 19 member Healthcare Workforce Council, which will oversee the newly created loan repayment program for behavioral health providers (including social workers). Behavioral Health will be represented on the Council.
  • The bill also creates a 19 member Behavioral Health Special Task Force, of which NASW MA Chapter is a member. NASW will strongly advocate for and support the needs of social workers and consumers as the task force addresses a variety of as yet unanswered issues with respect to the new payment system. The Task Force will report out by July 1, 2013.

As with any bill that passes, our work is not over. And that is especially so in the case of this landmark legislation. We will continue to keep you informed about the status of the Behavioral Health Special Task Force and additional implications of the new law. Onward!

For questions or more information, please be in touch with Rebekah Gewirtz, NASW MA Chapter Director of Government Relations and Political Action at gewirtz@naswma.org or 617-227-9635 x12.


PROFESSIONAL SOCIAL WORK IN PAYMENT REFORM

INTRODUCTION:
In an effort to enhance cost effective, accessible, quality patient care, the Massachusetts Chapter of National Association of Social Workers (NASW) strongly supports the Integrated Care Organization (ICO) model. Through its internal Payment Reform Advisory Group, NASW has developed recommendations to address the Commonwealth’s ongoing effort to integrate care and control costs.

BACKGROUND ON SOCIAL WORK:
The social work profession makes significant contributions to integrating care, improving health and controlling costs today. The profession:

  • Is the largest single source of licensed behavioral health providers among public and private health plans in Massachusetts and nationally
  • Provides a vast source of expertise and experience in behavioral and lifestyle change to improve outcomes in chronic diseases and patient compliance
  • Serves as a leading care coordination profession, crossing organizational boundaries and program silos to engage clients in improving the behavioral health and the social, educational, familial and economic self-sufficiency of its clientele
  • Has been at the forefront of confronting and developing methods for overcoming the debilitating effects of poverty and discrimination and their negative effects on individual health
  • Is comprised of practitioners that are highly skilled in the use of standardized screening tools for measuring improvements in the treatment process, patient satisfaction, and outcomes

RECOMMENDATIONS FOR POLICY MAKERS:
The contributions of social workers make possible the achievement of a whole-person-centered healthcare system through payment reform and the financing and operation of ICOs. Accordingly, NASW recommends that ICO's integrate behavioral health providers into primary care practices as in-house staff and/or through contracted services with solo or group behavioral health practices. We advise ICO's adopt the following fundamental principles:

  1. Recognize and draw upon provider strengths identified above both in governing board and advisory committee representation and in the entity’s operations.
  2. Support development of a) affordable interoperable Electronic Health Records and data exchanges that will make these features financially and technically accessible to solo and small group practitioners who wish to participate in ICOs, b) practice management technologies and limited risk tolerances that accommodate and strengthen existing capabilities.
  3. Elevate reimbursement rates to behavioral healthcare providers across the board and ensure greater equity in compensation and reimbursement among provider types.
  4. Ensure that ICOs use licensed mental health professionals to determine the qualification of other licensed mental health professionals to participate in the ICOs.
  5. Ensure that staff/consultants of ICOs who are providing behavioral healthcare services but who are not independently licensed, be supervised by independently licensed behavioral healthcare providers.
  6. Ensure confidentiality of client records while assuring ample opportunities for interdisciplinary collaboration.
  7. Ensure patient choice, to the maximum extent possible, in the selection of providers.
  8. Ensure continuity of care for consumers, which will save in the long term by avoiding patient regression.

For more information, please contact Rebekah Gewirtz, Director of Government Relations and Political Action at 617-227-9635 x12 or Gewirtz@naswma.org

 

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Updated 6.3.13

National Association of Social Workers - Massachusetts Chapter
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tel: (617)227-9635 fax: (617)227-9877 email: chapter@naswma.org
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