Legislation and Policy Changes Impacting Clinical Social Work

Extension of H Codes for Billing Allows for PLCSW Employment:
This past spring, NCSCSW joined NASW in representing clinical social workers at a meeting with Secretary Cansler and officials from MHDDSAS and DMA to discuss the on-going problems with billing Medicaid for services provided by provisionally licensed social workers.

Currently, PLCSW clinical services can be reimbursed with Medicaid funds when billed "incident to" a physician or through the LME using H Codes. The use of H codes for billing was scheduled to be discontinued as of June 30, 2011. We advocated for the H code billing mechanism to remain and for a permanent solution to be developed. On June 6, the Division of MHDDSAS announced the extension of the H Code billing mechanism for another year. See Implementation Update # 87 at http://www.ncdhhs.gov/mhddsas. DMA has said PLCSWs can not be directly enrolled with Medicaid because our "provisionally-licensed" designation suggests the clinician is unlicensed, making services non-reimbursable and the PLCSW unemployable. NCSCSW and NASW leadership has discussed studying our licensure statute for changes that would ensure professional standards, allow for the new professional to practice supervised clinical social work, and meet Medicaid billing criteria. Thank you to Drew Pledger for representing NCSCSW at this important meeting.

HB423/SB437 First Exam for Involuntary Commitment: This statute allows LMEs to request DHHS waive the requirement for psychiatrists and psychologists to be the examiner on involuntary commitments and allow LCSWs, master-level RNs, and LCASs to be the examiner if they have undergone the first exam training and are contracted by the LME. Former NCSCSW President Laurie Conaty and long-time member Jan Cheek were the force seeking this change in the statute over a decade ago. The first exam by master-level clinicians has been piloted successfully for many years in several counties throughout NC. This statute recognizes our professional expertise and scope of practice. It has been a long time coming. Thank you to Laurie and Jan for this initiative.

HB916 Expansion of Medicaid Waiver Sites: This complicated and controversial statute will allow DHHS to waive certain requirements currently stipulated by federal law so Medicaid funds may be distributed as the individual LMEs deem appropriate. The goal is for all of NC Medicaid money be managed in this manner by 2013. At this time, it is difficult to know how this will affect our public system clients and our profession but it will change the way mental health services are appropriated.

SB323/HB578: Changes to State Health Plan
This statute moves oversight of the SHP to the Office of the Treasury and changes premiums, co-pays and deductibles for the State Health Plan as of September 1. For insured members in the 70/30 plan, the co-pay for mental health services will be $64 and members in the 80/20 plan will have a co-pay of $52. It appears mental health services are not subject to the deductibles.

SB517 Freedom to Negotiate Health Care Rates:
This bill was not ratified this session. It prohibits contract provisions restricting rate negotiations between the provider and the insurer. It was sent to the House Judiciary Committee.