Tuesday, August 28, 2007

NASW-NC Welcomes Interns for Fall 2007

NASW-NC Welcomes the following Interns for Fall 2007

Melissa Ahrens: 2nd year student MSW program UNC-Chapel Hill

Kathryn Schley: part time MSW student NC State University

Kelsi Wilson: Senior BSW student NC State University

Background information on Federal Loan Forgiveness

For those who may not have seen what National NASW efforts have been regarding loan forgiveness here is some background.

July 10, 2007
Support Loan Forgiveness for Social Workers!!


The Senate is currently considering important legislation that would make it easier for students to afford a college education, thereby directly assisting the social work workforce through loan forgiveness and other incentives.

The Higher Education Access Act of 2007 would allow social workers in a public child or family service agency to take advantage of loan forgiveness programs because it would cancel their obligation to repay federal loans after 25 years if they earn less than $65,000 annually and have worked full-time for 10 years in a “public sector job” without defaulting on their loan. Other “public sector jobs” eligible for loan forgiveness are:

* Public Emergency Management* Public Law Enforcement* Public Early Childhood Education* Public Services for the Elderly * Public library sciences* Public interest legal services (including prosecution or public defense)* Public services for individuals with disabilities
* Public Safety* Public Law Enforcement* Public Education* Public school library sciences* Other public school-based services
* Government* Public Health* Public Child Care

In addition to loan forgiveness, the bill reduces interest rates on subsidized student loans from 2008 until 2013. Although this legislation would grant loan forgiveness to certain social workers in the public sector, it does not extend to social workers in the private sector. We see this as a shortcoming of the bill. However, this legislation is crucial for all college students, but especially for social workers who are among the least paid professionals; almost 45% of social workers make under $40,000 annually. In addition, the average social worker has between $25,000 and $33,000 in debt, depending on whether they earned a Bachelor’s, Master’s, or Doctorate degree.

Action Needed
Please call your Senator at 202-224-3121 and urge them to support the Higher Education Access Act of 2007. Let your Senator know that you are a constituent and a social worker requesting their support for loan forgiveness provisions for social workers in the public and private sector.

Contact Nancy McFall Jean, Lobbyist, Government Relations Department at 202-408-8600 x 440 for more information.

Monday, August 6, 2007

Session is over

The General Assembly called session last Thursday evening. NASW-NC is busy wrapping up our notes and pulling together a final report. Look to the Aug/Sept newsletter for a detailed report to membership. Thank you to everyone who responded to the flurry of email and requests for action. We cannot do what we do without your support!

LCSW changes to Medicare passes House: from National NASW!

Legislative Update
August 2, 2007
House Gives Fast Victory to NASW Medicare SWRI Agenda!

Congratulations to NASW’s Advocacy Network, the U.S. House passed on August 1, 2007, key components of NASW's 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.


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!

For further information, contact Jim Finley at NASW: jfinley@naswdc.org.

Frightening article on hospital admissions

The article below is quite long but is a good read. NASW-NC is consistently involved with our coalition partners on issues of access. This is a prime example of what is NOT right with the transformation of our mental health/developmental disability/substance abuse services system.

Subject: lead article from the 6 August News & Observer

Published: Aug 06, 2007 12:30 AM Modified: Aug 06, 2007 04:43 AM

Mental patients suffer delays
The waiting list for Dorothea Dix is lengthening, straining other facilities and families

Michael Biesecker, Staff Writer

RALEIGH - Local doctors and social workers say they are increasingly being told there is no room for new patients at Dorothea Dix Hospital, the state psychiatric facility in Raleigh.
Those referred to Dix for treatment are often forced to wait days for a spot to open or are diverted to other, out-of-town hospitals.

In May, June and July, patients seeking admission to Dix were placed on waiting lists about two-thirds of the time -- 60 out of 92 days, according to state records.
"We've seen a trend over the last four or five years where it has always been difficult to place patients at Dorothea Dix, but even more so over the last three months," said Melody Hunter-Pillion, communications coordinator for Rex Healthcare. "We are pretty consistently, more often than not, getting word from them that they just don't have the space."

The situation leaves staff at the county's major medical centers -- WakeMed, Duke Health Raleigh Hospital and Rex -- scrambling to find spots for their patients in psychiatric facilities as far as three hours away. Many private mental hospitals won't take patients without health insurance or who exhibit violent or threatening behavior.

"It's becoming increasingly difficult to find a good inpatient setting for some of these patients," said Carla Parker Hollis, a spokeswoman for Duke Health Raleigh. "The dilemma is that these patients often end up in our emergency rooms when they need inpatient psychiatric care.
That's just not a service we're equipped to provide."

At WakeMed Raleigh Campus, which has the busiest emergency room in the county, about a quarter of patients in need of placement in a psychiatric facility now spend at least one night waiting.

"We end up holding them as inpatients so they're not sitting indefinitely in an emergency room bed," said Dr. James Hartye, WakeMed's medical director for clinical services. "That's not optimum. That's not fair to the patient."

The limit on admissions at Dix is funding, not square footage. The 156- year-old hospital west of downtown Raleigh has space to accommodate hundreds more patients than are currently admitted. Since North Carolina began reforming its state mental health system in 2001, total capacity at Dix has been downsized by about a quarter, to 307 patients.

Monthly admissions of adult patients at the hospital, by contrast, have increased by more than a third in the past four years. And the numbers often spike in the hot summer months.
Having more patients than available beds has inevitably led to increasing periods of "admissions delay," when the hospital freezes new admissions as it works through a backlog of patients needing to get in.

"We do have a maximum capacity, and when we exceed that by roughly 110 percent, then we go a on a delay status until we have an opening through a discharge," said Dr. Jim Osberg, who was director at Dix until Tuesday, when he was promoted to a new job as chief of operative services for the state Division of Mental Health. "Going on delay is becoming more frequent because admissions are increasing."

A mother's fright

In June, when Eileen Marks' teenage son was hearing voices in his head and saying he would kill himself to silence them, Wake County's mental health crisis center sought to refer him to Dix.
But after the county called the state psychiatric hospital, the Cary mother says she was given an answer she found both frightening and infuriating.

"Dix said there weren't any beds," Marks remembers. "My son was threatening suicide, and they wouldn't take him. I was terrified."

After a delay of several hours, Marks' son was admitted.

But advocates for the mentally ill say treatment delayed is too often treatment denied, and that the difficulty getting in to Dix is only half of the equation.

"They're turning away consumers who need to be there," said Frank Edwards, president of the Wake County chapter of the National Alliance for the Mentally Ill. "The other thing we're hearing is that they are letting the consumers go too quickly, where the family members can tell they are not even close to being ready to come out, and the Dix people are saying, 'No, no, they're ready,' and releasing them. Many times, they end up back on the street or in jail."

The revolving door

Admissions of mental patients for stays of one to seven days increased more than 82 percent from 2001 to 2005. Often, it can take more than two weeks for anti-psychotic drugs to begin working.

Many of those released quickly return to be admitted again, according to state data. Critics say the surge in admissions shows that the strategy of downsizing state mental hospitals in favor of private outpatient care is not working.

The problems are growing so severe, Edwards said, that his group is preparing a special memo for the families of those admitted to Dix with tips on how to keep their loved ones from being pushed out the door.

Marks says that's what happened to her son, an 18-year-old who was diagnosed more than two years ago with bipolar disorder. After about a week in the state hospital, she was pressured to move him to a private facility.

"They wanted him outta there," she said. "They were very clear."

Marks' son now lives in a local group home for the mentally ill, where he is receiving the long-term care once provided by the state hospital system.

"I'm a lot more sane, now that I know he is monitored," the mother said. "I can go to work and not have to worry about coming home to a dead kid."

Many don't find such constructive accommodations. A recent study funded by the N.C. Governor's Advocacy Council for Persons with Disabilities found that people with mental illness are increasingly ending up in county jails.

It is estimated that more than 11,000 inmates in North Carolina jails have serious mental health problems.

Hospitals closing

Health care professionals and advocates for the mentally ill are concerned the issue will only get worse when the the state shuts down two of its four psychiatric hospitals in February 2008.
Dix and John Umstead Hospital in Butner will be replaced by a 432-bed facility under construction in Butner. That is 171 beds fewer than are now available at the two aging hospitals.
The scheduled cut is the latest in a series of downsizings to the state's mental health institutions.
In 1972, North Carolina's four state mental hospitals had room for nearly 7,000 patients. Though the state's population has nearly doubled over the past three decades, the capacity of its mental hospitals will shrink to 1,153 after Dix closes.

Osberg, the operative services chief for the state, said that changes made when the new Central Regional Hospital opens next year should help ease the capacity crunch.

Fifty beds in a forensic psychiatric unit now at Dix will be transferred to Broughton Hospital in Morganton. An additional 36 patients can be accommodated at the new hospital if some of the larger patient rooms are converted to double occupancy. Another 115 beds at the old Umstead hospital campus will be retained as overflow capacity.

State officials maintain that the number of beds for short-term adult psychiatric patients, those most often admitted, will decline by only 14 when the new hospital opens.

"The capacity will essentially remain unchanged," Osberg said. "I can't say there won't be any delays at the new hospital, but there should be additional crisis services available in the local communities, whether it's Wake County or any other area, to help decrease demand on the hospitals. Frankly, I don't think it will be any worse than it is today."

Plans in Wake

Wake County is planning to build a new mental health crisis center to open in 2010. The county is also contracting with Holly Hill Hospital, a private psychiatric facility in Raleigh, to admit the indigent patients it now turns away.

In cooperation with the county, Holly Hill wants to add 44 beds to its hospital to make up for some of the capacity lost when Dix closes.

Regulatory approval for the expansion at Holly Hill is pending, but interim chief executive officer Ron Howard said last week the new wing should open by early 2009.

That could still leave a gap of at least 10 months between the closure of Dix and the opening of additional beds at Holly Hill.

County officials and medical centers are working to prepare for the change, while Raleigh police officers and Wake sheriff's deputies have been receiving additional training on handling those with mental illnesses.

If there's a silver lining to Dix's impending closure, according to those involved, it is that the remaining local institutions are working more closely than ever to focus on helping the mentally ill.

"We have much better communication now," Dr. Hartye at WakeMed said.
"In the past, for whatever reason, folks were working in their own silos.
That time is gone. We're all in this together."

Staff writer Michael Biesecker can be reached at 829-4698 or michael.


Since February, the number of days Dorothea Dix Hospital has put those seeking admission on waiting lists has increased. Patients can spend days waiting for a spot to open. Over the past three months, new patients were deferred about two-thirds of the time.
February 4
March 12
April 4
May 16
June 23
July 21

Aetna news from NJ

This comes from the Joint Insurance Committee where NASW-NC is a member.


This week the New Jersey Department of Banking & Insurance (DOBI) fined Aetna almost $9.5 million for its attempt to pay certain out-of-network providers what it deemed a "fair" amount—125% of Medicare—rather than the providers’ billed charges. DOBI also ordered Aetna to directly pay the affected providers’ billed charges, in reparation, for certain services rendered out-of-network. The $9,457,500 total penalty is among the largest that DOBI has ever levied against a healthcare insurer and includes penalties in the amount of:

􀂃 $650,000 for misrepresenting its obligations in letters sent to 130 providers (amounting to $5,000 per offending letter);

􀂃 $7,747,500 for not attempting in good faith to effectuate prompt, fair and equitable satisfaction of the claims for certain services; and

􀂃 $530,000 for not providing its HMO member/patients the right to be free of balance billing by providers for medically necessary services that were authorized or covered.

Aetna’s recent payment policy was apparently directed toward providers who rendered services to Aetna’s HMO patients for emergency care, for services rendered by non-participating providers during an admission to a network hospital by a network provider, and for services rendered by non-participating providers pursuant to a referral or authorization by Aetna. Aetna took the position in letters to the out-of-network providers that it was only obligated to pay its determination of a "fair" amount, which it deemed to be 125% of the Medicare allowable amount. Aetna further stated that no additional payment would be considered. Physicians objected to this new payment practice and took the matter to DOBI.

In its order DOBI cited New Jersey regulations requiring Aetna’s HMO to limit their member/patients’ liability for services to the network co-payment, deductible or coinsurance when rendered during emergency care and during an admission to a network hospital by a network physician. DOBI also cited regulatory authority for the proposition that an HMO is fully responsible for payment when it refers a patient to a non-participating provider.

Reading the regulations together, DOBI found that member/patients "have no liability for the difference between the non-participating provider’s billed charges and the benefit paid by the HMO because the member is responsible only for the network copayment, coinsurance or deductible." DOBI further found that "Aetna must pay the non-participating provider a benefit large enough to insure that the non-participating provider does not balance bill the member for the difference between his billed charges and the Aetna payment, even if it means that Aetna must pay the provider’s billed charges less the member’s network copayment, coinsurance or deductible."

Aetna has 30 days to object to DOBI’s order.

MSNJ applauds DOBI for enforcing the regulations that require adequate reimbursement to out-of-network providers and that protect HMO patients from paying a larger than bargained for share, out-of-pocket, for their medically necessary expenses. MSNJ recognizes the leadership of physicians who took Aetna to task and provided DOBI with the information needed to pursue this important enforcement action. MSNJ encourages our members to continue the battle against insurers for truly fair and adequate reimbursement rates to ensure patient access to quality care in New Jersey.