How do PLCSWs in NC bill for services?

by Jack Register, Director of Advocacy & Legislation & Hull House NC Editor

This is a frequent question we get at NASW-NC. I want to spend some time describing the current state of billing for PLCSWs in the state. But before I do I want to preface the comments with this statement.

NASW-NC is reporting this to you. We don't agree with the current state of affairs in NC. We don't support the state's position that PLCSWs are not "fully licensed." We do not support the current practice of PLCSWs being in the QP or Qualified Professional catagory. In our opinion, and according to the statute, a PLCSW is fully licensed as a PLCSW with all the rights and privileges associated with licensure.

In terms of billing, there are currently two (2) mechanisms. The first is called incident to. " Incident to" is a model where you use an MD's Medicaid number in order to bill. The MD must be employed by or in a contractual relationship with the agency the PLCSW works in. The MD is responsible for practice in so far as Medicaid is concerned. However, they DO NOT replace the clinical supervisor (LCSW) as deemed by the licensure board. So, in some cases, it may seem like the PLCSW has two supervisors. Incident to is a medicalized model of billing that allows several allied professionals to see a client and bill under the physician. It requires medical neccessity to be met as well.

The second model of billing is the H code. The H codes are billed through the LME. There is usually a cost, approxiamtely $.15 according to the last Implementation Update. The LME creates a contract with the agency the PLCSW works in and bills Medicaid for these services. As of now, H codes are slated for elimination from Medciaid in July 2010.

Another key issue regarding billing is what payor sources do PLCSWs qualify to use. The answer is there are two (2). Private payment for services and Medicaid. A PLCSW cannot direct enroll, cannot apply for panel membership with any third party payor at this time.


Jack is the Director of Advocacy & Legislation for NASW-NC and the Editor of Hull House NC. He is the lobbyist and advocate for the association and represents NASW-NC in statewide advocacy coalitions, to the departments of state government, and is the lobbyist for the legislature. Jack is an LCSW and has practice experience in a wide variety of mental health, medical and addiction settings. He can be reached at the association by email at jack@naswnc.org.

NASW-NC & Urban Growth

NASW-NC listening to the Urban Growth and Infrastructure Issues with NC General Assembly: Tell us what you think! Wht is this important to social workers?

New Face of NC Legislature & Social Work Practice

by Jack Register, Director of Advocacy & Legislation NASW-NC & Hull House NC Editor

The NC Legislature has transformed in recent weeks. From the scandals and resignations to the simple decisions of lawmakers to move on in their lives to new adventures. The face of NC politics is changing. I for one am glad to see it and be a part of it.

I believe now is the perfect time for all North Carolinians who care about their state, the citizens of the state, heck, even their own lives to become involved. NC faces the distinction of being one of the best places in the country to do business and yet one that struggles to care for its citizens who are sick, disabled, or poor.

So, what is an advocate to do? Well, getting involved is always a good place to begin. I for one am proud to be a social worker and live in NC. I am proud to be an advocate and member of the lobbying community who is a recognized member of the crowd of folk who wade into the morass of politics and try to make policy change.

What motivates me on a daily basis is the notion that something I do or say today to a member of the legislature, a staffer in state government, or to a colleague will shift their perception of what it means to need care. Polyanna I know, but it is what motivates me and I go with it.

Frequently when I speak to community groups of social workers I will ask them to remember what brought them to the profession. I ask them to remember what the experience was that said to them that they need to become a social worker. For many people it is an experience in their family of origin where they had the help of a social worker, for some it is a calling from their faith to give their lives to service, for some it is a duty based and grounded in a frame of social justice. For me, it is all of the above.

So as we continue to hear about our elected leaders leaving and the face of NC politics changes remember what brought you to social work. Remember why it is you go to work on a daily basis. Ask yourself what can I do or say today that may shift someone's perception. Then do it!

Simple advocacy steps to do everyday:

1. Write to some elected official who represents you. Local, state, or national it doesn't matter.
2. Identify yourself as a social worker and become a resource to them for social work practice issues and concerns.
3. Get involved in the social work community. Find a group, organization, like NASW, and get involved. Our work cannot happen without you!

Jack is the Director of Advocacy & Legislation for NASW-NC and the Editor of Hull House NC. He is the lobbyist and advocate for the association and represents NASW-NC in statewide advocacy coalitions, to the departments of state government, and is the lobbyist for the legislature. Jack is an LCSW and has practice experience in a wide variety of mental health, medical and addiction settings. He can be reached at the association by email at jack@naswnc.org.

NASW-NC deletes posts from 10-19 & 10-7

*Editor Note* NASW-NC has removed posts from the above dates due to the non approved posting of the materials from the WRAL news website. Our apologies for this oversight. For information from the Triangle area of NC, go to www.wral.com.

Editor, Hull House NC Policy Blog

Health Reform Matters for People with Mental Disabilities

 

Volume VIII, No. 7 of the Bazelon Center's Mental Health Policy Reporter October 15, 2009 We're on the Road to Health Care Reform House and Senate Ready to Merge Their Committee Bills In this Issue Senate Finance Committee Approves Health Care Reform Bill Time Winding Down for Federal Appropriations House Approves Medicare Premium Fairness Act Newsbytes Education Secretary Proclaims Now is the Time for NCLB Rewrite Pamela Hyde Nominated to Head SAMHSA Genetic Nondiscrimination Act Rules Released Rules Proposed for ADA Amendments Act Rules to Implement Parity Law Delayed Report Documents all Federal Spending on Children National Council on Disability Releases Health Care Report On the national news front, it often seems as if it's health care reform all the time, and now that all five congressional committees have approved bills, as described in this Reporter, the focus may become ever more intense. But there's more happening in the policy arena that's of interest to people with mental disabilities. Time is running down on Senate approval of the fiscal year 2010 federal budget for operations by the key departments of Justice, Health and Human Services, and Education, for some of which the House has granted increases. And the prospect of increased Medicare premiums led the House to approve a bill that will "hold harmless" 11 million seniors and people with disabilities. Newsbytes highlight a schedule for stakeholder meetings on Education Secretary Arne Duncan's desire for "a transformative education law," and two proposed rules -to protect individuals from discrimination based on personal genetic information and to implement the 2008 amendments to the Americans with Disabilities Act. Read the full Reporter at www.bazelon.org/newsroom/reporter/2009/10-15-09reporter.htm Help spread the word by forwarding this message to friends and colleagues. And please support the Bazelon Center's advocacy! You can subscribe at www.democracyinaction.org/dia/organizationsORG/bazelon/signUp.jsp Click here to unsubscribe

Medicaid cuts -- including mental health

http://www.newsobserver.com/news/health_science/story/140354.html

Published Wed, Oct 14, 2009 07:42 AM
Modified Wed, Oct 14, 2009 05:47 AM

Strained Medicaid in for cuts

North Carolina is trying to squeeze savings out of Medicaid, even as
more
people than anticipated sign up for coverage under the government
health-care program for the poor.

So far, the cuts primarily mean that doctors, hospitals and providers
are
being paid less for their services, but state officials and others are
warning that cuts to medical services and significant job losses in
health
care could be looming.

Cuts ordered by the legislature this year mean that Medicaid, which is
funded jointly by federal and state government, will lose $1.5 billion
this
year.

Those cuts have touched nearly all areas of health care. Doctors and
hospitals are being paid less to treat Medicaid patients, and the state
is
spending less on community mental health and personal care services for
the
elderly.

Meanwhile, more people are asking for help. About 8,000 more people than
legislators budgeted for were signed up for the government insurance
program
in August, and September enrollment was 3,000 people higher than
anticipated.

Unless there's a dramatic economic turnaround in the next year, the
budget
pressure could increase, said Lanier Cansler, head of the state
Department
of Health and Human Services, which oversees Medicaid.

The state is expected to get $440 million less next year from the
federal
government to fill Medicaid budget holes, he said, which may mean
legislators will have to consider cutting medical services.

"We're at the point to where we're not going to be able to keep access
in
place if we reduce the budget substantially more," Cansler said Tuesday.

Department administrators also worry that some doctors may decide to
stop
treating Medicaid patients.

"We've got a tremendous challenge this year," Cansler said. "The
challenge
will just be multiple next year."

This year, most of the state's 1.4 million Medicaid recipients -- those
who
use the insurance for routine health care -- won't feel the pinch,
Cansler
said.

But doctors, hospitals and health agencies that care for them will get
less
money to do so, and paid caregivers will be watched more closely as the
state tries to contain costs by making sure patients don't get
treatments
they don't need.

Hospitals, mental health providers and home health agencies anticipate
thousands of job losses as a result of rate reductions and program
constraints.

Mental health to be hit

Mental health providers who call the budget and program cuts "an
avalanche
of destruction" will hold a news conference today to demand the
legislature
call a special session to restore mental health money.

Late Tuesday, Gov. Beverly Perdue announced that DHHS has been told to
find
an additional $15 million to cushion the drop in community mental health
spending. This year's Medicaid cuts in mental health came to $400
million.

Hospitals expect to cut about 400 jobs because of the cut in Medicaid
payments, said Don Dalton, spokesman for the N.C. Hospital Association.
Most
of those losses will be from rural hospitals.

The recession has already forced hospitals to cut staff, Dalton said,
and
lower Medicaid payments only add more pressure.

"These will force administrators and trustees to make hard decisions on
what
services to eliminate in their communities," he said.

The home health care industry expects substantial job losses, with fewer
patients receiving home care and agencies earning less money for them.

Up to one-fifth of the state's 100,000 home health employees could lose
their jobs as a result of state and federal cuts, with the state budget
reductions responsible for about 80 percent of the loss, said Tim
Rogers,
chief executive officer for the Association for Home & Hospice Care of
North
Carolina.

For elderly people who have trouble getting in and out of a bathtub or
using
the bathroom, the state wants to replace home care workers with bathroom
bars and raised toilet seats, Rogers said.

"They're trying to replace caregivers with pieces of equipment," he
said.
"That's not the right thing to do."

Everyone wants Medicaid services to stay the same, Cansler said, but
it's
not possible.

"The system can't stay the same when we're taking the amount of dollars
out
of it the legislature has required us to take out of the system because
of
the budget crisis," he said.

lynn.bonner@newsobserver.com or 919-829-4821

Mom's depression tied to child abuse in some families

CHILD PROTECTION

 

NATION: "Mom's depression tied to child abuse in some families"

By: Staff Writer

According to a study of 5,500 U.S. families investigated by child welfare agencies published Archives of Pediatrics & Adolescent Medicine, a mother's depression may increase the risk that she will act aggressively toward her child, including engaging in name-calling and threats. While the research does not prove that a mother's depression, per se, leads to child abuse, it does suggest that adults with children should be screened by a physician for depression and partner abuse, which also increases the risk of child abuse. The research shows that mothers that developed depression during the course of the study had increased incidents of psychological aggression against their children.

 

Mothers who reported an increase in abuse from their partner were more likely to state that there was also an increase in neglect and physical abuse toward their children. However, there was a reported decrease in psychological aggression towards children by mothers who moved in with a non-violent partner during the study.

 

Reuters News Service, October 5, 2009

For Full Article Click Here

<http://abcnews.go.com/Health/WireStory?id=8757408&page=1>