Since 1997, The Sustainable Growth Rate (SGR) has been used to calculate Medicare reimbursement and was based on economic growth and the quantity of services performed. Although the SGR was scheduled to decrease Medicare payments in April 2015 by 21.2 percent, the Medicare Access and Children Health Insurance Program Reauthorization Act of 2015 (MACRA) eliminated the formula. Medicare Fee for Services is being replaced with payment increases for clinical social workers and other Medicare providers over the next five years.
Beginning July 1, 2015 through December 31, 2015, clinical social workers will receive a 0.5 percent in Medicare reimbursement. They will continue to receive an annual increase of 0.5 percent from 2016 through 2019. Medicare will transition to a new payment system focusing on quality and value. Alternative payment options are being considered including a “Merit-Based Incentive Payment System.” A technical advisory panel is also being established to recommend payment models. For several years, NASW advocated for the elimination of the SGR to prevent Medicare reimbursement reductions for clinical social workers.
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