Medical Social Worker
Medicare Benefit Policy Manual (CMS Pub. 100-02) Ch. 9 §40.1.2
Medical social services must be provided by a person who:
- Has a Master of Social Work (MSW) degree from a school of social work accredited by the Council on Social Work Education or
- Has a baccalaureate degree in social work from an institution accredited by the Council on Social Work Education; or a baccalaureate degree in psychology, sociology, or other field related to social work and is supervised by an MSW as described in paragraph (b)(3)(i)(A); and
- Has 1 year of social work experience in a healthcare setting or
- Has a baccalaureate degree from a school of social work accredited by the Council on Social Work Education, is employed by the hospice before December 2, 2008, and is not required to be supervised by an MSW.
Services of these professionals may include, but are not limited to:
- Assessment of the social and emotional factors related to the beneficiary's illness, need for care, response to treatment and adjustment to care;
- Assessment of the relationship of the beneficiary's medical and nursing requirements to the beneficiary's home situation, financial resources and availability of community resources;
- Appropriate action to obtain available community resources to assist in resolving the beneficiary's problem. (NOTE: Medicare does not cover the services of a medical social worker to complete or assist in the completion of an application for Medicaid because Federal regulations require the State to provide assistance in completing the application to anyone who chooses to apply for Medicaid.);
- Counseling services that are required by the patient; and
- Medical social services furnished to the patient's family member or caregiver on a short-term basis when the hospice can demonstrate that a brief intervention (that is, two or three visits) by a medical social worker is necessary to remove a clear and direct impediment to the effective palliation and management of the patient's terminal illness and related conditions. To be considered "clear and direct," the behavior or actions of the family member or caregiver must plainly obstruct, contravene, or prevent the patient's medical treatment. Medical social services to address general problems that do not clearly and directly impede treatment, as well as long-term social services furnished to family members, such as ongoing alcohol counseling, are not covered.
Reviewed: 12.08.21