clinical social work association

The Aware Advocate - October 2024

(An occasional summary of clinical social work issues)

by Laura Groshong, LICSW, CSWA Director of Policy and Practice

On November 12, 2024, at 5:30 pm ET, CSWA will hold its 50th Town Hall. These zoom meetings, which began in August of 2020, have become a great way to connect with other CSWA members and find out what is happening in the profession. Hope to see you then!

It has been a while since the last The Aware Advocate was published, primarily because so much of my work for CSWA has been focused on the creation of the Social Work Compact. Here is a summary of the past few months about issues that affect LCSWs, including the current status of the ASWB exams; the current status of the Compact; recent MHLG sign-ons to Congressional bills and letters; information on the Compact Commission development; a KQED report on lower reimbursement for LCSWs doing outpatient work compared to those working in hospitals; and LCSW problems with insurance.

ASWB Update

ASWB held a Work Force Coalition meeting last month, attended by CSWA President Stephanie Payne and CSWA Deputy Director of Policy and Practice Judy Gallant, that reviewed the results of the Social Work Census and explained the work that is being done to address disparities in pass rates for the clinical, master’s, and bachelor’s examinations. As a follow-up to the August 2022 ASWB Report, which first identified these disparities, another report was released which goes into more detail about the disparities by schools which social workers have attended. To view this report please visit https://www.aswb.org/exam/contributing-to-the-conversation/exam-performance-reports-for-social-work-schools-and-programs/. 

In addition to the disparities in pass rates for the clinical exam between Black and white social workers, those with English as a second language and a primary language, and older social workers compared to younger social workers, there are also disparities between other minority groups of social workers and white social workers, male and female social workers, and other breakdowns of the pass rates. A detailed analysis of this new data is being developed which will be sent to CSWA members as soon as it is available. 

The changes that ASWB is making to improve the test-taking process so that those who fail can have additional help and adjustments to exam structure were also discussed. The harm being done to certain groups who do not have the training and education to pass the test needs to be corrected.

Compact Commission Update

The first meeting of the Interim Social Work Compact Commission was held on September 17. There were representatives in attendance from all 22 states that have passed the Compact bill into law at the 5-hour meeting. In addition, there were about 75 members of the public. I was asked to chair this meeting and will also chair the next meeting which will be held in January 2025. At that meeting, the Executive Committee – Chair, Vice-Chair, Secretary, and Treasurer – will be elected by the delegates; I am not eligible for these positions because I represent a national organization, not a state. CSWA will have a representative as an ex officio member or as a public member at future meetings.

It is likely that the Commission will be running by fall of 2025 or winter of 2026, at which time all individual LCSWs in states that have joined the Compact, can join the Compact individually and work with clients in all 22 states. Other states are still eligible to join the Compact if they pass the bill.

Mental Health Liaison Group (MHLG)

Here are recent letters that CSWA has signed on to through MHLG or by request from sponsors:

Sign-On in Support of the Stabilization to Prevent (STOP) Suicide Act

• Rep. Raskin (MD-08) and Rep. Bacon (NE-02) will be introducing the Stabilization to Prevent (STOP) Suicide Act. The bill will create a SAMHSA grant program to expand the use of evidence-based models for stabilizing individuals with serious thoughts of suicide.

Sandy Hook Promise is circulating a FY 25 letter of support for increased STOP School Violence Act

• Sandy Hook Promise is circulating a FY 25 letter of support for increased STOP School Violence Act funding. The STOP School Violence Act program makes annual grants available to states, school districts and tribal organizations to bring evidence-based safety programs and strategies to schools on topics including suicide, bullying, and violence prevention. This programming seeks to empower students and adults in schools to know how to reach out for help when concerned about violence toward themselves or others. 

Sign-on Letter on Mental Health Parity and Addiction Equity Act

• Legal Action Center is circulating a sign-on letter urging the Departments of HHS, Labor, and Treasury to finalize the proposed 2023 parity rules. To sign-on and view the text of the letter, please visit https://forms.gle/NxSn6zGy5BopUpvj7.

Endorsement Opportunity: Improving Seniors’ Timely Access to Care Act

• The Improving Seniors’ Timely Access to Care Act (the Seniors’ Act) is bipartisan legislation that will tackle the overuse and abuse of prior authorization (PA) by Medicare Advantage (MA) plans, which threatens access to patient care and increases provider administrative burden.

Workforce Working Group Leading Letter on Bipartisan Workforce Policies

• This letter originated from ideas submitted by members of the MHLG Behavioral Health Workforce Working Group. The letter is addressed to the Senate Finance Committee and House Energy and Commerce Committee, uplifting the importance of several behavioral health workforce issues and policy recommendations for consideration during the duration of the 118^th Congress.

The CSWA Government Relations Committee has reviewed about 20 letters and bills in the past eight months for sign-ons.

Request from KQED on Clinical Social Work Reimbursement

A reporter from NPR station KQED contacted CSWA for information about the disparity in California reimbursement rates for in-hospital work and out-patient work. While the article was not focused on private practitioners, it was related to the pay disparities for LCSWs which we are very familiar with. To view the article please visit https://www.kqed.org/news/12007779/sf-frontline-workers-who-help-people-on-streets-in-shelters-call-for-fair-pay.

Insurance Issues

Problems with insurance reimbursement are numerous but the most challenging ones are the way that some insurers are engaging in “clawbacks” which are a demand that payments made be returned to the insurer, sometimes many months after they have been made. The most recent example is the way that a company called Change Healthcare made payments that were at the wrong (higher) rate for LCSWs. Another issue is the refusal of insurers to pay for more than one session a week, questioning the use of 90837 regularly, or seeing a patient for more than a year, all of which can lead to audits. Finally, there is an increase in “prior authorizations” for some kinds of treatment by some insurers, a practice that had not been active for several years.

These issues have been around for about 10 years but have had an uptick in the past year. This increase could be due to the likelihood that mental health parity rules are being made more stringent and that insurers will have to comply with more coverage of mental health conditions that they have avoided until now. CSWA will be offering a webinar on these issues in January of 2025.

Please let me know if you have questions or comments about any of these issues.

Laura Groshong, LICSW, Director, Policy and Practice

Clinical Social Work Association

lwgroshong@clinicalsocialworkassociation.org