Dear CSWA Members,
There are several concerns about the potential risks of accepting the funds which many members have received as compensation for the potential loss of income due to COVID-19. There is no clear guidance on the meaning of the Relief Fund Payment Terms and Conditions, some of which are ambiguous, but the risk which accepting the funds causes seems less problematic than so have suggested. This is not legal advice, but my best guess about what the likely outcome of accepting the reimbursement will be and factors you may want to consider in making your decision.
Purpose of Funds – This statement in the Relief Fund Terms and Conditions is unclear when applied to psychotherapy: “The Recipient certifies that the Payment will only be used to prevent, prepare for, and respond to coronavirus, and shall reimburse the Recipient only for health care related expenses or lost revenues that are attributable to coronavirus.” This can be interpreted in the broadest of terms, i.e., that there is anxiety and depression about the pandemic which almost all patient face even if that is not their primary reason for treatment, or in a narrower way, that the presenting problem is specifically emotional distress about being ill with COVID-19, having family members with COVID-19, or fears about this happening. We must use our judgment about which way to interpret this section.
Meaning of UHC Involvement in Payments – this may be unusual in the way we are generally paid but this public/private partnership should not have any impact on our status as out-of-network providers, if we are. UHC is a pass through in this case, writing checks for HHS; Medicare does not accept out-of-network clinicians so there is no possibility of that option being limited for beneficiaries.
Out-of-Pocket Payments – finding LCSWs to provide services is challenging even without the additional burden of the emotional stress that has been created by the pandemic. Accepting the reimbursement requires us to agree that we have not charged anyone our out-of-network rates if we saw them outside of Medicare and that we will not do so going forward.
Consequences of Attestation – there may be some auditing of how the funds are used but it seems unlikely that the amount of money being distributed to LCSWs will be targeted. Signing the attestation that you have received the funds and intend to use them to treat Medicare beneficiaries with COVID-19 mental health problems seems like it is likely, to one degree or another. It is probably less risky if you affirmatively accept or reject the funds that you have received, after weighing all the factors involved.
Keeping the funds may be appealing and well-earned, but some members have decided to reject them because of the involvement with UHC, the ambiguity about whether the work we are doing meets the criteria for accepting the funds, and the possibility of being audited is not worth the risk. Each of us will need to come to our own conclusions about this difficult decision.
Laura Groshong, LICSW, Director, Policy and Practice
www.clinicalsocialworkassociation.org
Clinical Social Work AssociationThe National Voice of Clinical Social WorkStrengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY
Many members have begun to get Medicare ‘reimbursements’ as a result of the CARES Act. This has caused some confusion which I will try to clear up here.
1. Funding Source - These funds come from the from the $34 billion provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act through DHHS. The CARES Act appropriation is a payment that does not need to be repaid.
2. Amounts Reimbursed - The amounts are based on the treatment that an LCSW provided to Medicare patients on a fee-for-service basis in 2019; this does not apply to Medicare Advantage patients. The amount is based on the LCSW’s share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.
3. Reason for Reimbursement – Though these funds are primarily for services provided connected to COVID-19 issues, it applies to other mental health problems as well. It goes without saying that there is widespread anxiety and depression as a result of the pandemic which affects almost everyone in the country.
4. United Health Care Role - The reimbursements are distributed by HHS through United Health Care in a public/private partnership. Most reimbursements are under $2000, many under $500 from what I have heard.
5. Attestation - You can either ‘attest’ that you accept the funds directly at https://covid19.linkhealth.com/ or do nothing which will be seen as an affirmative attestation in 30 days from distribution. There is no penalty if an affirmative attestation is not made.
For more information go to https://www.cms.gov/newsroom/press-releases/cms-approves-approximately-34-billion-providers-acceleratedadvance-payment-program-medicare , hhs.gov/providerrelief or call the CARES Provider Relief line at (866) 569-3522.
There is another program which provides loans to LCSWs and other health care providers who need financial assistance as a result of the COVID-19 crisis. The CMS Accelerated and Advance Payment Program has delivered billions of dollars to healthcare providers, including some LCSWs. These accelerated and advance payments are loans that providers must start paying back within 120 days and complete paying back by 210 days. For more information on applying for these loans, go to https://www.cms.gov/newsroom/press-releases/cms-approves-approximately-34-billion-providers-acceleratedadvance-payment-program-medicare
I hope this is helpful. Let me know if you have any further questions.
Many clinical social workers have noticed the way that our current shift to working through telemental health platforms has affected the treatment relationship and our own view of our work. This summary of the discussions that we have had in the CSWA "Open Webinars" may help us think through these changes. The summary can be found at CSWA - Clinical Issues in Virtual Therapy - 4-16-20.docx .
Another "Open Webinar" will be held this Sunday at 2 pm ET/11 am PT. This is an excellent way to connect with colleagues and navigate the brave new world (for some) of telemental health. All CSWA members can register at https://www.clinicalsocialworkassociation.org/event-3814579 . Hope to see you then.
Clinical Social Work Association The National Voice of Clinical Social WorkStrengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY
Below is a summary of most of the changes LCSWs have faced in the past few weeks as we have moved to telemental health psychotherapy at CSWA - Summary of COVID Changes for LCSWs - 4-8-20.pdf
Please let me know if you have questions that are not addressed or corrections to the material presented.
I can't stress enough how important it is to let your members of Congress know about the harm being caused by the lack of access to patients who do not have computers or smart phones. The only way to conduct treatment with them, primarily Medicare beneficiaries, at this time is through telephonic sessions. HHS has the ability to allow expanded coverage of telephonic sessions under the CARES Act. We need to keep up the pressure that Sec. Azar make this change. See the suggested language below to send messages to him and members of Congress.
I thought you might like to see the letter sent by CSWA to Sec. Azar and CMS Administrator Verma which can be found at CSWA - Letter on Audio Only Coverage - 4-7-20.docx
As for those members who have had questions about small business loans for self-employed business owners, the programs that were set up under CARES are swamped. If you have applied, do not expect a response for about a month. Priority is being given to large corporations. I will provide more information on this topic as I have it.
Let me know if you have any other questions in these difficult times. Keep your patients and yourselves healthy, rested and safe.
“I am a constituent and a member of the Clinical Social Work Association. I have patients who are unable to meet with me in person for psychotherapy because of the COVID-19 crisis and do not have access to a smart phone or computer. The Centers for Medicare and Medicaid Services have not expanded coverage of psychotherapy to telephonic sessions, only videoconferencing; however, the only way I can provide services to these beneficiaries is by telephone.
Some enlightened insurers like Cigna and Aetna have already allowed some temporary coverage of telephonic psychotherapy sessions. Some states such as Texas, and Ohio have also required temporary coverage of telephonic psychotherapy sessions by private insurers.
Please tell CMS [and/or private insurers for state legislators and Insurance Commissioners] to approve coverage of telephonic psychotherapy sessions, sorely needed in these fraught times, for Medicare beneficiaries [and other enrollees privately insured] who may be isolated, emotionally fragile, and in need of mental health services."
You can find contact information for members of Congress at https://www.house.gov/representatives and https://www.senate.gov/general/contact_information/senators_cfm.cfm. You can find email addresses for your state legislators and Insurance Commissioners by going to your state websites.
Below is an update on several issues related to our transition to telemental health services.
1. Zoom – There have been concerns raised about the security of the Zoom platform and Zoom is taking steps to address these issues. A more secure system will be in place by April 5 for the ZoomPro and other platforms Zoom offers. Here is a summary of what will be happening:
Zoom
We’re always striving to deliver you a secure virtual meeting environment. Starting April 5th, we’ve chosen to enable passwords on your meetings and turn on Waiting Rooms by default as additional security enhancements to protect your privacy.
Meeting Passwords Enabled “On” Going forward, your previously scheduled meetings (including those scheduled via your Personal Meeting ID) will have passwords enabled. If your attendees are joining via a meeting link, there will be no change to their joining experience. For attendees who join meetings by manually entering a Meeting ID, they will need to enter a password to access the meeting.
For attendees joining manually, we highly recommend re-sharing the updated meeting invitation before your workweek begins. Here’s how you can do that:
Log in to your account, visit your Meetings tab, select your upcoming meeting by name, and copy the new meeting invitation to share with your attendees. For step-by-step instructions, please watch this 2-minute video or read this FAQ.
For meetings scheduled moving forward, the meeting password can be found in the invitation. For instant meetings, the password will be displayed in the Zoom client. The password can also be found in the meeting join URL.
Virtual Waiting Room Turned on by Default Going forward, the virtual waiting room feature will be automatically turned on by default. The Waiting Room is just like it sounds: It’s a virtual staging area that prevents people from joining a meeting until the host is ready.
How do I admit participants into my meeting? It’s simple. As the host, once you’ve joined, you’ll begin to see the number of participants in your waiting room within the Manage Participants icon. Select Manage Participants to view the full list of participants , then, you’ll have the option to admit individually by selecting the blue Admit button or all at once with the Admit All option on the top right-hand side of your screen. For step-by-step instructions, please watch this 2-minute video.
Check out these resources to learn How to Manage Your Waiting Room and Secure Your Meetings with Virtual Waiting Rooms.
For more information on how to leverage passwords and Waiting Rooms to secure your meetings, please visit our Knowledge Center, attend a daily live demo, or visit our Blog.
Please reach out to our Support Team if you have any questions at support@zoom.us.Medicare Issue
Medicare has made several changes in the past few days, revising some previous guidance. Below are some of the most important changes. To see the latest guidance, go to https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient
2. Medicare Coding – the Medicare coding for psychotherapy continues to be in flux. Here is Guidance which came out today saying we should now use the POS we would have used had the service been provided in person, e.g., “11” for in-office psychotherapy, and the modifier “95”:
Billing for Professional Telehealth Distant Site Services During the Public Health Emergency — Revised (4/3/20)
This corrects a prior message that appeared in our March 31, 2020 Special Edition.
Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. When billing professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with:
As a reminder, CMS is not requiring the CR modifier on telehealth services. However, consistent with current rules for telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:
There are no billing changes for institutional claims; critical access hospital method II claims should continue to bill with modifier GT.
3. Medicare Reimbursement – this is the area that has seen the most confusion; previous guidance had stated that reimbursement would be the same for telemental health as in-person treatment. So far, there have been payments made for telemental health that are 7-8% lower than previous reimbursement, some that have remained the same This seems to vary by region. Contact your MAC to discuss if you have received a payment that is not consistent with previous reimbursement.
4. Medicare Provider Enrollment - CMS is making it easier for providers to enroll in Medicare. Local private practice clinicians and their trained staff may be available for temporary employment since nonessential planned medical and surgical services are postponed during the pandemic.
5. Telephonic Coverage – this is the area that has caused the most confusion based on the March 30 guidance: “Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only.” The problem with this statement for LCSWs is that there is only one service that is expanded for psychotherapy, e.g., the E/M 10 minute evaluation, NOT psychotherapy sessions. CSWA is still working hard to get coverage of telephonic sessions by Medicare. At present, they are not covered. Continue to let your members of Congress know that this is a problem as noted below.
CSWA will continue to provide information on regulatory changes to members that affect LCSW practices which will likely be continuing for the next month.
Please let me know if you have any other questions.Laura Groshong, LICSW, Director, Policy and Practiceww.clinicalsocialworkassociation.org
Things are changing rapidly to give people better access to mental health services. Here is some more information that affects LCSWs.
First, a correction. Maryland has not required coverage of telephonic sessions; Gov. Hogan was one of the first states to allow emergency reciprocity for LCSWs not licensed in Maryland. Apologies for the error.
Along these lines, many states have followed his example and are now allowing LCSWs to practice in states where they are not licensed, as long as they are licensed in at least one state. There are many variations so make sure to read the emergency declarations carefully. The list helpfully created by Shrink Space can be found at https://theshrinkspace.blog/covid-19-teletherapy-across-state-lines/ . It is being updated daily.
Finally, sending a message like the one below to the President would be a good idea. You can send it to www.White House.gov.
I will be sending more information as it comes in. Let me know about any changes to practice in your state/jurisdiction.
The complete change to our personal and professional lives in the past two weeks as the result of the COVID-19 pandemic has been overwhelming. It has led to feelings of helplessness about how to do our jobs as clinical social workers that many of us have not had to face for decades.
CSWA has tried to outline the changes that most private practitioners are facing and ways to adjust our practices. Once we get past the shock of feeling disoriented, the shift to telemental health that we need to make for at least the next 2-3 months are manageable. Below is a brief summary of the areas that should be considered. The complete hour-long webinar can be found under the Members-only area of the CSWA website.
CLICK HERE TO ACCESS THE EMERGENCY TELEMENTAL HEALTH WEBINAR
Practice Considerations:
I spoke this morning with Karyn Anderson, CMS Technical Director as she was about to develop this guidance from CMS on telemental health services. She was quite receptive to our concerns.
I am happy to report that CMS has approved an expansion of Medicare telemental health to cover anyone we see, new patients or ongoing ones. Unfortunately, it does not include telephonic sessions. CSWA will keep working to get them included as well. To see the FAQ on all the changes included see 3.17.20 COVID 19 Telehealth Waiver FAQ Final.pdf
Please read this carefully and let me know if you have any questions.
Laura Groshong, LICSW, Director, Policy and Practice, Government Relations ChairClinical Social Work AssociationThe National Voice of Clinical Social WorkStrengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY
There have been many questions about how to establish a telemental health practice as we address COVID-19. Here are some ideas about what to consider.
If you have any other questions, please let me know.
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