Here is an article in which I was quoted about the Social Work Compact extensively. The article is about the Social Work Compact, not a “single social work license”, but the text is very well done. Please find the article at this link:
https://news.bloomberglaw.com/health-law-and-business/states-pursue-single-social-work-license-to-boost-labor-supply
Licensed Clinical Social Workers (LCSWs) are the largest group of licensed mental health clinicians in the country, working in the public and private sector, providing psychotherapy and counseling on an individual, family and group basis in every state and jurisdiction. The acronyms below are the titles used in each state/ jurisdiction to designate independent clinical social work practice in that state. Here is a list of the number of LCSWs in each state with the exact title used in that state. This data was collected from state social work Boards and administrators in November, 2023. All LCSWs have requirements of two-three years post-graduate supervised experience and have taken a national exam. Most LCSWs are licensed to diagnose all mental health disorders in the Diagnostic and Statistical Manual-5-TR and future editions and to treat these disorders through psychotherapy when appropriate.
November 15, 2023
The recent communication about Medicare Advantage led to several questions. Please see answers below:
Will Medicare Advantage reimburse traditional Medicare paneled LCSWs? Since Medicare Advantage is a separate program from traditional Medicare, it does not reimburse claims for traditional Medicare.
Why does Medicare Advantage often pay less than traditional Medicare? Because Medicare Advantage plans are run by commercial insurers, some reimburse at less than traditional Medicare and some at a higher rate. Remember that traditional Medicare rates vary from region to region as well.
Should LCSWs accept Medicare Advantage, even if rates are lower, because it is all that some people can afford? Some people think of Medicare Advantage as a midway point between Medicare and Medicaid and want to accept these plans to offer services to lower income patients.
How can we make Medicare Advantage have reimbursement parity with traditional Medicare? Medicare Advantage is a completely different system from traditional Medicare with different reimbursement. Medicare Advantage reimbursement has reimbursement governed by commercial insurers; traditional Medicare has reimbursement governed by CMS. While CSWA has advocated for reimbursement parity in traditional Medicare (with medical/surgical reimbursement) and in commercial plans (with medical/surgical), there is no way to create parity between Medicare Advantage and traditional Medicare.
How can we improve access to mental health treatment in general? There is no one way to accomplish this but the new mental health parity rules and integration of primary care and mental health should help.
Do LCSWs have to be credentialed with Medicare to be eligible for Medicare Advantage? No. The reverse is true as well, i.e., LCSWs can be credentialed with Medicare without accepting Medicare Advantage patients.
Do LCSWs have to be credentialed with the commercial insurer sponsoring the Medicare Advantage plan? This varies, but in general it is not necessary to be credentialed with a commercial insurer to be reimbursed for a Medicare Advantage plan. Check with each plan.
How much will Medicare Advantage plans affect Medicare beneficiaries going forward? Many analysts have said that the Medicare Advantage plans will continue to grow to cover 50-60% of Medicare beneficiaries by 2030.
Please continue to send questions on Medicare Advantage as they occur.
Medicare Advantage (MA) plans have been heavily marketed for the past year or so. LCSWs have had many questions about what the difference is between MA plans and traditional Medicare. This summary of those differences may be helpful in understanding what mental health coverage patients have in these plans and how MA plans may affect coverage overall.
MA plans, known as Part C plans, are overseen by commercial insurers, i.e., United, Aetna, Cigna, BCBS, etc. The general goal of these plans is to improve profits; this is not different from the other plans that commercial insurers offer. Traditional Medicare, a public plan with Federal oversight, has an interest in keeping costs down balanced with an interest in giving the elderly and disabled reasonable health care.
Some Medicare Advantage plans inappropriately delay and deny critical care; have low premiums but then charge exorbitant copays that prevent people from getting care; have limited networks and few providers available; and may have networks with poor quality providers. Additionally, MA plans do not have the Medigap component that traditional Medicare offers to cover the “gap” that Medicare does not allow for certain conditions, including mental health treatment.
There is little doubt that the for-profit MA plans will put the needs of their shareholders first. Most Medicare-eligible beneficiaries are drawn to the low premiums and do not read the fine print about the limitations of MA plans. This may happen when there is a health crisis and the limitations on what care is covered by which paneled clinicians becomes suddenly clear.
According to the Psychotherapy Action Network, “Medicare Advantage (Part C) plans have been demonstrably disadvantageous to people who are sicker. If you have Part C and wait until you are sick to shift over to a Traditional Medicare plan, you may not be able to get a Medigap policy to cover copays and coinsurance, or that premium may be much higher.”
How do the MA plans affect mental health treatment coverage? For acute or short-term treatment, the lower premiums may be an advantage. The advantage will disappear in an MA plan if a beneficiary needs long-term psychotherapy. The cost of copays may be so high that the total cost of treatment may be much more expensive. Further, beneficiaries cannot purchase a Medigap policy (which covers co-pays) if MA is their primary insurance.
There are many articles on what can be done to prevent the “bait-and-switch” approach of MA plans, from lawsuits against commercial insurers to advocating for a single payer health care plan. For now, the best option in the view of CSWA, is to think carefully about the pros and cons of MA plans and traditional Medicare before choosing MA plans. Please contact me if you have any other questions about MA plans.
Please see the below link for an editorial written by our Director of Policy and Practice and Board President:
https://jswve.org/volume-20/issue-1/item-03/
For the past year, I have been working on a document with NASW on Clinical Social Work Standards. A draft of this document has been released for public comment. I hope all CSWA members will take a look at it and offer your comments. You can find it at https://www.socialworkers.org/Practice/Clinical-Social-Work/Practice/clinical-social-work-standards-draft-forum2. The comment period is open until September 15, 2023.
This is kind of a condensed version of the Private Practice in Clinical Social Work: A Reference Manual, which I also participated in developing with NASW, released in 2021.
Please send me your thoughts as well.
Laura Groshong, LICSW, CSWA Director of Policy and Practice lwgroshong@clinicalsocialworkassociation.org
Social Work Compact Update - July 12, 2023
Good news! On July 7th, 2023, Governor Mike Parson signed Senate Bill 670 and Senate Bill 157 making Missouri the first state to enact the Social Work Licensure Compact. This is a milestone development in supporting the mobility of licensed social workers.
SB 670 was sponsored by Senator Travis Fitzpatrick and Senator Lauren Arthur, and SB 157 was sponsored by Senator Rusty Black.
The Social Work Licensure Compact seeks to increase public access to social work services, provide licensees with opportunities for multistate practice, support relocating military families, and allow for expanded use of telehealth technologies. Currently, the model compact legislation is available for other states to introduce and enact like Missouri. Thus far there have been nine other states that have introduced: Utah, Kentucky, Vermont, New Hampshire, New Jersey, Georgia, South Carolina, North Carolina, and Ohio.
How is the Social Work Compact progressing in your state?
If you have not reached out to your legislators to let them know about the Compact, please start the process now. You can find the materials to use at https://www.clinicalsocialworkassociation.org/Announcements/13212620.
Please let me know when you have 1) a pending or passed bill in your state, 2) a legislator who is willing to sponsor the bill, 3) if you need assistance in finding a legislator to sponsor the Compact bill, and/or 4) have talked to NASW about working together to get the Compact going.
Let me know when you have any information on the above issues.
Many thanks,
Laura Groshong, LICSW, CSWA Director of Policy and Practice
lwgroshong@clinicalsocialworkassociation.org
Looking for a way to be more involved?
Organizations that Offer Support for Trans People
June 2023
To follow up on our Position Paper released in April, please find resources below that may be helpful in promoting efforts to block anti-trans bills, notably relative to the provision of gender-affirming care.
https://www.acludc.org/en/cases/hinton-v-district-columbia-challenging-department-corrections-policy-discriminatorily-housing
https://www.aclu.org/legislative-attacks-on-lgbtq-rights
https://www.them.us/story/orgs-fighting-back-anti-trans-legislation
https://www.npr.org/2022/11/28/1138396067/transgender-youth-bills-trans-sports
https://www.wbur.org/hereandnow/2023/06/16/anti-trans-laws-mental-health
https://www.cnn.com/2023/04/06/politics/anti-lgbtq-plus-state-bill-rights-dg/index.html
Barsky, A. E. (2023, June 16). Ethics Alive: Urgent Alert – “Some states have banned gender-affirming care for transgender minors. What are our responsibilities?” The New Social Worker.
https://www.socialworker.com/feature-articles/ethics-articles/urgent-alert-states-banned-gender-affirming-care-social-workers-responsibilities
Please let us know if you have other resources that we can share with CSWA members. CSWA will continue our efforts to oppose anti-trans legislation and other harmful practices.
Contact: Laura Groshong, LICSW, CSWA Director, Policy and Practice lwgroshong@clinicalsocialworkassociation.org
Below are the materials to use to begin lobbying for the creation of the Social Work Compact. They are hopefully self-explanatory but let me know if you need any further information or direction. Please start the process in the next couple weeks.
Laura Groshong, LICSW, CSWA Director, Policy and Practice lwgroshong@clinicalsocialworkassociation.org
Background on SW Compact 6-23
LCSW Compact - Lobbying 6-23
Here is some clarifying information about Medicare’s requirement that patients that are being seen through telemental health must have an in-person session every six or twelve months.
The language from Medicare is as follows: (yellow outline is mine):
Telehealth includes certain medical or health services that you get from your doctor or other health care provider who's located elsewhere (or in the U.S.) using audio and video communications technology (or audio-only telehealth services in some cases), like your phone or a computer. You can get many of the same services that usually occur in-person as telehealth services, like psychotherapy and office visits.
Through December 31, 2024, you can get telehealth services at any location in the U.S., including your home. After this period, you must be at an office or medical facility located in a rural area (in the U.S.) for most telehealth services.
You can get certain Medicare telehealth services without being in a rural health care setting, including:
In short, diagnosis and treatment of mental health disorders will be covered by traditional Medicare until at least 12/31/24 without an in-person session. Audio only treatment will be covered “in some cases” so more guidance is needed on what the cases are that will be covered.
Treatment overseen by Medicare Advantage, or commercial insurers, may or may not require in-person sessions, and may or may not cover telemental health or audio only treatment.
I hope this clarifies the situation for now. Let me know if you need more information.
Laura Groshong, LICSW, Director, Policy and Practice lwgroshong@clinicalsocialworkassociation.org
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