clinical social work association

Questions and Answers about the Compact

February 13, 2023

Laura Groshong, LICSW, Director, Policy and Practice

The information about the Compact development has led to a number of questions which I will try to answer here. However, there are some basic misunderstandings about the way that CSWA functions which need to be clarified first.

The Clinical Social Work Association is an independent membership organization; to have access to staff and the materials that CSWA has created, LCSWs need to join CSWA. State Societies are affiliated with CSWA and receive some materials for all their members, even those who are not CSWA members. This causes some confusion because being a member of a state Society does not mean you are a member of CSWA. You can join CSWA if you are a member of a State Society for a reduced rate at www.clinicalsocialworkassociation.org. You can also join CSWA as an individual member if you are not a member of a State Society. This underlying structure is one that has been hard to grasp at times. I hope this clears it up. Now on to the questions that have been raised by the Compact information.

Compact Questions and Answers

CSWA members who reached out to me had mixed emotions about the outcome of the Compact meetings this week. In general, the outcomes were consistent with the goals that CSWA has explained to members for the past year and a half during the development of the Compact. Please review the information on the CSWA website for more background on how CSWA has worked to implement the Compact during this time.

One important piece of information is that NO STATE OR JURISDICTION belongs to the Compact yet. We are in about step three of a process that has many more to go and will require up to two years to accomplish. We will need seven individual states/jurisdictions to sign on before we can begin the process of establishing a Commission to oversee the Compact. Thus, we will need everyone’s help to get the Compact passed in as many states as possible and eventually in each state/jurisdiction. Once the final language of the Compact bill is available on February 27, CSWA will be explain how to advocate for the Compact in your state/jurisdiction.

In no particular order, here are the questions that have come in about the Compact and answers to them:

1. How would we know if our state legislature is interested in pursuing the compact? Do you reach out to legislators or should we? I’m in Florida. When the final draft of the Compact bill comes out on February 27, I will send it to all CSWA members with instructions on how to advocate to your legislators to create a bill and pass it in your state.
2. Any idea how much the fee for social workers will be? The fees will be determined by the Commission.
3. My question is around the licensed home state issue as I was initially licensed in Delaware in 2018, but in 2021 moved to Georgia. Would my move impact my ability to be a part of the compact? I still have an office in Delaware, would that count? You will only be able to have one home state for purposes of the Compact; your home state must be the state in which you are licensed AND the state in which you reside.
4. I have been able to obtain an LCSW licensing in Georgia and Louisiana but would like the opportunity to work in other states as a client moves but would like to maintain the relationship. Your ability to do so will depend on which states join the Compact.
5. Do you know which states are planning on joining? Can you get the multistate approval if your state is not joining? You can only join the Compact if your home state joins.
6. Do PhD's have to sit for an exam? That depends on your state laws. No one who became licensed without taking the exam will have to take it to join the Compact, if the LCSW has no actional complaints.
7. I received my MSW in 1984. When ASWB came up with its exam, I was grandfathered in. After 39 years of clinical practice, am I understanding the above memo to say that in order to join the Compact, I would now have to take the ASWB exam? The language of the bill says that those who were grandfathered into licensure and have no actionable complaints do not have to take the ASWB exam now.
8. While it's hard to say as we haven't seen final language yet  and are unsure whether Illinois will even be eligible to join the Compact, we join the national NASW office in not supporting the Compact so long as it continues to codify the ASWB exam. There was much discussion about whether states that do not have licensure and/or an exam requirement at the BSW or new MSW levels will be able to join the Compact. The final decision was that it will be optional for each state to offer the ASWB exam at these levels for those who wish to join the Compact, even if the state does not require the exams and/or licensure at these levels. 
9. It sounds like having already completed the clinical licensing exam for your state of residence is not going to be enough to qualify for participation in the Compact, and that those of us who are already clinically licensed in our state will need to take the ASWB exam. See #7. You will not have to take the exam if you were licensed without taking it.
10. I am an acquaintance of my State Senator. What do I need to do to move this compact forward to her? I just sent her a message on Facebook. Do you have a list of the states that are currently included in the Compact? Do you have information about Michigan specifically? No states are currently in the Compact as the language for state legislators is not available yet. All these questions will be answered when the final language comes out on February 27, along with guidance on how to make legislators aware of the Compact.
11. I am glad about the progress with the Compact but very disappointed about the requirement of the ASWB exam. I passed the NY CSW exam in 1982. I was later grandfathered into the licensure when it became available in 1991 in NJ. I have been actively practicing since with advanced qualifications. There has been a lot of confusion about this issue. See #7 and #10.
12. What to do about differing standards of care. A member state might forbid a clinician from discussing abortion or a member state might require a clinician to provide conversion therapy to queer folks. The conveners simply ignored the concerns and I haven’t heard a thing about that since. I hope this has been worked out—does anyone have new information on this topic? The language of the Compact deliberately says nothing about state laws and regulations or scopes of practice. These are left to the states, though they may be problematic.
13. I have been following all of these but not closely. The most recent email talks about a possible requirement that people would have to have taken or take the national exam or demonstrate competency. I am wondering what ways one could demonstrate competency. See answers to #7, #10, and #11.

ASWB Report

ASWB has put out a report on the ways that they intend to correct the disparities in the pass rates for the exams. See below for their update, or find it on their website at this link: https://www.aswb.org/aswb-social-work-examination-update/

As we enter 2023, the Association of Social Work Boards wants to provide an update on our social work licensing examinations. Last year, we took the groundbreaking step of publishing the national, state, and school exam pass rate data to contribute to and lead engagement in profession-wide conversations around diversity, equity, and inclusion.

The data highlighted disparities in exam pass rates for different demographic groups. For Black test-takers and older test-takers, pass rates were particularly low. The discrepancies seen in the data are unacceptable. Recognizing that multiple factors impact a test-taker’s performance and need to be addressed, we remain committed to doing our part and working with other members of the social work community to address the societal inequities that are reflected in the pass rate differences.

We are actively exploring the causes of these gaps with educators and practitioners and are already taking action to better prepare all social workers for licensed practice while continuing to support our members—social work regulators—with their public protection mandate.

We welcome the chance to share our latest efforts with the profession. The initiatives outlined below build on our previously communicated pledge to include a more diverse set of voices in our exam development process and recent efforts to provide support and resources for educators and supervisors as they prepare licensing candidates.

ASWB is taking seriously the feedback we have received from the social work community and is committed to continue listening. ASWB has engaged HumRRO, an independent nonprofit research and consulting firm, to collaborate with community partners in facilitating inclusive and productive conversations about the social work licensing exams. This series of community conversations launched in January and will continue through May. The sessions are designed to gather information to be used as we develop exams for the future of social work. For anyone not able to participate in a session, we are also offering a self-paced online survey to gather additional feedback and ensure the largest possible number of voices can be heard.

We are also exploring additional or alternative assessments, in line with our strategic framework. As we re-envision competence assessment, we are looking at ways that candidates can demonstrate competence beyond the use of a multiple-choice examination format. We are carefully weighing the feasibility of numerous assessment options. Our primary concern is to ensure the validity and reliability of any assessment format we choose; however, we are also reviewing the impacts of changes on test-taker well-being and the potential for cost increases for test-takers. We anticipate that qualitative data gleaned from the community conversations will influence decision making.

In addition, we are continuously reviewing our exam administrative policies and procedures. We are considering, for example, the possibility of offering secure, remote proctoring of examinations. As each possibility is explored and measured, the goal of keeping the exam fair and accessible for all will remain at the forefront.

Finally, we will issue a call for proposals for third-party research in March. ASWB will provide data sets and limited funding for approved proposals through its research arm, the American Foundation for Research and Consumer Education in Social Work Regulation. ASWB has committed to investing in this important work. Areas that would benefit from research include exploring how the professional standard of competency is defined and measured and gaining a more complete understanding of pipeline variables that account for differences in pass rates.

While these important research initiatives are underway, ASWB is continually evaluating other ways of supporting test-takers that are appropriate to our work as stewards of a professional competency assessment program. In January, we began piloting a free test mastery program for test-takers who did not pass the social work licensing exams. We have engaged Fifth Theory, an independent firm with expertise in helping individuals understand and develop the test mastery mindset required to succeed on high-stakes exams. Rather than teaching specific exam content, Fifth Theory provides tools that strengthen general skills needed to pass important exams, like anxiety reduction and preparation strategies. ASWB will solicit feedback from users during this pilot phase of the initiative.

We look forward to more collective conversations and action in the future. Look for updates on aswb.org.

Summary of Compact Technical Assistance Group Meetings

February 7-8, 2023

Laura Groshong, LICSW, CSWA Director, Policy and Practice

 

Kendra Roberson, CSWA President, and I attended 12 hours of meetings about the Social Work Compact sponsored by the Council of State Governments (CSG) this week. We are part of the Technical Assistance Group (TAG) which has been working to develop the Compact language for the past 18 months. There were 20 TAG members with representatives from major social work and clinical social work organizations at these meetings.

There has been general agreement that the benefit of the Compact would be to allow LCSWs, licensed new MSWs, and licensed BSWs (in states where they are licensed) to work across state lines in any state that joins the Compact. Nurses, physicians, counselors, and about 10 other professions have already set up Compacts, sponsored by CSG. Funding is provided by the Department of Defense which started the project to give military spouses the ability to work in multiple states; they have now expanded this option to all licensed social workers whose home state is a member of the Compact.

Examinations

One of the main topics under discussion at these meetings was the requirement that all licensees have passed a national examination or other demonstration that they have met competencies for their licensure level’s scope of practice. Currently the only way these criteria can be met is by taking the ASWB examination. There has been great concern by CSWA and other groups about the ASWB report issued in August of 2022 which showed disparities in pass rates between white applicants and BIPOC applicants; older applicants; and applicants who had English as a second language. There were several ASWB representatives at the meetings who outlined what ASWB is doing to remove these existing disparities which are:

• They have hired an organization called Fifth Theory which will help any applicant who fails an examination improve their test taking skills
• They are planning to continue to gather detailed data to assess whether the disparity gap closes, and to release this data every year
• They are considering allowing applicants to only retake the parts of the examination that they have failed
• They are reducing multiple choice questions from 4 to 3 choices to decrease test taker fatigue and burden (see their website for details on this)
• They will continue to engage in Practice Analysis
• They will create an RFP to conduct research on their data, relative to the pass/fail rates
• They may make the examinations optional for new MSWs and BSWs who wish to join the Compact

The TAG was somewhat pleased by these changes, but felt more information is necessary to determine whether they will resolve the disparities.

 

Oversight of the Compact

All Compacts are run by a Commission which is created when seven states have passed the Compact into law. The Commission will have nothing to do with defining scopes of practice or changing any existing state laws and regulations. There will be one representative from each state that joins the Compact and four ex officio members from national social work associations and regulatory bodies. Many of the details of running the Commission will be developed by the Commission when the Commission is created.

There will be a fee for states to join the Compact. There will also be a fee for individual LCSWs (and other licensees) to join the Compact.  Every LCSW must have a home state, which is also the state in which the LCSW resides. One of the requirements for a state joining the Compact is that they accept the language of the Compact as developed. One of the most helpful items is that if an LCSW moves from one state in the Compact to another state in the Compact, they will automatically be licensed in the new state.

 

Next Steps

The language for the Compact will be available on February 27, 2023. While this may be too late for most 2023 legislative sessions, it should be possible to reach the seven state threshold by 2024.

I will be sending information about how to lobby your state legislatures in the next two weeks. CSWA will provide guidance as the process moves forward. We know there is a lot of interest in making the Social Work Compact ‘real’ and have made state passage a priority.

Please let me know if you have any questions about the meetings or the passage of the Compact in your state.

After a successful meeting with the Social Work Compact Document Team and Technical Assistance Group, CSG and partners are proud to share that compact language will be finalized and ready for state enactment by February 27, 2023. The compact must be enacted into state law by at least seven states. Once the Social Work Compact Commission and additional infrastructure is established, multistate licenses will begin to be issued. If your state legislature is interested in pursuing the compact this legislative session or would like additional information, please contact socialworkcompact@csg.org  or matthew.shafer@csg.org. 

Pictured here are most of the members of the Technical Assistance Group, including our own Director of Policy & Practice, Laura Groshong, bottom right. TAG members include national social worker organizations, State regulators, CSG staff and counsel.

The End of CareDash

February 2, 2022

Laura Groshong, LICSW, Director Policy ad Practice

As you will recall, last August there was an attempt by a company called CareDash, in connection with BetterHelp, that co-opted our practices by getting all our NPI numbers and sending potential patients to clinicians that were on the CareDash panel and directing them away from any clinician that was not on their panel. Their information was incorrect and harmful to many CSWA members.

As a result of CSWA’s immediate response, and those of other mental health organizations, BetterHelp removed its name from the project and CareDash changed the most egregious procedures they had in place.  CSWA talked with Bloomberg News and sent information to numerous news outlets. Our members sent hundreds of Legislative Alerts to members of Congress and state legislators. Many of our members also filed complaints with the Attorneys General in their state. CSWA spoke with the Federal Trade Commission about the threat this represented to our practices.

Yesterday it was announced that CareDash and the company which ran it, NuFit, Inc., have ceased operation. CareDash and NuFit no longer have websites. We thank all members who participated in this effort and hope it will serve as a warning to other companies who attempt to take over our practices.

Implications of the End of the Public Health Emergency For LCSWs providing Telemental Health and Our Patients

February 1, 2022

Laura Groshong, LICSW, Director of Policy and Practice

As you have no doubt heard, the Public Health Emergency (PHE) will end on May 11, 2023. Continued coverage for telemental health treatment may depend on the insurance your patient holds when the PHE ends. Here is what we know currently.

Federal Government

CMS, which oversees Medicare and Medicare Advantage, has already announced that these programs will cover telemental health through December 31, 2024. CMS is reviewing the use of telemental health treatment and will make a decision, along with DHHS, about the future of expanded telemental health coverage after the end of 2024.

Some members of Congress are wanting to end the PHE immediately. The Senate and the President will not agree to this, so it is extremely unlikely that this will happen. Regardless, it will not affect the coverage of telemental health by Medicare and Medicare Advantage at this time.

Medicaid

All 50 states and DC expanded coverage and/or access to telehealth services in Medicaid during the PHE. When the PHE ends, coverage for telehealth services may be tied to federal and/or state PHEs. Most states have made, or plan to make, some Medicaid telehealth flexibilities permanent. 

Commercial Insurers

It is likely that some commercial insurers will no longer cover telemental health after May 11, 2023. I have heard that LCSWs have been told that telemental health will no longer be covered by commercial insurers NOW. Those companies should be reported to your Insurance Commissioner. As long as the PHE is in effect, telemental health should be covered.

Communication about commercial insurance has been spotty, so have patients check with their insurers. Some states, but not all, are putting laws into effect that will require commercial insurers to cover telemental health treatment.

Free Vaccines and COVID-19 Tests

Separate from the coverage of telemental health, the end of the PHE creates changes about who may receive free vaccines and COVID-19 test kits. A good summary of the changes that are coming has been put together by Kaiser Family Foundation at https://www.kff.org/coronavirus-covid-19/issue-brief/what-happens-when-covid-19-emergency-declarations-end-implications-for-coverage-costs-and-access/#coverage-costs-and-payment .

The Possible Impact on LCSWs

Many of us have converted our practices to exclusively provide telemental health and some us no longer have physical offices. The end of the PHE may require us to reconsider these decisions if telemental health does not continue in the way that we have been using it.

There is a lot of uncertainty at the moment, and CSWA will do our best to give you timely and accurate information about the situation.

Update - Social Work Interstate Compact

January 2023

Laura Groshong, LICSW, CSWA Director of Policy and Practice

Judy Gallant, LICSW, CSWA Deputy Director of Policy and Practice

As most of you know, CSWA has been working for over 2 years on a project funded by the Department of Defense and led by the Council of State Governments to develop the Interstate Compact for Social Workers for occupational licensing portability. Representatives from CSWA, NASW and ASWB have been working with the National Center for Interstate Compacts (part of the Council of State Governments) on the framework and language for a Compact to be put into place.

One question that has come up frequently is which levels of social work practice will be covered by the Compact. The answer is that all forms of licensed social work practice will be eligible to join the Compact, i.e., licensed clinical social work; licensed associate social work; and licensed bachelor social work practice. The only way a licensed social worker will be eligible to work through the Compact is to abide by the scope of practice established in the Compact language. For clinical social workers this means having met the standards for clinical social work licensure in their home state.

Another question that has come up often is whether LCSWs who have not taken the ASWB Clinical Examination will be able to join the Compact. If an LCSW was grandparented into licensure in their home state without taking the Examination, they do not need to take the examination to join the Compact.

The Compact, once finalized, will be distributed to stakeholders in each state and a campaign started to inform state legislatures and Boards of Social Work about the compact. The Compact will need to become law in at least 7 states in order for Social Workers to be able to participate in states that agree to accept it. Once we have a finalized document, we will also be informing you, our members, how you can best help advocate for this to be enacted within your state.

Unfortunately, even though we were expecting the Compact to be finalized by the beginning of 2023, this has not yet happened. Kendra Roberson, PhD, CSWA President, and Laura Groshong, LICSW, CSWA Director of Policy and Practice, along with others who have been working in the Technical Assistance Group, will be attending a meeting in DC in early February in order to finalize the Compact language. We are hopeful that the Compact will be sent to all states and jurisdictions shortly after that.

Because many state legislatures meet for limited amounts of time, frequently at the beginning of each year, it is unlikely that legislatures will be able to approve the Compact within 2023. It is more likely that legislatures will be considering, and hopefully, voting the Compact into law, in 2024. Once at least seven states have voted to approve the Compact, a Commission will be formed for the administration of the Compact. After the Commission is formed, additional states can still join the Compact.

Although this is not the timeline we would have hoped for, the compact is slowly but surely moving in the right direction. CSWA will update you as we get more information.

There are two issues which have been causing some confusion in the past couple of weeks that I would like to clear up:

1. Compact Delay – as you know, the Social Work Compact, which would allow LCSWs to practice in any state that joins the Compact, has been in development since October of 2021. CSWA President, Kendra Roberson, and I are members of the Technical Assistance Group (TAG) which has provided information about what the Compact should look like, along with representatives from other clinical social work and social work organizations. The process is being overseen by the Department of Defense and Council of State Governments. DoD and CSG had told us that the document, which will be submitted as bills to state legislatures, would be ready at the end of 2022. Unfortunately for several reasons, that deadline could not be met. Correspondingly, Kendra Roberson and I will be attending a meeting in Washington, DC in early February to finalize the document. We are hopeful that the document will be ready by early spring and will keep you posted on how to support the compact in your state legislatures when it is ready. CSWA knows how many members are looking forward to the Compact, as is CSWA.
2. Medicare Rules – there are two issues regarding new Medicare rules that have caused confusion. First, the need for in-person meetings with patients will not be put in place until 151 days AFTER the end of the Public Health Emergency. With many regions seeing increases in COVID and other viruses at this time, it is unlikely that the PHE will end any time soon. Second, the ability to see Medicare beneficiaries across state lines will not be in place until the end of the PHE as well. Please keep this in mind.  We are all looking forward to the ability to work across state lines. CSWA will let you know when that becomes a reality.

Please let me know if you have any questions on these issues.

Laura Groshong, LICSW, Director, Policy and Practice  
lwgroshong@clinicalsocialworkassociation.org

UPDATE: Medicare Coverage and Parity Changes for LCSWS

There continue to be questions about the change to Medicare policy about treating patients across state lines. Different regions have different policies in this regard. Look at the section in yellow below and call your MAC to get information about a region you wish to practice in. Here is more detailed information on the telehealth changes: https://telehealth.hhs.gov/providers/billing-and-reimbursement/medicare-payment-policies-during-covid-19/

Telehealth Policy Changes

The federal government announced a series of policy changes that broaden Medicare coverage for telehealth during the COVID-19 public health emergency.

Some important changes to Medicare telehealth coverage and reimbursement during this period include:

• Location: No geographic restrictions for patients or providers
• Eligible providers: All health care providers who are eligible to bill Medicare can bill for telehealth services, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
• Eligible services: See the list of telehealth services from the Centers for Medicare & Medicaid Services
• Cost-sharing: Providers can reduce or waive patient cost-sharing (copayments and deductibles) for telehealth visits
• Licensing: Providers can furnish services outside their state of enrollment. For questions about new enrollment flexibilities, or to enroll for temporary billing privileges, use this list of Medicare Administrative Contractors (MACs) to call the hotline for your area
• Modality: The 2022 Physician Fee Schedule has codified the ability for behavior health services to do audio only. It is still required to complete an in-person appointment every 6 months.

Mental Health Parity

There is one more piece of good news in the omnibus bill. You may recall that when the parity act passed in 2008 there was a loophole that allowed public plans to opt out of having a mental health benefit at all. That meant that they did not have to have a benefit AT PARITY with medical/surgical benefits. That loophole has been closed in the omnibus bill. This means a million more people will have mandated mental health treatment. More information can be found at https://www.thekennedyforum.org/blog/these-major-employers-have-opted-out-of-providing-adequate-mental-health-addiction-coverage/

H.R. 432, Mental Health Access Improvement Act

The Mental Health Access Improvement Act passed as part of the omnibus bill. This means that LMFTs and LPCs are now Medicare providers. Their reimbursement rates will be 75% of psychologist rates, like LCSWs, or 80% of their usual and customary rates, whichever is less. This is possibly more than what LCSWs are paid and CSWA will be looking into keeping LCSWs at the same reimbursement level.

These changes were passed by the House this morning so the President should be signing the bill shortly.

Happy Holidays!

Laura Groshong, LICSW, Director, Policy and Practice  
lwgroshong@clinicalsocialworkassociation.org

Congress just passed a $1.7 trillion spending bill which has some impact on LCSWs through Medicare coverage. Now it is up to the President to sign it. Here are the ways that our practices will be affected if all these changes take place on January 1, 2023:

This two-year extension is not without future implications. The bill instructs the Secretary of Health and Human Services to study how telehealth has affected Medicare beneficiaries’ overall health outcomes and whether there are geographic differences in use. It also calls for a review of medical claims data. The initial report is due by Oct. 1, 2024. 

One more item – the Good Faith Estimate is supposed to be given to patients every year so look at when you gave your patients their first GFE and prepare to repeat the process.

Please let me know if you have any questions about these changes.

Laura Groshong, LICSW, Director, Policy and Practice  
lwgroshong@clinicalsocialworkassociation.org

UPDATE: The rule addressing working across state lines is for LCSWs who are Medicare paneled and working with Medicare beneficiaries. This does not apply to LCSWs who are opted out, or not opted in or out. The rule does not apply to commercial insurers. 

CSWA would like to clarify information about the rules that CMS and Congress will be putting into place when clinicians provide telemental health treatment under Medicare when the Public Health Emergency ends.

No one knows when the Public Health Emergency (PHE) will end.  When it does, the following rules go into effect 151 days after the PHE ends.

1. Until 151 days after the PHE ends, you do not need to see anyone in person in order to provide telemental health treatment. After that time, CMS Guidelines require that you see a new patient one time in person before beginning to see that patient virtually. After that, you will need to see the patient in person once a year.
2. For patients you already see through telemental health treatment, you need to have seen them at least once in person within the past 6 months in order to continue seeing them virtually. If you have not seen them in person within the past 6 months, you will need to do so the first time you see them when the rules go into effect. After that initial in person session, you will need to see them again in person at least once per year.

While there is no requirement that the rules will apply to commercial insurers, they often follow the Medicare rules. At this time, there are no insurers who have said they will require the above rules.

Some of us no longer have a physical office anymore, are concerned about getting COVID, or want to avoid in-person meetings for other reasons. CSWA is working with the Mental Health Liaison Group (MHLG) and Congress to eliminate the requirement to see patients in person.

In short, there is no need to see patients in person currently. CSWA will let members know when or if this requirement goes into effect.

Happy holidays,

Laura Groshong, LICSW, Director, Policy and Practice  
lwgroshong@clinicalsocialworkassociation.org