clinical social work association

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

LIST OF CHANGES TO MEDICARE TELEHEALTH SERVICES:

January 1, 2023  (updated November 1, 2022)

Here is some new information on Medical Telemental Health Coverage in 2023.

Postponing the Effective Date of the Telemental Health In-Person Six-Month Rule

In 2020, Congress imposed new conditions on telemental health coverage under Medicare, creating an in-person “exam” requirement alongside coverage of telemental health services when the patient is located at home. Under the rule, Medicare will cover a telehealth service delivered while the patient is located at home if the following conditions are met:

1. The practitioner conducts an in-person exam of the patient within the six months before the initial telehealth service starting 151 days after the end of the Public Health Emergency.
2. The telehealth service is furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder (other than for treatment of a diagnosed substance use disorder (SUD) or co-occurring mental health disorder); and
3. The practitioner conducts at least one in-person service every 12 months of each follow-up telehealth service starting 151 days after the Public Health Emergency.

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

Behavioral Health
A new proposal is being finalized to create a new HCPCS code (G0323) describing General Behavioral Health Integration performed by clinical psychologists (CP) or clinical social workers (CSW). This code is to account for monthly care integration where the mental health services provided by a CP or CSW are serving as the focal point of care integration.

New Telemental Health Codes (Audio Only)
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

The following is a list of behavioral health ICD-10 codes that CMS will cover by audio-only through 2023 OR for 151 days after the end of the Public Health Emergency (PHE). To read the CMS statement go to the link above. Videoconferencing will be covered during the Public Health Emergency for the same codes that are used for in-person and also have 151 days after the end of the Public Health Emergency (PHE). 

There are two new codes – 0362T And 0373T – which are connected to integrated medical and behavioral health care.

Code     Short Descriptor of Telemental Health Codes for Audio-Only CPT Codes   

0362T   Bhv id suprt assmt ea 15 min      Available Through December 31, 2023       

0373T   Adapt bhv tx ea 15 min                Available Through December 31, 2023     

90785   Psytx complex interactive            Available Indefinitely            

90791   Psych diagnostic evaluation        Available Indefinitely   

90832   Psytx w pt 30 minutes                 Available Indefinitely 

90834   Psytx w pt 45 minutes                 Available Indefinitely 

90837   Psytx w pt 60 minutes                 Available Indefinitely 

90838   Psytx w pt w e/m 60 min             Available Indefinitely 

90839   Psytx crisis initial 60 min             Available Indefinitely 

90840   Psytx crisis ea addl 30 min         Available Indefinitely 

90845   Psychoanalysis                           Available Indefinitely 

90846   Family psytx w/o pt 50 min         Available Indefinitely 

90847   Family psytx w/pt 50 min            Available Indefinitely 

90853   Group psychotherapy                 Available Indefinitely 

Please let me know if you have any questions about these changes to Medicare mental health coverage.

Laura Groshong, LICSW, Director, Policy and Practice  
Clinical Social Work Association  
lwgroshong@clinicalsocialworkassociation.org