clinical social work association

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

The Aware Advocate is an occasional summary of issues that affect LCSWs. Comments and updates are courtesy of CSWA Director of Policy and Practice, Laura Groshong, LICSW.

There are many issues affecting clinical social workers at this time, some of which are still being determined. This summary will address the recent issues that members have had questions about, even if the outcomes are not clear.

National Elections

At this point, the election results for the House of Representatives are still not complete. The Senate will remain in Democratic hands. This means there will be a better chance that the two issues which CSWA has been working on for LCSWs, i.e., improving the CMS RVU rates for Medicare and getting student loan forgiveness for CSWs will have a better chance of passage.

CMS Coverage of Telemental Health

The bills which are addressing telemental health will continue to be developed but are not clearly defined yet.

The current policy of CMS is that coverage of psychotherapy through videoconferencing and audio only will continue for 151 days after the end of the Public Health Emergency (PHE). There is no imminent attempt to end the PHE, as COVID continues to mutate and is still a major problem in many areas. It is unlikely that the PHE will end before next spring at the earliest.

BetterHelp

Many CSWA members have been receiving requests to join the BetterHelp panel, as well as being bombarded with ads to use BetterHelp clinicians on NPR, in magazines, on TV, and just about everywhere. While the short-lived partnership with CareDash that BetterHelp formed last summer has ended, there have been other problems with the way that BetterHelp provides services. Dr. Marlene Maheu, the Executive Director of Telebehavioral Health Institute, has found that BetterHelp is a multi-billion dollar company despite putting most of the burden of liability on the clinician (TBHI Newsletter, 11/22).

Social Work Compact

After a few months of little activity on the Compact – which would allow participating clinicians to be automatically licensed in other states – it appears that the draft bill that will need to be passed in any state that wants to participate will be ready by the beginning of 2023! I will be sending you the bill and some information on how to get the bill through state legislatures.

I hope you all have a wonderful holiday season!

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 September 2022. All LCSWs have requirements of two-three years post-graduate supervised experience and have taken a national examination. Most LCSWs are licensed to diagnose all mental health disorders in the Diagnostic and Statistical Manual-5-TR and future editions, and treat these disorders when appropriate. 

The following letter from the Council on Social Work Education (CSWE) was sent to all social work schools, programs and social work regulators on October 3, 2022.

As you know, CSWA has taken a stand on the recent ASWB report which noted alarming, disparate pass rates between white and Black MSWs, as well as between younger and older MSWs and between English speaking and bilingual MSWs (the whole position paper can be found here: https://www.clinicalsocialworkassociation.org/Announcements/12908309). While we believe that a Clinical Examination must be kept in place and that the CSWE recommendation that new MSWs no longer take the examination for new graduates be carefully reviewed, we are actively working toward engaging social work stakeholders and identifying viable and equitable solutions to this critical issue.

Please let us know if you have any questions about the ASWB controversy and/or recommendations about how to address these disparities.

Kendra Roberson, PhD, LICSW, President
Clinical Social Work Association  
president@clinicalsocialworkassociation.org

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

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October 3, 2022

As president and chief executive officer of the Council on Social Work Education (CSWE), I write to you on behalf of social work education programs across the country. As you are likely aware, the Association of Social Work Boards (ASWB) recently released a report documenting examination pass rates across different levels of the social work profession.

Although the data needs further analysis, the descriptive statistics suggest alarming disparities for exam takers in several categories. The most egregious disparity impacts Black test takers. In addition, Indigenous, and other People of Color also pass at lower rates than White test takers; those that speak English as a second language pass at lower rates than native English speakers; and older test-takers pass at lower rates than younger ones.

Given that the ASWB exam is the only national licensing examination available, these data raise grave concern that the need for a diverse health, behavioral health, and social service workforce (of which social workers are a considerable portion of providers1) is being significantly impeded.

As the national body for social work education in the United States, Puerto Rico, and Guam, the CSWE urges you to:

a. Suspend the use of the ASWB exam until a thorough analysis has been completed which will suggest evidenced based recommendations to correct for inequities.

b. Consider graduation from a CSWE Accredited social work education program evidence of beginning competence to practice social work as a professional social worker (granting all graduates licensure or pre-licensure status).

c. The only exception to the above involves the license to practice clinical social work. CSWE supports the need for a post-graduate process to license practice at this level, however if the ASWB exam remains central to this process, further analysis of the descriptive data must also occur for this category to identify possible issues.

d. Consider the action taken by the state of Illinois (January 1, 2022) through the Public Act 102-0326, whereby a licensing examination is no longer required for licensure as an Illinois Licensed Social Worker (LSW).

e. Consider decoupling the Interstate Compact, currently in development, from the ASWB licensure exam.

Thank you for your consideration. I would be happy to engage with you further about the concerns and/or recommendations I offer.

Sincerely,

Darla Spence Coffey, PhD, MSW  
President and Chief Executive Officer  
dcoffey@cswe.org

1 U.S. Bureau of Labor Statistics (bls.gov) 2020 report indicates there are 715,600 social workers that work in Child, Family, School, Healthcare, Mental Health, and Substance abuse treatment settings.

The U.S. House of Representatives just passed the Mental Health Matters Act, a bill that could significantly improve access to mental health and addiction care in this country.

There are two critical provisions within the bill: Strengthening Behavioral Health Benefits Act (Title VI) and the Employee and Retiree Access to Justice Act (ERISA, Title VII):

• The Strengthening Behavioral Health Benefits Act (Title VI) would provide civil monetary penalty authority to the U.S. Department of Labor (USDOL) to enforce the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which required insurers to cover mental health and addiction treatment at parity with treatment for physical health. The problem is that USDOL currently has one investigator for every 12,500 plans. USDOL has asked Congress to give it this authority with more funding for investigators.
• The Employee and Retiree Access to Justice Act (Title VII), would better protect the 136 million Americans enrolled in private sector employer (ERISA) health plans. This legislation would prohibit ERISA plans from inserting mandatory arbitration provisions into plan policies that prevent consumers from using the courts to challenge wrongful coverage denials. The Employee and Retiree Access to Justice Act also addresses “discretionary clauses” into their plan policies, which allows plans to decide what treatment is medically necessary when they consider adjudicating benefits under these policies.

Hopefully the Senate will take up this bill and we will see the kind of changes that are necessary to make mental health parity a reality. I will let you know when we need to support the bill in the Senate.

To see a summary of the Act go to: https://edlabor.house.gov/imo/media/doc/mental_health_matters_act_fact_sheet2.pdf

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

As those of you who have attended the CSWA webinars on the Social Work Compact know, there is one more week to send your comments to the Council of State Governments on the draft document. Please visit

https://www.clinicalsocialworkassociation.org/Announcements to see information on the Social Work Compact.

To see the whole draft document, please visit https://compacts.csg.org/compact-updates/social-work/.

To send comments on the draft document, please visit 

https://www.surveymonkey.com/r/socialworkcompact.

The final date for sending comments is close of business on September 16, 2022.

Let me know if you have any questions.

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

On August 5, 2022, the Association of Social Work Boards (ASWB) published data on pass rates for the Clinical Social Work Examination, which it oversees, as well as data on the other three levels of social work licensure (2022 ASWB Exam Pass Rate Analysis for Social Work Licensing Exams [aswb.org]). Publication of this initial data was long overdue. The noted disparities in pass rates, which vary by almost 40% for white and Black social workers were striking. Here CSWA provides historical context and suggestions for steps ahead.

History of Clinical Social Work Licensure

The clinical social work examination has been the national standard for independent clinical practice since 19­­­­­­­­­­­­­50 when ASWB (formerly AASWB) began creating examinations and states began licensing clinical social workers (formerly called psychiatric social workers), beginning with California. As clinical licensure became the norm over the next 54 years (the last state to achieve licensure was Michigan in 2004), the profession established a general standard for licensure based on four elements: 1) obtaining an MSW at an accredited school of social work; 2) having 2-3 years of supervised experience, post-MSW; 3) passing the ASWB Clinical Examination; and finally, 4) having a social work licensure law approved by each state legislature and overseen by each state’s Board of social work. All four areas have different oversight mechanisms and little connection to each other. Correspondingly, there are no two states that have the exact same standards.

There is now a nationwide patchwork system which makes transferring licensure from one state to another problematic. The Council on Social Work Education (CSWE) has overseen schools of social work, but the standards for doing the work that leads to an MSW are quite elusive. Similarly, specific standards for supervised experience vary widely across the states.

Clearly, clinical social work is a young profession. LCSWs were approved to provide psychotherapy through Medicare in 1965, yet, there has been much fragmentation in the field. Efforts to standardize and integrate all parts of clinical social work were understandably set aside by stakeholder organizations in favor of creating licensure in all states and jurisdictions and achieving vendorship for clinical social workers.

Next Steps

There has been a widespread condemnation of ASWB for withholding information about the pass rates and/or being indifferent to the way that the clinical exam has yielded disparate pass rates for BIPOC and older clinical social workers. CSWA is in discussions with the new ASWB Executive Director, Stacey Hardy-Chandler, PhD, about the ways that ASWB, CSWA, and other stakeholders can work together to improve not only the clinical examination, but also the collective preparation of pre-licensed social workers to ensure an equitable exam experience. To this end, ASWB has also issued a statement about their intentions following the release of their report, which includes the following:

• “Continuing to evaluate all aspects of the licensing exam development process, beginning with an in-depth review of item generation, and then implementing a comprehensive, user-centered investigation of test-takers’ experiences
• Offering a collection of free resources designed for social work educators to help them understand the exams and candidate performance so they can better prepare their students for the exams and to increase access to exam resources
• Bringing a greater diversity of voices into the exam creation process through the Social Work Workforce Coalition
• Hosting community input sessions to expand the range of perspectives involved in the creation of the next iteration of the exams
• Launching the Social Work Census, an in-depth survey of social workers, to better understand who today’s social work practitioners are and what they do”

Need for the Clinical Examination

CSWA is aware of strong opinions of many, including LCSWs, that the clinical examination should be eliminated. There are three key reasons that CSWA does not support this idea:

1. In order to practice independently, LCSWs need to substantiate they have sufficient expertise to practice psychotherapy independently. The examination is a primary means of assessing that ability.

2. Passing the examination is written in to each states’ and jurisdictions’ laws and regulations.

3. The Social Work Compact, currently in development, which would allow LCSWs more flexibility to work in states with a multi-state license, will require LCSWs to pass a national examination.

Summary

CSWA believes that ASWB is now poised to attend to the inherent inequities exposed in the ASWB Clinical Examination process. We hope to work with ASWB toward that goal and encourage others to do so as well. Additionally, CSWA will press forward to advocate for meaningful integration of our education programs and licensing boards, efforts that can significantly impact ways the clinical examination is approached and regarded.

Contacts:

Kendra Roberson, PhD, LICSW, President
Clinical Social Work Association  
president@clinicalsocialworkassociation.org

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

Earlier yesterday I sent you the BetterHelp statement which said that they were ending their connection to CareDash.

Now I am pleased to send you the news that CareDash is backing off their harmful stance toward clinical social workers in private practice, as well. While there are still some problems to be resolved, CareDash has 1) stopped their deliberate confusion about LCSW availability; 2) removed their “book an appointment” option which directed potential patients away from LCSWs who were not part of the CareDash network; and 3) clarified that their information comes from the NPI list of clinicians and has nothing to do with the quality of those clinicians. To see the whole CareDash statement, click HERE.  

I am fairly certain that the outstanding response of CSWA members to the demeaning policies of CareDash had a major impact on their decision to back off their original stance. Thanks to all of you for your great contributions to this effort.

CSWA will continue to insist on the rights of all LCSWs in private practice to have access to all patients who want to see them without interference by any external organizations.

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

Here is a link to an article published today in Bloomberg Law today about the CareDash situation which mentions CSWA:

https://www.bloomberg.com/news/articles/2022-08-05/shadow-profiles-from-therapist-directory-spark-startup-backlash?sref=yqJvNODh

Keep sending your complaints to your state consumer protection agencies and the FTC. The original post and template can be found HERE. 

Let me know when you have sent them, as always.

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

 

    July 16, 2022 was the roll-out date for ”9-8-8”, the new US network for people looking for help with suicidality or other emotional crises. This phone number is designed to be used for text or for telephone access to volunteers who will provide initial assistance to callers, then triage them to LCSWs and other licensed clinicians.

      Ultimately, 9-8-8 will become the National Suicide Prevention Lifeline (1-800-273-TALK); the new number will be easier to remember and access. This older hotline will remain in effect for an as yet undetermined period of time while 9-8-8 becomes fully operational. 

       There is no question of need: there has been an exponential increase in suicides and suicide attempts since the pandemic began almost three years ago. Here is what LCSWs should know about the implementation of this new system.

Funding

The $400 million set aside in Federal funding for 9-8-8 is about half of what will be needed to fund the services in every state. So far, the only states that have provided the needed state funding are Colorado, Nevada, Virginia and Washington. Nine states have legislation in progress to provide this funding; 37 states have no plan to provide funding. CSWA encourages members to ask their state legislators to find the state funding for 9-8-8 so that it can be fully functional as soon as possible. To see what your state’s plan is for funding 9-8-8, go to https://reimaginecrisis.org/map/.

Current Statistics

How serious is the issue of suicide? Here are the number of suicides in the most recently recorded year, 2020:

• In 2020, the U.S. had one death by suicide about every 11 minutes
• Suicide was the leading cause of death for individuals between ages 10-34 in 2020
• Over 100,000 individuals died from drug overdoses in the nine months from April 2020 to the end of the year

While 2020 actually saw a decrease in suicides from 2019 overall (17.7%, https://suicidology.org/2021/04/02/2020data/), of grave concern is the fact that there was an increase for young adults and BIPOC communities of all ages in 2020 (https://www.webmd.com/mental-health/news/20211103/suicide-rates-2020-cdc) .

More Information

The Substance Abuse and Mental Health Services Administration has prepared a toolkit to further explain the need for 988. For FAQs and Fact Sheets, go to

https://www.samhsa.gov/find-help/988/partner-toolkit. Also feel free to contact me for more information.

Laura Groshong, LICSW, Director, Policy and Practice