clinical social work association

CSWA members have expressed concerns about the way that companies like Betterhelp are providing a kind of mental health treatment based on texting. The lack of direct contact is cause for concern. The asynchronous nature of Betterhelp limits emotional communication.

A new article from California Healthline written by award-winning journalist Harris Meyer, has just come out and has echoed some of these concerns. The article, “Digital Mental Health Companies Draw Scrutiny and Growing Concerns”, can be found at https://californiahealthline.org/news/article/digital-mental-health-companies-scrutiny-concerns/.

Both Marlene Maheu, PhD, who presented a webinar on telemental health for CSWA, and Laura Groshong, CSWA Director, Policy and Practice, are quoted in the article.

Below is a Letter to Congress on gun violence that CSWA signed on to with 9 other national organizations which was published in USA Today this morning. ~Laura Groshong, LICSW, Director, Policy and Practice, lwgroshong@clinicalsocialworkassociation.org, 6/7/22

The Clinical Social Work Journal (CSWJ) is pleased to announce a call for papers for a special issue called: Life After the MSW. This special issue will be co-edited by the Editor in Chief of the journal, Melissa D. Grady, PhD and Kendra C. Roberson, PhD, the President of the Clinical Social Work Association (CSWA). In this issue we will be seeking manuscripts that offer readers a mix of historical/scholarly information about the topic, as well as concrete and practical information for soon to be and/or recent MSW graduates. The aim of this special issue is to offer practical advice to newer professionals in the field. We hope that the articles within this special issue can be used by faculty members and supervisors who are helping to train new social work practitioners, as well as by the graduates/students themselves. 

Some examples of topics for this special issue could include, but are not limited to issues related to post-masters education, clinical supervision considerations, navigating and/or preparing for the licensure process, practicing clinical social work with a social justice lens, and potential career paths as a clinical social worker.

Interested authors should submit an abstract of no more than 750 words describing the proposed manuscript. Those that are chosen will then be invited to submit full manuscripts that will be between 10-15 pages in length. 

Each abstract should include the following:

• Introduction of the topic AND its relevance to soon to be and/or recent MSW graduates
• How the authors will provide practical information for the intended audience (e.g., bullet lists of areas to consider, tips for accessing information, resources that would be useful for further exploration, pros and cons of the issue, lists of questions that readers could consider for themselves)

In addition to the above, full manuscripts will also require

• Background information on the topic (e.g., historical background, any scholarly information on the topic)
• Expanded practical information section as described above

Deadlines for process:

• Abstracts should be submitted by Oct 1, 2022
• Invitations for full manuscripts will be sent out by Dec 31, 2022
• Full manuscripts will be submitted by Mar 1, 2022

For any questions, please contact Melissa D. Grady at grady@cua.edu or Kendra Roberson at kacey@uw.edu.

I have received a deluge of emails from you about the use of POS “10” for Medicare and other insurers.  This guidance that Medicare has provided about this policy is complicated.

The current guidance from CMS is that:

• POS “11” should be used until the end of the Public Health Emergency, timing of which is currently unknown, even though this is not what the POS “11” is for. 
• And, as of April 4, 2022, there is some variation according to Medicare Administrative Contractors (MACs) about whether or not to move to POS “10” as initially stated by CMS. 
• Check with YOUR MAC to clarify  which POS code is being accepted currently if the patient is being seen through telemental health in their home; for example, technically, if a patient is in their car, the POS code should be “02”. 
• You can find your MAC contact information at the CSWA website under “Clinical Practice”.
• The Medicare Modifier for POS codes is still 95. This may seem counterintuitive as 95 is supposed to be for telemental health but it is the only combination that currently works.

Be sure to check with EACH private insurer for a patient to find out what combination of POS and Modifier are being requested so that claims will not be denied.

I hope this resolves the confusion about POS codes.  Let me know if there are any other questions.

POS Codes as of 4/1/22 – Medicare

There has been some confusion about what Point of Service (POS) Codes should be used for Medicare and other insurers as of April 1, 2022. 

As you know, there were changes to POS codes that were announced as of January 1, 2022 to be “available” for Medicare as of April 1, 2022.  POS “10”, a new POS code for telemental health services that are provided when the patient is in their home, and the LCSW is in their office or elsewhere.  Other POS Codes are “2” which is used when a patient is not in their own home and receiving telemental health services from an LCSW or “11” which is used when seeing a patient in the LCSW’s office.

The Medicare modifier is 95 for any of the above codes.

It appears that the POS 10 is now being used instead of POS 2 for Medicare for reimbursement.  All other insurers, public and private, should be contacted about the POS codes that are required for reimbursement of claims. The same goes for which modifier is being used – check with the individual insurer.

For more information, go to https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  If you have other question, contact me at lwgroshong@clinicalsocialworkassociation.org.

There has been some confusion about what Point of Service (POS) Codes should be used for Medicare and other insurers as of April 1, 2022. 

As you know, there were changes to POS codes that were announced as of January 1, 2022 to be “available” for Medicare as of April 1, 2022.  POS “10”, a new POS code for telemental health services that are provided when the patient is in their home, and the LCSW is in their office or elsewhere.  Other POS Codes are “2” which is used when a patient is not in their own home and receiving telemental health services from an LCSW or “11” which is used when seeing a patient in the LCSW’s office.

The Medicare modifier is 95 for any of the above codes.

It appears that the POS 10 is now being used instead of POS 2 for Medicare for reimbursement.  All other insurers, public and private, should be contacted about the POS codes that are required for reimbursement of claims. The same goes for which modifier is being used – check with the individual insurer.

For more information, go to https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  If you have other question, contact me at lwgroshong@clinicalsocialworkassociation.org.

Transgender children have been in the crosshairs of conservative groups in the legislature and elsewhere for the past decade.  Amongst legislative attempts to discriminate against them, there have been attempts to ban them from gender-specific bathrooms or from participating in sports consistent with their gender identity.  Support for transphobic attitudes and actions has grown. Now there is an attempt in Texas to lay blame on parents who affirm their child’s gender identity. This bill is one of the most harmful to trans children, but is the tip of the iceberg; there have been over 235 state-based bills that limit the rights of trans children in 2022 (https://www.msn.com/en-us/news/us/nearly-240-anti-lgbtq-bills-filed-in-2022-so-far-with-most-targeting-trans-people/ar-AAVhMSa) . The current law that has passed in Texas, abhorrently describes parental support of trans children as child abuse; though, for now, it has been placed on hold by a Texas appeals court.

CSWA believes that gender identity is an integral aspect of our intersectional identities and that children’s rights to express their identities, and to participate in everyday activities of childhood, regardless of this expression, should be protected.  LCSWs work with trans-children and adults who have been harmed because their trans identities. To our affiliated colleagues in the Texas Society for Clinical Social Work, we send our support and encouragement to stand strong.  No law can persuade us to ignore our ethical stance on respecting the identity of any individual child, and for parents that support and affirm their children.  Also notable, the Texas law does nothing to prevent the violence directed toward trans BIPOC youth for being themselves. This violence has increased at alarming rates in the last few years.

As reported by Forbes, 30 trans youth were killed in 2020, including 23 that were BIPOC youth. (Forbes, “Transgender America: 30 Killed And Fatally Shot Already In 2020”, 10/2/20, https://www.forbes.com/sites/jamiewareham/2020/10/02/30-trans-woman-have-now-been-violently-murdered-in-america-in-2020/?sh=296cb38564a4). The work of groups like GLAAD (glaad.org), the Trans Youth Equality Foundation (http://www.transyouthequality.org/), and the Transgender Law Center (https://transgenderlawcenter.org/) are crucial to educating the public and advocating across multiple domains to prevent transphobic violence and discrimination against trans youth and their parents.  CSWA supports the work of these groups in preventing harm and protecting trans children.

President Biden’s State of the Union address tonight will have a major focus on the need for more mental health funding and services.  A few of the areas he will discuss are:

• A vision to transform how mental health is understood, perceived, accessed, treated, and integrated – in and out of health care settings. The American Rescue Plan laid the groundwork, providing critical investments to expand access to mental health services. Now, far more is needed to ensure that everyone who needs help can access care when and where they seek it.
• A national mental health strategy to strengthen system capacity, connect more Americans to care, and create a continuum of support –transforming our health and social services infrastructure to address mental health holistically and equitably.
• Expand the supply, diversity, and cultural competency of our mental health and substance use disorder workforce – from psychiatrists to psychologists, peers to paraprofessionals – and increase both opportunity and incentive for them to practice in areas of highest need. 
• The President’s FY23 budget will invest $700 million in programs – like the National Health Service Corps, Behavioral Health Workforce Education and Training Program, and the Minority Fellowship Program – that provide training, access to scholarships and loan repayment to mental health and substance use disorder clinicians committed to practicing in rural and other underserved communities.

To see a complete summary of what the President will discuss regarding mental health go to: https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/

CSWA will provide a message to send to Congress, who will have to approve the funding and policy measures regarding mental health, on the issues that most affect clinical social workers following the State of the Union speech.

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

In the rush to figure out the Good Faith Estimate, another important issue has been on the back burner.

As you know, the No Surprises Act also had a provision that we see every patient at least once every 12 months.  This was extended from the previous rule which required this provision every 6 months.

With recent guidance from CMS, it is now clear that this requirement will go into effect after the end of the Public Health Emergency (PHE).   That is not likely to be before the end of 2022 at the earliest.

CSWA is hoping to work with many other mental health groups to eliminate this rule. We will keep you posted.

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

The Aware Advocate: Focus on 2022 Medicare Changes 

December, 2021  
Laura Groshong, LICSW, CSWA Director, Policy and Practice

There are a number of issues that are affecting LCSW practices in the waning days of 2021, particularly in the area of Medicare (which we know affects commercial insurance heavily). These issues are:  1) giving patients a “Good Faith Estimate” of what the treatment we provide will cost; 2) elimination of 2022 cuts to Medicare reimbursement; 3) telemental health coverage; and 4) DCEs. Discussion of each of these follows.

Good Faith Estimates

This rule requires us to give a “good faith estimate” (GFE) to a patient of what our services will cost and how long they may last.  While this policy is part of most of our informed consent forms, signed by the patient already, it is prudent to review what the GFE is more formally requesting we include in our information to the patient. The main difference about past practices and the GFE is that it applies to private pay patients as well as insured patients and uninsured patients.

For more information and a template of what belongs in a GFE, go to the CSWA website under “Templates” in the Members Only section.

Medicare Cuts Stopped

LCSWs can take a deep breath as Congress has acted to prevent the trio of Medicare payment cuts that were set to take effect at the beginning of 2022—a 3.75% cut due to scheduled changes in the Medicare Physician Fee Schedule (“PFS”), a 2% cut for Medicare sequestration, and a 4% Statutory Pay-As-You-Go Act (“PAYGO”). These Act cuts would have slashed Medicare payments by nearly 10% during a tumultuous time for healthcare. Instead, tThe Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) was approved by the U.S. House of Representatives on December 7 and passed the U.S. Senate on December 9, 2021.  The bill has been sent to President Biden’s desk for his signature.

The Protecting Medicare and American Farmers from Sequester Cuts Act includes:

• A one-year increase in the Medicare PFS of 3%;
• A delay in resuming the 2% Medicare sequester for three months, followed by a reduction to 1% for three months;
• Erasure of the 4% Medicare PAYGO cut; and
• Prevention of additional PAYGO cuts through 2022

This is the second year that a last-minute change stopped a substantial reimbursement cut for LCSWs.  CSWA will be encouraging CMS and Congress to stop these attempts to balance the Medicare budget on the backs of clinicians moving forward.

Telemental Health Coverage

As you know, CMS issued a new rule last month to expand telemental health and audio only psychotherapy through 2023. You also know we are still unable to practice across state lines unless we are licensed in the state where the patient resides and/or there is still increased reciprocity in the state where the patient resides.  CSWA is still working with Department of Defense and the Council of State Governments to create a “Compact” that will make it much easier to work across state lines; it should be ready to begin implementing in early 2023.

The requirement that LCSWs see patients in person every 6 months has been extended to every 12 months. This is a still a hardship for some patients and LCSWs who have given up a physical office.  CSWA will be working to eliminate this requirement.

For more information go to the CSWA website under “Legislative Alerts”.

Medicare Direct Contracting Entity

Over the past decade, over 50 models of delivering health care through Medicare have been explored, with the goals of lowering costs for dual-eligibles; eliminating access to care, based on economic disparities; and, moving away from a fee for service (FFS) payment model.  The last goal has an impact on LCSWs in private practice who have used the FFS model for some time.

A new model has been emerging called the Medicare Direct Contracting Entity (MDCE).  It is similar to the Accountable Care Organizations that have been in use for the past five years, but is run by commercial for-profit agencies. CMS has started to ‘assign’ beneficiaries who are in traditional Medicare to MDCE plans without consent.  There is concern that this could lead to the privatizing of Medicare which would have the same difficulties that commercial insurance for-profit plans have, i.e., the focus on profit leads to diminished health care services.

Surgeon General Report on Youth Mental Health

U.S. Surgeon General Vivek Murthy, MD, released an advisory statement on December 7 to highlight the urgent need to address the nation’s youth mental health crisis. “Protecting Youth Mental Health” (PDF, 1.01MB) . This excellent document outlines the COVID-19 pandemic’s harm to the mental health of America’s youth and families, as well as the mental health challenges that had accumulated before the pandemic began. CSWA is delighted to see the Surgeon General paying attention to this increasingly difficult situation.

CSWA wishes you a happy and healthy holiday season!

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

I want to call your attention to a new rule from CMS that will go into effect on January 1, 2022.  This rule requires us to give a “good faith estimate” (GFE) to a patient of what our services will cost and how long they may last.  While this policy is part of most of our informed consent forms, signed by the patient already, it is prudent to review what the GFE is more formally requesting we include in our information to the patient about the course of their treatment.  The main difference about past practices and the GFE is that it applies to private pay patients as well as uninsured patients.

There is a CMS template for providing this information which can be found at good faith estimate (PDF, 130KB) . However, this 8-page document is more applicable to hospital stays and procedures.  It may be more helpful for LCSWs to make sure they have the following information in their informed consent or verbally transmitted and documented.

Here is a list of what belongs in the GFE (which can also be part of an informed consent or disclosure statement) for private practitioners:

• The patient’s name and date of birth;
• A description of the psychotherapy or other service(s) being furnished to the patient;
• An itemized list of items or services that are “reasonably expected” to be furnished;
• Expected charges associated with each psychotherapy session or other service(s);
• Your name, National Provider Identifier, Tax Identification Number, office location where services will be provided;
• A disclaimer that there may be additional items or services that you recommend as part of the treatment that will be scheduled separately and are not reflected in the good faith estimate;
• A disclaimer that the information provided in the good faith estimate is only an estimate and that actual items, services, or charges may differ from the good faith estimate; and
• A disclaimer that the good faith estimate does not require the private pay patient to obtain psychotherapy or other services from you.

This information can be transmitted orally but should be given to the patient as soon as possible. For ongoing patients, there should be a new informed consent or GTE statement provided with the information above.  CSWA will provide a template for this shortly.

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