Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY
THE AWARE ADVOCATE
Implications of the UBH Decision for LCSWs
Laura Groshong, LICSW, CSWA Director, Policy and Practice
April 17, 2019
Much excitement has been generated in the mental health community since “the UBH decision” – that is, the decision in the US District Court in Northern California case of Wit et al versus United Behavioral Health, filed March 5, 2019 - found UBH liable with respect to the denials of benefits claims. The clarity and detail of Chief Magistrate Judge Joseph Spero’s 106-page Findings of Fact and Conclusions has provided us with an extraordinary resource for moving forward.
At the same time, there are clear limits to this big win: this is not the end of insurance denials and parity violations. UBH will surely be appealing the judgment, and other judges may or may not uphold the present ruling. Further, the insurance arena is complex. Each state has its own insurance regulations, and each type of plan (ERISA, Medicare, Medicaid, Exchange Plans, or private) has a different source/s of oversight. (CSWA has posted information to clarify the differences in the Clinical Practices section of our website.)
How, then, can we use this decision effectively to affect access to mental health and substance use treatment? At the individual level, if your client is being denied care that you deem critical, the detailed court document provides a list of “generally accepted standards of care” that may prove very helpful in your discussion with the insurance representative.
Judge Spero spent considerable time during the hearing determining what is meant by generally accepted standards of care. Many sources exist, and CSWA will post the judge’s summary of these on our website. The standards listed below were agreed upon by both plaintiffs and UBH; the wording is taken from the court document itself:
The nine plaintiffs whose cases were reviewed during the ten-day bench trial included denials of residential treatment for substance use disorder, for rehab, for mental health treatment, and, in two cases, for teenagers with substance issues, as well as denials of outpatient mental health treatment two to three times per week, and Intensive Outpatient Treatment (IOP) for a minor with SUD. The Judge provided detail for each case considered, noting the discrepancy between the UBH stated standard of care and the actual guidelines that the reviewers was expected to follow. His descriptive language throughout, when referring to the UBH testimony, tended toward generous use of the words “evasive” “even deceptive” and “not credible”.
Given the widespread interest in this case, LCSWs may want to be assertive in appealing denials of care, especially where there is any failure to meet the standards. As you present your argument - even if you are dealing with a different insurer and a different type of plan - a mention of the UBH case will likely have an effect on the discussion. (The CSWA website has an Appeals template in the Members-only section; the generally accepted standards of care list will also be there, as well as a description of the five types of insurance plans.)
Another important avenue for LCSWs may be their state insurance laws/regulations and then perhaps their legislators. The plaintiffs came from different states, and three of these states – Illinois, Connecticut and Rhode Island - have legislation mandating use of the American Society of Addiction Medicine (ASAM) Standards in their insurance laws/regulations; it was not difficult to demonstrate that the UBH denials violated the state laws/regulations. A fourth state, Texas, has Department of Insurance criteria for standards of care; this proved equally effective.
The UBH decision is a good step toward making mental health and substance use parity a reality but is far from the end of making this happen. For now, we can speak out strongly on standards of care, ensure that standards in the client’s policy is being respected in any review process, and feel comfortable noting the UBH loss in court based on violation of these standards, as a basis for appealing a denial of care. As for the next steps, LCSWs should look to state laws/regulations governing insurance, including any standards of care or enforcement of parity. (Such information may be online at the website of the Office of the Insurance Commissioner). Insurance is a state-based system and it may be possible to make a legislative proposal about mental health and substance use that would appeal to your state legislators. Watch for more information from CSWA on this topic soon.
Footnote: Case 3:14-cv-02346-JCS Document 18 (Findings of Fact and Conclusions of Law). Heard and ordered UBH liable 2/28. Filed 3/05/19. 106 pages. United States District Court, Northern District of California.
Clinical Social Work Association
The National Voice of Clinical Social WorkStrengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY
You may have already heard that the CSWA Webinars on the Merit-Based Incentive Payments (MIPS) which were to be held on November 29 and 30 have been canceled. This post explains why.
Clinical social workers were among the 12 additional practitioner groups that were to be included as eligible providers (EPs) for the MIPS bonus of 2% a year in 2019 if reports on quality, cost, improvement in treatment, and increased use of health care records were met. There were some options that would have allowed LCSWs to be eligible if they had less than $90,000 in Medicare claims and less than 200 Medicare beneficiaries as clients with less reporting. Most LCSWs who are sole practitioners would be in this category. There would have been no penalties for LCSWs who did not submit data in the areas described above.
Two weeks ago CMS took LCSWs off the list of EPs who would be included in 2019 for the bonus. While this certainly will cut down on the administrative work MIPS would have required, it also takes the option for a bonus away from LCSWs. So is the glass half empty, or half full? That depends on how you feel about the loss of the bonus option.
One other note of interest: it appears that there will be a 2-3% increase in reimbursement for psychotherapy services in 2019. The exact amount will vary by region.
In January, CSWA will be presenting a webinar on the ins and outs of Medicare, a complicated topic about which I receive questions regularly. Watch for the announcement next month on “Everything LCSWs Need to Know about Medicare Practice”.
Please let me know if you have any questions on the MIPS changes.
With all the environmental challenges we are facing – flooding in Texas, fires and smoke in the Northwest and California, anticipated hurricanes in Florida, South Carolina and up the east coast – it may be hard to think about something as mundane as how to transfer our licenses when we move to a different state. But this is a situation I have had many people tell me they struggled with so I urge everyone to look at this post in case you have been in this situation.
The Association of Social Work Boards (ASWB) is launching an effort to make transferring an LCSW easier by creating more reciprocity between state boards. This will not be easy as state boards have vested interests in their own laws and rules. Nonetheless, I hope who has an experience to share will go to http://movingsocialwork.org/take-action/share-your-story/
This will be used as the base for making the case to the boards that this is an important issue for LCSWs and should be made easier than it is.
Thanks for your help. I hope everyone gets through this weekend as well as possible.
Red Cross has initiated a direct deployment for Hurricane Harvey. This program is for those who are not currently a Red Cross volunteer. I have attached a document with two versions regarding the Direct Deployment program that you can use to share this information far and wide and get the word out.
These Event Based Volunteers (EBVs) will be 'screened' and followed by a mental health volunteer to guide and support them thru the process. The process has been streamlined and formalized since it was developed last year. To check it out yourself click on the link: http://www.redcross.org/take-a-class/lp/hurricane-harvey-health-professionals They must deploy for 9 days which includes 1 day on each end for travel, plus take a few classes online and other paperwork. Important to note that eligibility now includes retirees and out of state licenses.
Please post this on your respective websites, Facebook, LinkedIn, emails, listservs etc. It is anticipated that this will be a long haul with a great need for mental health.
Current volunteers are encouraged to note their availability in Volunteer Connection.or contact their local Staffing person.
If you have any questions, feel free to contact me at email@example.com
The Clinical Social Work Association is stunned and outraged at the violence by white supremacists that took place in Charlottesville, Virginia, yesterday. CSWA sends our best wishes and prayers to the families of those who injured and killed in Charlottesville. We oppose bigotry in any form and encourage all Americans to make it clear that our country will not stand for ‘internal’ terrorism based on prejudice.
According to the Southern Poverty Law Center, there are now 917 hate groups in the United State (www.splcenter.org) . There has been a 67% increase in hate crimes (from 2014) as of 2015, the latest data available, according to the FBI (https://ucr.fbi.gov/hate-crime/2015) .
CSWA is disturbed by the fact that President Trump’s original statement about the incidents in Charlottesville was such a weak condemnation of the clear bigotry that led to the deaths of three people. His support of actions based on discrimination during his campaign paved the way for white extremist groups to act destructively toward those that they see as their enemies.
We call upon President Trump to speak out against this rage that has been simmering in some of our citizens and stop this dangerous trend. It is time for all Americans to take a stand against those of us whose racist anger is turning into actions that hurt or destroy those they hate.
The Clinical Social Work Association has been working for several months to assess and discuss diversity of our membership and our Board. Planning and discussion at the 2016 Annual Summit helped to launch a larger consideration of diversity within our membership. While it is beyond the mission of CSWA to alter the demographics of clinical social work, it is our responsibility to regularly assess our membership and evaluate the perspective we are representing. Our goal was simple: start a conversation about encouraging diversity of membership and Board representation, and continue this conversation by offering action steps and educational tools. In order to reach our goal, we disseminated a survey, created an ad hoc diversity committee, and incorporated the results into our strategic planning.
We are not alone in our commitment to assess and discuss diversity and inclusion. Several Societies have been facilitating these critical conversations for years. Others have begun to take action recently. We know that despite CSWA’s best efforts, there will always be room for improvement. We encourage all state societies to promote through trainings and increased inclusion of diverse populations on Society Boards and in membership. Additionally, CSWA encourages Societies to reach out to other clinical social work organizations to build bridges for more unified membership and advocacy efforts. CSWA supports all attempts to create a clinical social work community that is inclusive and sensitive to the experience of all its members.
We are proud to send the following statement and reminder of the CSWA Code of Ethics that outlines our long standing commitment to cultural competency.
2017 CSWA Diversity Statement
The Clinical Social Work Association has long supported the values of diversity and inclusion. During these troubling times it is vital we create a welcoming and supportive environment for all our members and the people we serve. We firmly believe that we can best promote excellence within our profession by offering educational tools for dialogue and professional development, assessing our membership, and promoting our strong code of ethics regarding cultural competency standards. Further, we recognize the responsibility for excellence, diversity and inclusion lies within each of us who make up the clinical social work profession. CSWA encourages all members and affiliated societies to promote increased awareness of the meaning of diversity to all.
Melissa Johnson, CSWA President, July, 2017
The Clinical Social Work Association has been working for several months to assess and discuss diversity of our membership. Several Societies have begun to develop programs to promote diversity awareness. Based on their work, below are some suggestions.
Define your terms. Everyone has a different idea about what diversity means. Beyond race and gender, it can also include but is not limited to considerations of age, ethnicity, sexual orientation, mental and physical capabilities, gender identity, family status, language, opinions and experience.
Assess. Review your bylaws and clauses that define diversity standards; check for any institutional bias or exclusionary language. Start a conversation about diversity and inclusion with Board members and within your Society. Be prepared to have difficult conversations. Collect rich data; the goal of a survey is not just a head count, but rather the beginning of an education process.
Listen and affirm. Ask about the experiences of your members. Do not make assumptions about how people view this complicated issue. Encourage all Board members to evaluate their own perspective. Don’t scold or shame those who are struggling with understanding.
Learn, share, educate. Offer trainings; invite speakers; build coalitions with other associations; plan a conference on diversity and inclusion. Identify all of the ways you can define diversity and how inclusion is experienced within your society and the profession. Embed these principles in your leadership and others will follow.
Contact Melissa Johnson, CSWA Board President or any of the board members if you want to discuss these concepts with other Societies or find experts to conduct trainings. It helps to not have to reinvent the wheel. CSWA wants all its members and Societies to be self-aware about what healthy understanding and acceptance of diversity means to them and others.
Four major national social work organizations - NASW, CSWA, CSWE, and ASWB - have been developing draft Social Work Technology Standards for the past two and a half years. These standards will cover every area in clinical social work practice that may be affected by the use of technology including clinical practice, record-keeping, education, and macro social work. Many thanks to Laura Groshong, CSWA Director of Policy and Practice, who served as CSWA's representative on the Task Force that put in hundreds of hours on this project.
These standards have been posted for public comment until July 20, 2016. They are available at the following link with instructions on how to submit comments: http://www.socialworkers.org/practice/naswstandards/TechnologyStandardsInSocialWorkPractice/CommentSubmission.aspx Another way to obtain the draft standards is to go to www.socialworkers.org. To the right, look for the “What’s New” box. Scroll down and click on “Draft Technology Standards in Social Work Practice.”
Comments must be submitted by July 20, 2016 to be considered. After consideration of the changes by the Task Force, the draft technology standards will be submitted for review and approval to the NASW Board of Directors in September, 2016 and the other organization Boards (CSWA will meet in October).
The goal is to have these standards published by the end of 2016.
CSWA is proud to have been a participant in this important project and encourages all members to review the draft standards and send comments.
Dear CSWA Members,
It is hard to accept the massacre of LGBTQ people in Orlando and the hate it represents.
There have been some good summaries of how to think about it, including one by Glenda Russell (attached). A PDF version is available online at http://drglendarussell.com/wp-content/uploads/2016/06/Responding-to-Orlando.pdf. Please feel free to share with others.
"Give an Hour" is making the thousands of therapists who give an hour of treatment to veterans available to the Orlando LGBT community - to join go to http://www.giveanhour.org/ForProviders.aspx . To read their press release, go to http://bit.ly/1YnkaTl .
We can never stop insisting on the right of everyone to live their lives regardless of color, sexual orientation, gender or any identity that has been demonized. Please re-read the CSWA Statement on Discrimination (attached). The hate being legalized against trans people in the states mentioned is a contributing factor to the terrible loss in Orlando. Speak out against all forms of hate."
Susanna Ward, PhD, LCSWPresident & CEO, Clinical Social Work Association(606) firstname.lastname@example.org
Melissa Johnson, LCSWPresident-Elect, Clinical Social Work Associationmjohnson@clinicalsocialworkassociation.org
Laura Groshong, LICSWDirector, Policy and Practicelwgroshong@clinicalsocialworkassociation.org
attachment: Russell - RespondingtoOrlando - 6-16.pdf
CSWA - "The National Voice for Clinical Social Work"Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY
We clinical social workers all recognize the possibility that an unexpected life event could interfere with our clinical social work practice. We help our patients deal with unanticipated events every day. Yet many clinical social workers have no plan for notifying patients in such a case, and no arrangement with a colleague who, should it become necessary, would enact this plan.
Of equal concern is the end of a practice: best practice dictates a mindful approach to closing a practice, with a plan developed long before retirement draws near. Yet a comprehensive study (Hovey, 2014) of how social workers address the end of a practice found that only 18% of those surveyed had completed a professional will. The sample (n=83) consisted primarily of White/Caucasians (94 %), female social workers (82 %), ranging in age from 24 to 80 years, most of whom were in private practice (78 %). While 35 % said they had made some informal arrangements with colleagues, 47 % had made no arrangements at all. These results highlight the likelihood that clinical social workers have not given practice interruptions and endings the attention that they should have.
What Makes Planning So Difficult?
As Ragesua, Shatsky, and others have noted, it is often difficult for clinicians, including clinical social workers, to anticipate interruptions in a practice, planned closing of a practice, or instructions for the unplanned closing of a practice. Shatsky states: “As clinicians, we champion our patients’ examination of the difficult, important transitions of their lives. Yet, when it comes to this issue, more often than not we fail to conduct a competency examination on ourselves….Why is it unusual to hear cognitively fit colleagues openly discuss looking forward to retirement? Unlike other health professional arenas, why is planning for and discussing this significant transition (amongst psychotherapists) rarely embarked upon with enthusiasm?” (2016). Ragusea gets to the heart of the matter in his adaptation on ending a practice “On rare occasions, reality breaks through our merciful denial and we all consider our own demise. Yes, the last great adventure beckons to us; even psychologists [and clinical social workers] die. Most of us like to think that we will pass away quietly in old age, peacefully sleeping in our own beds and, perhaps, surrounded by loved ones. But, what if the path goes off in a different, surprising direction? What if we die suddenly, unexpectedly?” (Ragusea, 2002).
The internal process of accepting the fact that there are likely to be interruptions and there will definitely be endings to clinical practice may involve working through feelings of loss, ambivalence, guilt, relief, and much more. Clinical social workers should begin to consider their feelings about the inevitable ending of clinical practice from the beginning of their careers, rather than wait until nearing the likely end of their working lives. Having no plan in place for an unexpected interruption or ending could put patients at risk for a wrenching disruption in treatment and may burden an unprepared spouse, partner, or colleague with the complex task of closing a practice. The responsible clinical social worker will have a plan in place; this is best practice, ethical practice, and even required in some states by the boards of social work.
What The Clinical Social Work Association Can Do To Help
There are four major ways that clinical social work practices may be interrupted or ended:
Hovey, J. K. (2014). “Mortality practices: How clinical social workers interact with their mortality within their clinical and professional practice” (Unpublished master’s thesis). Smith College School for Social Work, Northampton, MA. Available from https://dspace.smith .
Ragusea, S. "A Professional Will for Psychologists", adapted from VandeCreek, L. & Jackson, T., Eds. (2002) Innovations in Clinical Practice: A Source Book, Vol. 20, pp. 301-305. Sarasota, FL: Professional Resource Press.
Shatsky, P. (2016) “Everything Ends: Identity and the Therapist’s Retirement”. Clinical Social Work Journal, Vol. 44, No. 2, pp. 43-149.
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