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The National Voice of Clinical Social Work 

Strengthening IDENTITY  | Preserving INTEGRITYAdvocating PARITY

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Legislative Alerts

CSWA Director of Legislation and Policy, Laura Groshong regularly provides Legislative/Regulatory Alerts to the membership to keep them informed about important legislation or regulations that have been introduced at the national level.  In addition to keeping members informed, the CSWA also monitors all current national legislation that affects clinical social workers and the need for action to members of Congress. The list of Legislative Alerts listed below allows members to review the history of CSWA action on national bills in Congress that affect clinical social workers and the outcomes of our actions.

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  • 30 Aug 2021 10:58 AM | CSWA Administrator (Administrator)


    As you know, each August CMS puts out changes to the rules that govern the Physician Fee Schedule (PFS).  These changes affect our practices and CSWA sends comments on the rules, which go into effect the following year.

    Below please find the comments which CSWA has sent on the PFS 2022, a 1747-page document.  CSWA chose three areas for comment, Mental Health Disparities, Telemental Health Coverage, and Telemental Health Parity in reimbursement.  CSWA encourages all members to send their individual comments on any or all of these areas.  CMS is asking that members not send a standard message.  Use any of the language in the CSWA comments for your own comments.  Send them by September 13, 2021, to https://www.federalregister.gov/documents/2021/07/23/2021-14973/medicare-program-cy-2022-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part .

    As always, let me know when you have sent your comments and send a copy.  Thanks for your help.

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


    August 27, 2021

    Centers for Medicare and Medicaid Services
    Department of Health and Human Services
    RE: Comment on Physician Fee Schedule 2022
    https://www.federalregister.gov/documents/2021/07/23/2021-14973/medicare-program-cy-2022-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part

    The Clinical Social Work Association (CSWA) is pleased to have the opportunity to submit comments on the proposed Physician Fee Schedule for 2022 (PFS2022).  We also want to take this opportunity to thank CMS for covering mental health treatment provided through videoconferencing and audio-only delivery during this Public Health Emergency (PHE).

    We will be commenting on three major areas of the bill which are of particular interest to Licensed Clinical Social Workers (LCSWs). These areas are 1) addressing mental health disparities; 2) telemental health continuation after the Public Health Emergency; and 3) reimbursement parity between in-person mental health treatment and telemental health treatment.

    Mental Health Disparities

    The disparities between mental health access, treatment, and outcomes for white populations as compared to Black, Indigenous, and People of Color (BIPOC), have been well-documented and it is past time to address the root causes.  CSWA is pleased to see the request in the PFS2022 for comment on p. 434: “Solicit comments on addressing health disparities and promoting health equity.” 

    Health disparities are costly:  approximately 30% of direct medical costs for African Americans, Hispanics and Asian Americans are excess costs due to these health inequities, and the economy loses an estimated $309 billion per year due to the direct and indirect costs of disparities. (Nov. 2012, Henry J Kaiser Family Foundation)

    A major root cause driving these inequities lies in Social Determinants of Health (SDOH).  According to the peer reviewed journal,

    Health Affairs, disparities may be rooted in differences in insurance coverage, inequalities in access to good providers, or discrimination by health professionals in the clinical encounter.  Disparities may be the result of years of institutional racism, lack of trust due to years of broken promises, cultural traditions, and more.” (Health Affairs, 2008, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.2.393)

    When it comes to mental health treatment, whites are more likely to receive psychotherapy and medication on an out-patient basis, whereas BIPOC citizens are more likely to be referred to in-patient treatment for the same conditions

    (Health Affairs, 2015, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.2.393
    Yet, the rates of depression are lower in Blacks (24.6%) and Hispanics (19.6%) than in whites (34.7%). Correspondingly, depression in African Americans and Hispanics tends to be more persistent, likely due at least in part to difficulties accessing effective and affordable out-patient care.

    Further, since untreated mental health issues tend to exacerbate physical health issues, treatment costs related to physical health tend to rise as well.  Simultaneously, outcomes become less hopeful, and may come to include disability, addiction, homelessness, and incarceration - again disproportionately affecting BIPOC communities.

    Indeed, the prison population has become the largest group of people with diagnosable mental health disorders, between 45-60% (When Did Prisons Become Acceptable Mental Health Facilities?, Stanford Law School, 2017.)   Lack of critical mental health care during incarceration has been persistent, as are the difficulties accessing mental health care through Medicaid upon release. Here, then, is another example of the SDOH role in exacerbating disparities, especially given the excessively high numbers of brown and Black people incarcerated in the US.

    CSWA would be happy to provide additional data on how SDOH factors are connected to mental health disparities and need to be addressed.

    Telemental Health Coverage

    When the Public Health Emergency was implemented in March, 2020, most LCSWs began providing psychotherapy through virtual telemental health (videoconferencing) and audio-only (telephone).  The decision by CMS to cover these new delivery systems during the PHE has been crucial to the wellbeing of Medicare beneficiaries living in areas without local mental health services or accessible transportation to more remote care.  Previously unable to obtain in-person psychotherapy, they finally have the needed treatment because of the new delivery systems.  It is unrealistic to expect them to begin treatment in person when the PHE ends unless SDOH transportation and other barriers to access are addressed.

    CSWA therefore recommends that all three forms of treatment delivery be approved and reimbursed at the rate being paid for in-person treatment.   LCSWs who provide services through videoconferencing and audio-only are working as hard, if not harder, than when they see patients in person.  Further, even the requirement that patients being treated via videoconferencing and audio-only must be seen in person every six months is highly problematic; certainly it would be a huge barrier to seeing patients who can ONLY access treatment through virtual means.

    The elderly - the main group of Medicare beneficiaries - are chronically underserved when it comes to mental health treatment.  Not all Medicare beneficiaries have access to Rural Health Centers and Federally Qualified Health Centers; many had the opportunity to establish virtual  psychotherapy relationships with independent LCSWs as a result of the PHE.  However, the biannual in-person requirement has created a barrier to virtual treatment.  If it is not eliminated, these beneficiaries may well find themselves back among the “chronically underserved”.

    Telemental Health Parity

    As noted in the Proposed Rule, “the estimated cost impact of this proposal is unclear, the proposed requirement that a modifier be appended to the claim to identify that the service was furnished via audio-only communication technology would allow us to closely monitor utilization and address any potential concerns regarding overutilization through future rulemaking” (p.1198).  This comment applies to videoconferencing as well.

     In fact, LCSWs and other mental health clinicians have been involved in an in vivo application of these two delivery systems throughout the pandemic.  We ask that this data be collected and analyzed to see how much these services are being utilized and how their use affects cost offsets of medical conditions before CMS moves forward on plans to limit or eliminate them.

    CSWA recommends that all three forms of treatment delivery be approved until CMS completes such a study, and that all three be reimbursed at the rate being paid for in-person treatment.   LCSWs providing mental health treatment through videoconferencing and audio-only means are working just as hard, if not harder, providing professional clinical treatment virtually as when they provide services in person.

    LCSWs have been long been called the backbone of psychotherapy services, and with more than 250,000 licensees, LCSWs are the largest mental health provider group in the country.  However, as you know, LCSWs are reimbursed by Medicare at 25% less than psychologists for providing the same services, with the exact same CPT psychotherapy codes.  LCSWs have equivalent clinical training, experience, client overall satisfaction, and provide long-term relief of emotional problems.  The reimbursement disparity for LCSWs has not gone unnoticed and the number of LCSW Medicare providers has continually dropped. Lowering reimbursement for telemental health services would likely result in even fewer LCSW Medicare providers.

    CSWA hopes that these comments are helpful developing the Proposed Rule and would be happy to discuss them with you further.

    Sincerely,

    Kendra C. Roberson, PhD, LCSW, President  
    Clinical Social Work Association  
    kroberson@clinicalsocialworkassociation.org

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


  • 29 Apr 2021 1:04 PM | CSWA Administrator (Administrator)


    Many members have been asking questions about the Medicare coverage of telemental health.  This is an important topic because most commercial insurers follow Medicare policies regarding coverage of telemental health, as well as other coverage issues.

    Medicare has covered telemental health videoconferencing for our usual and customary psychotherapy codes since March, 2020, a major expansion of telehealth coverage.  Medicare also agreed to cover audio only psychotherapy in April of 2020.  Both were tied to the Public Health Emergency (PHE) being in effect.  The PHE was extended in three month increments until April of 2021 when CMS announced that telemental health videoconferencing would be extended until the end of 2021.  Audio only treatment would be covered as long as the PHE was in effect.  See https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes for more information.

    In other words, separation of telemental health videoconferencing and audio only coverage have been part of the expansion of psychotherapy coverage since the pandemic began.  The current intention from the current administration is that the PHE continue through 2021, which would make the difference between the two delivery systems moot.

    At this point, I believe that LCSWs can reasonably expect coverage of telemental health and audio only treatment to last through 2021.  There are several bills in Congress which would make this policy permanent.  Our Government Relations Committee is working hard to see one of these bills pass.  Stay tuned.

    Laura W. Groshong, LICSW, Director, Policy and Practice

    Clinical Social Work Association
    lwgroshong@clinicalsocialworkassociation.org
    CSWA - "The National Voice for Clinical Social Work"

    Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY


  • 19 Apr 2021 10:58 PM | CSWA Administrator (Administrator)


    Good news on the Medicare fee-for-service sequestration front!  The 2% cut which was scheduled for April 14, 2021, has been suspended until December 31, 2021.  See the announcement from CMS below:

    The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the sequestration payment adjustment percentage of 2% applied to all Medicare Fee-for-Service (FFS) claims from May 1 through December 31, 2020.  The Consolidated Appropriations Act, 2021, extended the suspension period to March 31, 2021. An Act to Prevent Across-the-Board Direct Spending Cuts, and for Other Purposes, signed into law on April 14, 2021, extends the suspension period to December 31, 2021.

    Medicare Administrative Contractors will:

    • Release any previously held claims with dates of service on or after April 1
    • Reprocess any claims paid with the reduction applied

    For more information, go to https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2021-04-16-mlnc#_Toc69394754

    Let me know if you have any questions.

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

  • 25 Mar 2021 10:37 AM | CSWA Administrator (Administrator)


    Today CSWA had its first meeting with members of the Council of State Governments, sponsored by the Department of Defense. For more information, see the original post sent on March 15.

    The goal of building a compact for states that want to have reciprocity for clinical social workers was outlined.  This project will take approximately 12-16 months to develop and will then be presented to the legislatures in the states and jurisdictions. Therefore, this project will require at least 2-3 years to be implemented. 

    CSWA is very pleased to have the support of DoD and CSG. We will keep you you apprised of the progress of the compact development.

    Laura

    ====================================================

    March 15, 2021

    Dear CSWA Member,

    We are delighted to inform you that we will be working with the US Depa­­­­­­rtment of Defense, National Center of Interstate Compacts and other key social work stakeholders to establish clinical social work reciprocity across states.  This effort has become increasingly important as we work utilizing telemental health; the requirement that we be licensed in the state where the patient is located is burdensome and amounts to restraint of trade.

    Below is the message that CSWA received today from the US Department of Defense:

    We are excited to inform you that the U.S. Department of Defense has selected your profession to receive technical assistance from The Council of State Governments to develop an interstate compact for occupational licensing portability. Based on the applications received from three organizations representing social work, DoD believes the Association of Social Work Boards is best suited to lead compact development efforts on behalf of the profession.  

    However, we believe that CSWA will be a crucial stakeholder in developing a compact for social workers. CSG would like to invite representatives from CSWA to join the compact technical assistance group that will engage in compact development activities jointly with ASWB and other social work regulatory stakeholders.  

    Thank you for your commitment to removing barriers to multistate practice for licensed practitioners. We will be in touch in the coming days to set up a call with our team at CSG. Please do not hesitate to reach out if you have any questions. 

    Sincerely, 

    National Center for Interstate Compacts 
    The Council of State Governments 
    1776 Avenue of the States, Lexington, KY 40511 

    CSWA will keep you informed on the progress of this helpful project.

    Kendra C. Roberson, PhD, LCSW | President & Education Committee, Social Work Consultant 
    president@clinicalsocialworkassociation.org

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


  • 19 Mar 2021 9:00 PM | CSWA Administrator (Administrator)


    CSWA is pleased to send you the announcement from Sen.  Debbie Stabenow (D-MI), Sen. John Barrasso (R-WY),  and Rep Barbara Lee (D-CA) about the re-introduction of the Improving Access to Mental Health Act of 2021

    This may be the year that this bill is finally passed with the exponential increase in mental health needs due to the COVID pandemic.  See the text of the announcement below.

    Please send the following message to your members of Congress, using your own words if you wish, at https://www.congress.gov/members?q={%22congress%22:117}&searchResultViewType=expanded :

    “I am a member of the Clinical Social Work Association and a constituent.  Please consider becoming a co-sponsor of the Improving Access to Mental Health Act of 2021.  As a clinical social worker, I have been working twice as hard during the pandemic, learning to work through telemental health, and handle a substantially increased caseload.  However, I am still being paid 25% less by Medicare than other mental health clinicians. I need your help to give clinical social workers, the backbone of the mental health treatment community, fair compensation and recognition of the way we are helping to maintain the mental health of our citizens.  Thanks for your consideration.”

    Thanks for your help.  As always, let me know when you have sent your messages.

    Laura W. Groshong, LICSW, Director, Policy and Practice

    Clinical Social Work Association
    lwgroshong@clinicalsocialworkassociation.org
    CSWA - "The National Voice for Clinical Social Work"

    Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY

    FOR IMMEDIATE RELEASE

    March 18, 2021
    Eliza Duckworth (Stabenow)
    Eliza_Duckworth@Stabenow.senate.gov

    Barrasso Press Office (Barrasso)
    Press@barrasso.senate.gov

    Sean Ryan (Lee)
    Sean.Ryan@mail.house.gov


    Senators Stabenow, Barrasso and Representative Lee Introduce Bill to Increase Seniors’ Access to Behavioral Health Services

    WASHINGTON, D.C. — U.S. Senators Debbie Stabenow (D-MI), John Barrasso (R-WY) and U.S. Representative Barbara Lee (D-CA-13) today reintroduced their bill to increase seniors’ access to behavioral health services. The Improving Access to Mental Health Act of 2021 would ensure clinical social workers can provide their full range of services to Medicare beneficiaries and increase the Medicare program’s reimbursement rate for clinical social workers, aligning it with that of other non-physician providers.

    “Increased stress and isolation during the COVID-19 crisis has resulted in an urgent need for behavioral health services, especially among our seniors,” said Senator Stabenow. “Seniors should be able to receive care from the provider of their choice, and this bill ensures that clinical social workers are among those providers.”

    “As a doctor, I know how vital it is for seniors to have access to mental health services,” said Senator Barrasso. “In particular, for those living in rural communities, finding a mental health provider is challenging. This is why I am proud to support bipartisan solutions that help more patients get the care they need.” 

    “As a former psychiatric social worker, I know the critical high-quality mental health services and care social workers provide in our communities,” said Congresswoman Barbara Lee. “Especially during a pandemic impacting the mental health of many, it is critical that we ensure Medicare beneficiaries have access to the essential mental health services provided by clinical social workers on a daily basis. I’m proud to join fellow social worker Senator Debbie Stabenow in reintroducing this critical bill and working to expand mental health services for all.”

    The Improving Access to Mental Health Act of 2021 would increase the Medicare payment reimbursement rate for clinical social workers from 75 percent to 85 percent of the physician fee schedule. This would align Medicare payments for clinical social workers with that of other non-physician providers such as nurse practitioners and physician assistants. This new payment structure would incentivize trained and licensed professionals to care for more seniors in their communities. The bill also ensures clinical social workers can provide psychosocial services to patients in nursing homes, and the full range of Health and Behavior Assessment and Intervention (HBAI) services within their scope of practice.

    The Improving Access to Mental Health Act of 2021 is supported by Aging Life Care Association, American Academy of Social Work and Social Welfare, Clinical Social Work Association, Congressional Research Institute for Social Work and Policy, Council on Social Work Education, Gerontological Society of America, National Association of County Behavioral Health and Developmental Disability Directors, National Association of Social Workers, National Association for Rural Mental Health, the International OCD Foundation, and the Jewish Federations of North America.

    “There is great need and a demand for mental health and behavioral health services due to the COVID-19 pandemic, especially among individuals of color and underserved communities who are disproportionately impacted,” said Angelo McClain, PhD, LICSW, NASW Chief Executive Officer. “This legislation ensures a sufficient number of clinical social workers will be there to provide much-needed support and services to Medicare beneficiaries.”

    For years, Senator Stabenow has been a champion for increasing access to behavioral health and addiction services. She created a new permanent funding system through the creation of Certified Community Behavioral Health Clinics, which provide a comprehensive set of high-quality behavioral health services. Her bipartisan Excellence in Mental Health and Addiction Treatment Act secured the most significant expansion of community mental health and addiction services in decades.

     

    ###

  • 16 Mar 2021 2:46 AM | CSWA Administrator (Administrator)


    We are delighted to inform you that we will be working with the US Depa­­­­­­rtment of Defense, National Center of Interstate Compacts and other key social work stakeholders to establish clinical social work reciprocity across states.  This effort has become increasingly important as we work utilizing telemental health; the requirement that we be licensed in the state where the patient is located is burdensome and amounts to restraint of trade.

    Below is the message that CSWA received today from the US Department of Defense:

    We are excited to inform you that the U.S. Department of Defense has selected your profession to receive technical assistance from The Council of State Governments to develop an interstate compact for occupational licensing portability. Based on the applications received from three organizations representing social work, DoD believes the Association of Social Work Boards is best suited to lead compact development efforts on behalf of the profession.  

    However, we believe that CSWA will be a crucial stakeholder in developing a compact for social workers. CSG would like to invite representatives from CSWA to join the compact technical assistance group that will engage in compact development activities jointly with ASWB and other social work regulatory stakeholders.  

    Thank you for your commitment to removing barriers to multistate practice for licensed practitioners. We will be in touch in the coming days to set up a call with our team at CSG. Please do not hesitate to reach out if you have any questions. 

    Sincerely, 

    National Center for Interstate Compacts 
    The Council of State Governments
    1776 Avenue of the States
    Lexington, KY 40511 

    CSWA will keep you informed on the progress of this helpful project.

    Kendra C. Roberson, PhD, LCSW | President & Education Committee, Social Work Consultant 
    president@clinicalsocialworkassociation.org

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

  • 26 Feb 2021 10:05 AM | CSWA Administrator (Administrator)


    You may have been hearing about part of a new law called Section 123 contained in the 1,000-page Consolidated Appropriations Act of 2021 (CAA) at the very end of 2020.  This Section requires all mental health clinicians who are working virtually to see their patients at least once every six months in-person, once the Public Health Emergency (PHE) ends.

    Meeting in-person would of course be dangerous in the time of COVID which is why we are working through videoconferencing and audio only in the first place.  There has been a lot of concern about the implementation of Section 123.  An article from the law firm of Foley and Lardner about Section123 is being circulated which is somewhat inaccurate, as it does not highlight the start of Section 123 only when the PHE ends. Here is what CSWA believes Section 123 means at this point:

    • The in-person requirement does not go into effect until AFTER HHS declares the Public Health Emergency has ended, which at this point is April 20, 2021, unless extended. 
    • Applying this rule solely to mental health treatment and no other medical services violates the mental health parity law.   
    • Inserting this rule into an appropriations law that has nothing to do with mental health treatment is duplicitous and misguided.

    Please know that CSWA is working in collaboration with the American Psychological Association to eliminate this section.  A bill is being drafted and we are confident that Section 123 can be changed.

    CSWA will also work to find out why HHS inserted this section into the CAA and will let you know what we find.

    Let me know if you have any other questions.

    Laura Groshong, Director, Policy and Practice


  • 14 Dec 2020 9:53 PM | CSWA Administrator (Administrator)

    The 6.9% Medicare cuts are still planned for 2021 in spite of the major efforts of CSWA and many other mental health groups.  Fortunately, there are two bills which would put off this cut for two years.  Time is short to get S. 5007 and H.R. 8702, “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020”, passed.  Send messages to your members of Congress.

    Both bills would institute additional payments, separate from the physician fee schedule, to essentially establish 2020 Medicare reimbursement rates as the floor for payments in both 2021 and 2022.

    Go to https://www.congress.gov/contact-us immediately to ask your Senators to cosponsor S.5007 and your Representative to cosponsor H.R.8702 to protect Medicare payment rates for services provided by LCSWs and other healthcare providers. 

    Below is a template for your use:

    I am a member of the Clinical Social Work Association and a constituent.  Please pass H.R. 7802/S. 5007 to allow LCSWs to continue working as Medicare providers.  The proposed cut of 6.9% will make it very hard for me to afford to continue as a Medicare provider.  In these perilous times, the need for mental health services has grown exponentially.  Please allow the 250,000 LCSWs in the country to be able to provide the help that is so sorely needed.”

    As always, let me know when your messages have been sent.

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

  • 04 Dec 2020 11:24 AM | CSWA Administrator (Administrator)


    There are now 25 new ICD-10 codes for substance use disorders (SUD) which all LCSWs who work with patients diagnosed with these disorders should know.

    They are:

    • F10.13 Alcohol abuse, with withdrawal
    • F10.130  Alcohol abuse with withdrawal, uncomplicated
    • F10.131 Alcohol abuse with withdrawal delirium
    • F10.132 Alcohol abuse with withdrawal with perceptual disturbance
    • F10.139 Alcohol abuse with withdrawal, unspecified
    • F10.93 Alcohol use, unspecified with withdrawal
    • F10.930 Alcohol use, unspecified with withdrawal, uncomplicated
    • F10.931 Alcohol use, unspecified with withdrawal delirium
    • F10.932 Alcohol use, unspecified with withdrawal with perceptual disturbance
    • F10.939 Alcohol use, unspecified with withdrawal, unspecified
    • F11.13 Opioid abuse with withdrawal
    • F12.13 Cannabis abuse with withdrawal
    • F13.13 Sedative, hypnotic or anxiolytic abuse with withdrawal
    • F13.130 Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated
    • F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium
    • F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance
    • F13.139 Sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified
    • F14.13 Cocaine abuse, unspecified with withdrawal
    • F14.93 Cocaine use, unspecified with withdrawal
    • F15.13 Other stimulant abuse with withdrawal
    • F19.13 Other psychoactive substance abuse with withdrawal
    • F19.130 Other psychoactive substance abuse with withdrawal, uncomplicated
    • F19.131 Other psychoactive substance abuse with withdrawal delirium
    • F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance
    • F19.139 Other psychoactive substance abuse with withdrawal, unspecified

    Be sure to use these codes in addition to the mental health disorder codes that we commonly use for anxiety, depression and other conditions.

    HEADS UP for the Physician Fee Schedule!  We have been waiting for this rule since last summer.  It should be coming out any day now.  I plan to answer any questions you have about it at the online Town Hall next Thursday, December 10, 2020, at 5 pm EST.  Register at the CSWA website (www.clinicalsocialworkassociation.org) , Hope to see you then.

    LWG

  • 04 Nov 2020 12:24 PM | CSWA Administrator (Administrator)


    I am delighted to inform you that the Federal Court which made the ruling in Wit v. United Behavioral Health in March of 2019 has issued further remedies for the implementation of this ruling today. This ruling was consolidated with Alexander et al. v. United Behavioral Health, another case which found UBH in violation of mental health parity laws nationally and in California. The court explained in the 99-page document the need for the following steps:

    1. a 10-year injunction requiring UBH to exclusively apply medical necessity criteria developed by non-profit clinical specialty associations;
    2. appointment of a special master;
    3. training of UBH in the proper use of court-ordered medical necessity criteria; and
    4. reprocessing of nearly 67,000 mental health and substance use disorder benefit claims denied during the class period.

    The remedies only apply to self-insured plans that fall under the Employee Retirement Income Security Act of 1974 (ERISA). It does not apply to government employees or commercial insurance plans.

    Nonetheless, this implementation of the Wit ruling is as a major success for fully implementing mental health parity for the 50,000 ERISA enrollees in California and serves as a guide for laws in other states which have not fully implemented mental health parity laws.


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