The Aware Advocate

A Quarterly Summary of Information Affecting LCSWs

January 2024

by Laura Groshong, LICSW, Director, Policy and Practice

There is a lot going on in the world of clinical social work at the moment that I will try to summarize here, some positive, some problematic. Let’s start with the positive:

Social Work Compact Bills

There are now 22 states that have bills pending to pass the Social Work Compact. As you know, when 7 states have passed the bill, a Commission will be created by the Council of State Governments (which has overseen the development of the Compact Bill) to oversee the implementation of the Compact. There will be a Commission member from each state that joins the Compact as well as ex officio members from major social work stakeholder groups, including CSWA. Please find out the numbers of the Compact bills being considered in your state, usually HB___ and/or SB___, and ask your legislators to support them. To view additional information on the CSWA website, visit https://www.clinicalsocialworkassociation.org/compact-information. Please let me know if your state passes the Compact!

“Inseparable” Report

A relatively new mental health policy organization, Inseparable, published a report last month called “Improving Mental Health Care: The Access Report” which has some excellent information about the percentage of citizens in each state that have a mental health problem and how many actually receive care. To view the report, please visit https://pdf.live/edit?url=https%3A%2F%2Fwww.inseparable.us%2FAccessReport.pdf&source=f&installDate=060322.

OPTUM “Clawbacks”

And now for the not so positive news.

I’ve heard from several members that they have received letters from OPTUM saying that they were overpaid between 2021 and 2023 and need to repay United Health Care the amount that was overpaid. This can amount to thousands of dollars. While OPTUM acknowledges that this was a “systems error” on their part, they still say that LCSWs who were overpaid should have known that they were overpaid and refused to accept the money. Remember that this is a Medicare Advantage plan which is overseen by commercial insurers, in this case, United Health Care, and not Medicare, which is a public plan. Commercial plans are overseen by either Department of Labor (ERISA or self-insured plans) or state insurance commissioners, if the plan is not an ERISA plan.

Here are some ways that you may choose to respond to this letter:

1. Find out if the plan is an ERISA plan or a commercial plan.
2. Check the insurance rules in your state and see whether there are any rules about how long insurers have to request LCSWs to pay back funds that they were not entitled to. If the request has exceeded the request, file a complaint with the insurance commissioner.
3. Hire an attorney to file a cease-and-desist letter to OPTUM/United, explaining that this was their error, not yours, and you should not have to repay the funds you were paid.

Let me know if you receive any responses regarding this situation.