LEGISLATIVE ALERT: Medicare Telemental Health

November 21, 2024

by Laura Groshong, LICSW, Director of Policy and Practice

 

I have received several questions about Medicare coverage of virtual telemental health which is currently scheduled to end on December 31, 2024. This would be a significant problem for the many LCSWs that have continued to see patients through videoconferencing since the pandemic first led to coverage of this option. Audio-only coverage is also being challenged.

It may be hard to remember that four and a half years ago, these delivery systems were not covered by Medicare; all patients were seen in person unless they lived in rural areas or had a disability that made it impossible for them to be seen in person. Commercial insurers, as they often do, generally followed the lead of CMS in their willingness to cover therapy through videoconferencing and audio-only means.

There are some bills in Congress now that would extend and/or make permanent the ability to have videoconferencing and audio-only treatment covered by Medicare. There is a good chance that one of them may pass or be attached to another bill. CMS has already recommended that videoconferencing and audio-only psychotherapy services be covered permanently, but Congress must pass a bill that will make that law.

Therefore, please send the following message to your members of Congress by visiting https://www.congress.gov/members/find-your-member and to the Senate at https://www.senate.gov/senators/senators-contact.htm?Class=1: "I am a licensed clinical social worker, a member of the Clinical Social Work Association, and a constituent. Please pass a bill that will allow me to continue treating Medicare patients with mental health and substance use problems virtually. This has become the only way many patients can receive treatment. If not changed, these patients will be unable to continue to work on these serious problems after December 31, 2024." As always, please let me know when you have sent your messages.

As for the issue of seeing patients in person every six or twelve months, that rule has been delayed for two years, and will be reviewed during that time.

It is frustrating to be faced with these changes that may significantly affect our practices. With any luck, we will be able to continue to do our work in ways that are best for our patients and for us as LCSWs.

Laura Groshong, LICSW, CSWA Director of Policy and Practice

lwgroshong@clinicalsocialworkassociation.org

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.

The final rule for the Medicare Physician Fee Schedule (PFS) in 2024 has been issued and will go into effect on January 1, 2024. This link is to the complete Summary: https://www.cms.gov/files/document/mm13452-medicare-physician-fee-schedule-final-rule-summary-cy-2024.pdf

Please find a list of the changes that will affect clinical social workers below.

Physician Fee Schedule Changes

New codes:

• CPT 0591T-0593T will now be available for “health and well-being coaching services” on a temporary basis.
• HCPCS G0136 will now be available for Social Determinants of Health Risk Assessment (SDOH) permanently.

Telemental Health Services:

• Telemental health services will continue to be covered through 2024, regardless of where the patient is located.
• The requirement that patients be seen in person every six months is delayed throughout 2024.
• The modifier for telemental health services will continue to be “95”.

Expansion of Behavioral Health Services:

• LMFTs and LMHCs will be included as mental health providers under Medicare.

Expansion of Crisis Codes:

• CPT codes for crisis services, 90839 and 90840, will be covered by Medicare regardless of the location of the patient.

New Codes for LCSWs:

• Health Behavior Assessment and Intervention (HBAI) services will now be covered for LCSWs by Medicare using CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168. These codes are designed to assess the psychological, behavioral, emotional, cognitive, and social factors included in the treatment of physical health problems.

Change to Relative Value Units (RVUs) for LCSWs:

• Over the next four years there will be an increase in payment for in-office psychotherapy, to be determined.

Please let me know if you have any questions.

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

Please take a moment to submit a comment on the proposed rule to make the Mental Health Parity and Addiction Equity Act more enforceable. You may use the template below or write your own. Comments are due on October 2, 2023.

To read the document visit https://www.regulations.gov/document/EBSA-2023-0010-0001.

To submit a comment visit https://www.regulations.gov/commenton/EBSA-2023-0010-0001.

Template: 

Subject: Re: 0938-AU93 1210-AC11 1545-BQ29 Requirements Related to the Mental Health Parity and Addiction Equity Act

Dear Secretary Becerra, Assistant Secretary Gomez, and Deputy Commissioner O’Donnell;

Thank you for the opportunity to comment on the Requirements Related to the Mental Health Parity and Addiction Equity Act (MHPAEA) proposed rule. I write as a licensed clinical social worker who has noticed increased difficulty for patients to find coverage for mental health and substance use (MH/SUD) treatment.

It is quite unfair that mental health and substance use treatment is still not covered at parity with medical/surgical care after the initial rules for the 2008 MHPAEA were delayed until 2014 and are still not covered at parity almost 10 years later.

Please finalize the following specific proposals WITHOUT EXCEPTION:

• Requiring health plans to prove their MH/SUD parity compliance by showing the effect the limits they place on benefits have on a person’s access to treatment;

• Evaluating the health plan’s provider network, including how long the wait times are; how often consumers must seek out-of-network providers; how much a plan pays providers; how often prior authorization is required for services a practitioner prescribes; and how often prior authorization requests are denied; and

• Imposing strong consequences when a plan is found to be out of compliance with the parity requirements, including barring them from imposing the plan requirement. 

We urge the Departments to consider penalties when plans ignore these consequences.

Please make these changes to eliminate barriers to care and ensure that everyone has the same access to mental health and substance use benefits as they do physical health benefits.

Thank you again for the opportunity to comment.

As always, let me know when you have submitted your comments.

Laura Groshong, LICSW, Director of Policy and Practice

lwgroshong@clinicalsocialworkassociation.org

Social Work Compact Update - July 12, 2023

Good news! On July 7th, 2023, Governor Mike Parson signed Senate Bill 670 and Senate Bill 157 making Missouri the first state to enact the Social Work Licensure Compact. This is a milestone development in supporting the mobility of licensed social workers.

SB 670 was sponsored by Senator Travis Fitzpatrick and Senator Lauren Arthur, and SB 157 was sponsored by Senator Rusty Black.

The Social Work Licensure Compact seeks to increase public access to social work services, provide licensees with opportunities for multistate practice, support relocating military families, and allow for expanded use of telehealth technologies. Currently, the model compact legislation is available for other states to introduce and enact like Missouri. Thus far there have been nine other states that have introduced: Utah, Kentucky, Vermont, New Hampshire, New Jersey, Georgia, South Carolina, North Carolina, and Ohio.

How is the Social Work Compact progressing in your state?

If you have not reached out to your legislators to let them know about the Compact, please start the process now. You can find the materials to use at https://www.clinicalsocialworkassociation.org/Announcements/13212620.  

Please let me know when you have 1) a pending or passed bill in your state, 2) a legislator who is willing to sponsor the bill, 3) if you need assistance in finding a legislator to sponsor the Compact bill, and/or 4) have talked to NASW about working together to get the Compact going.  

Let me know when you have any information on the above issues.  

Many thanks,  

Laura Groshong, LICSW, CSWA Director of Policy and Practice

lwgroshong@clinicalsocialworkassociation.org

The Aware Advocate - Legislative Alerts

June 29, 2023

by Laura Groshong, LICSW, Director, Policy and Practice

Here are two issues which I hope you will all address with your members of Congress and your state legislature.

For Members of Congress:

• H.R. 2474 is a bill which would improve Medicare reimbursement rates by using the rate of inflation as the way to adjust reimbursement each year instead of the Physician Fee Schedule (PFS) which does not use inflation as a factor. 
• H.R. 2474 would also tie reimbursement to the Medicare Economic Index which is based on provider expenses and other economic trends.
• Medicare rates have not increased since 2001, making payments 26% lower today than they were then, when adjusting for inflation. This is one of the major reasons that LCSWs are opting out as Medicare providers. There is a freeze on updated reimbursement until 2026.
• Though this is a House bill, please let your Senators know as well.  You can contact them all at https://www.congress.gov/contact-us. Here is a message you can use or change it to use your own words: “I am a Licensed Clinical Social Worker and a constituent. Please support H.R. 2474 which will make Medicare reimbursement more equitable for mental health services. Reimbursement rates have not increased since 2001 and are therefore 26% less when adjusted for inflation. LCSWs are opting out as Medicare providers, leaving vulnerable beneficiaries without adequate mental health services. Thank you for your support.”

For State Legislatures:

• The Social Work Compact is now available to be passed by state legislatures. There are 10 states which have begun the process of getting the bill passed; Missouri has already passed the bill. We need six more states to create the Commission to oversee the Compact. 
• Here is a map of the 26 states that have passed the Counselor Compact, https://counselingcompact.org/map/. These states should be open to passing the Social Work Compact as well.
• For more information on how to make your state legislators aware of the Social Work Compact, go to the CSWA website at https://www.clinicalsocialworkassociation.org/Announcements/13212620.

Please let me know when you have sent messages to Congress and members of your state legislatures. Thanks for your help.

Contact: Laura Groshong, LICSW, CSWA Director of Policy and Practice at lwgroshong@clinicalsocialworkassociation.org

Here is an urgent Legislative Alert to get coverage for telemental health before the end of the year. CSWA is concerned that coverage of telemental health may not be continued after the end of the Public Health Emergency.

Please send this message to your legislators BY TOMORROW, December 1, 2022, when the final legislative packages will be put in place, at https://www.congress.gov/contact-us:

“I am a member of the Clinical Social Work Association and a constituent. Please include permanent coverage of mental health services provided by videoconferencing or "audio only" after the end of the Public Health Emergency. Many patients who depend on these services will be harmed if this coverage is removed.“

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

Many thanks,

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

Update on CareDash

Here is an update on the CareDash/BetterHelp fiasco. Many members complained to CareDash and received the following form letter:

Sarah (CareDash)

Aug 2, 2022, 15:43 ADT

Hello,

Thanks for reaching out to CareDash! As a mental health provider, we understand your concerns regarding the importance of protecting your privacy and would be happy to help remove any personal information. We permit the redaction of a personal phone number or address and can flag profiles as retired or deceased, as needed. However, CareDash's policy is not to remove a profile since this information is of the interest to the general public.

While we provide information on healthcare providers and practices by aggregating information from various public sources, such as the NPI Registry, it is most important to us that you and your practice are appropriately represented on CareDash. The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.

We'd be happy to help you update your profile to ensure you and your practice are appropriately represented on CareDash. We permit the redaction of a personal phone number or address and can flag profiles as retired or deceased, as needed.

We've created this guide on how you can protect your privacy: https://www.caredash.com/articles/how-health-care-providers-can-protect-their-privacy. At CareDash, we're deeply committed to protecting the privacy of providers and keeping our data accurate, so please let us know if we may be misrepresenting you or your practice in any way in order for us to correct it immediately. The easiest way to ensure your data stays up-to-date is for you to take control of your profile by claiming and updating it on CareDash. Please follow the simple instructions here: https://www.caredash.com/portal.

Lastly, please visit the NPI Registry to edit the source of the public information we use: https://npiregistry.cms.hhs.gov. Many sites use this data and you may have accidentally placed personal information when registering for your NPI. Our team will periodically update our data to match what's in the NPI Registry if you choose not to claim and update your profile today. Please check back in a few weeks for your changes to be in effect.

Kind Regards,

Sarah B.

CSWA regards this letter as disingenuous, since the issue is not just where CareDash found all our information, the NPI list, but how they are using it to restrict access to our services. CSWA has also discovered that CareDash is connected to Teledoc and Nufit Media, which we are looking into.

Several members suggested that CSWA consider filing lawsuits against CareDash. We are exploring this possibility with attorneys, are examining what the legal issue or issues might be (restraint of trade, kickbacks, possibly) and are determining the feasibility of filing a lawsuit (class action, through attorneys general, etc.). In addition, we are working with PsiAN to send a letter to the FTC.

Several members have reported that they sent letters to NPR and other groups that use BetterHelp as a sponsor objecting to the policies of CareDash and BetterHelp.

Please continue to send your individual letters to your state attorney general and the FTC about your objections to CareDash and BetterHelp policies. They have already made a difference in Maryland where the consumer protection department at first refused to look into the situation but changed its mind after a flood of complaints.

I will be sending weekly updates about the progress being made and/or new actions to be taken. Thanks to the over 300 members who let me know they have sent messages on the subject. Please continue to let me know if you have done so.

I also urge you to join the discussion in the comments at this link.

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

LCSWs at Risk: CareDash and BetterHelp

CSWA would like to call to your attention a duplicitous practice which a company called CareDash is engaging in. CareDash has partnered with BetterHelp to drive potential patients to CareDash or BetterHelp affiliated therapists. It has gathered information about thousands of LCSWs and other clinicians to direct them to CareDash or BetterHelp affiliated clinicians without the permission of the non-affiliated LCSWs listed.

If the LCSW is not affiliated with BetterHelp, CareDash will say that there is no way to connect with them through CareDash, without directing them to the website of the LCSW, or noting that this is an active licensed clinical social worker. CareDash receives a commission for all patients referred to BetterHelp.

CareDash also has its own list of LCSWs which they will only use for referrals if an LSCW affiliates with them. These practices could significantly reduce the ability of patients in gaining access to LCSWs who are not connected to CareDash or BetterHelp. Please note that if you are not on the CareDash list, patients will be directed to BetterHelp. CareDash at this point refuses to take anyone off their list who is not officially connected with them or BetterHelp.

There is little doubt that the CareDash list has been compiled from public lists such as NPI, insurers, and others, then made to look as if the LCSWs listed are not being artificially limited by CareDash.

Here is what CareDash said about me:

About

Laura W. Groshong LICSW (she/her) is a clinical social worker in Seattle, WA.

For new and existing patients, please see recommendations on how to schedule an appointment with Laura Groshong online. As a clinical social worker, she may specialize in Anger Management and Anxiety, in addition to other issues.

Laura Groshong got her license to practice in Washington.

If you want to see Laura Groshong, please contact her to book an appointment. You can also see how she compares to other clinical social workers in Seattle or get matched to an online therapy provider.

When anyone clicks on “schedule an appointment” or “book an appointment” they get the following message: “Laura Groshong has not provided a way to schedule online through CareDash. However, you could get connected with an online therapist or chat with our virtual assistant to get help finding a therapist.” There are then over 1000 mental health clinicians listed as “the best” clinicians in the Seattle area, all sponsored by BetterHelp, many of which offer 20% discounts for the first month.

Here is what CSWA recommends each member do to protect your practice:

1. Go to CareDash.com and see if you are listed as a member. Unless you are working for BetterHelp and want to remain on the CareDash list, send a complaint to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. You will need the CareDash corporate address which is 614 Massachusetts Ave., Ste 400, Cambridge, MA 02139, and the BetterHelp corporate address which is 990 Villa Street, Mountain View, CA 94041.

2. You may also file a complaint with your state attorney general consumer protection department. To find the location of your state’s consumer protection department go to https://www.consumerresources.org/file-a-complaint/ .

3. A template for sending a complaint is found below:

I am a Licensed Clinical Social Worker writing to inform you that a company, CareDash, is unfairly restricting my practice as a clinical social worker. They have listed my professional information on their website without my permission and refer anyone who checks my name to another company, BetterHelp, or to their own list of clinicians. I do not wish to work with CareDash or BetterHelp. CareDash refuses to take my name off their list, claiming it is public information. Thus, CareDash is falsely marketing my services to generate online traffic for BetterHelp or itself, ultimately resulting in the selection of BetterHelp’s participating providers or its own, rather than me. This is a restriction of trade that should be stopped immediately.

CSWA encourages all members and affiliated societies to file complaints with the appropriate state and/or national organizations. Please let me know when you have done so.

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

H.R. 4040, THE ADVANCING TELEHEALTH BEYOND COVID–19 ACT OF 2021

A bill passed the House yesterday which would allow Medicare to cover LCSWs and other mental health professionals for telemental health services until 2024, including audio only treatment. Additionally, the requirement that patients be seen in person every six months was eliminated. The vote was 416-12.

This is a huge win for CSWA, clinical social work, and all of the groups in the Mental Health Liaison Group that worked to get this bill passed. The bill now goes to the Senate where it is likely to pass, as long as it is brought to a vote.

All CSWA members should send the following message to their senators at https://www.senate.gov/senators/senators-contact.htm?OrderBy=state&Sort=ASC: “I am a member of the Clinical Social Work Association and a constituent. Please ask Speaker Schumer to bring HR. 4040, The Advancing Telehealth Beyond Covid-19 Act of 2021, to a vote. Many patients struggling with mental health problems will be unable to get the help they need unless this bill is passed by the Senate. Thanks for your support on H.R. 4040.”

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

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