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.

 

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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

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

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

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

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.

CSWA is happy to report that the Texas State Board of Social Work Examiners has voted today to overturn the rule change that was enacted last week to allow LCSWs to refuse to see clients on the basis of disability, sexual orientation or gender identity.  For a more complete report go to the Texas Tribune article at https://www.texastribune.org/2020/10/27/texas-social-workers-lgbtq-disabilities-discrimination/ .

Many thanks go to CSWA Board member Kathy Rider, LCSW, a longtime advocate for clinical social work in Texas who was a major contributor to the effort to overturn the unethical rule.

You may have been hearing about a new rule that is called “Open Notes” which begins on November 2, 2020. It allows patients to have extended access to their Medical Record.

While it is technically true that patients have increased access to their electronic clinical records as of November 2, it should not be much of a change for the way we as LCSWs practice with one exception (see below).  Open Notes was part of the Interoperability section of the CURES Act last spring which says:

Blease C, Walker J, DesRoches CM, et al. Annals of Internal Medicine. October 13, 2020. doi: 10.7326/M20-5370

On 2 November 2020, new federal rules will implement the bipartisan 21st Century Cures Act that, in part, “. . . promotes patient access to their electronic health information, supports provider needs, advances innovation, and addresses industry-wide information blocking practices.” The rules forbid health care organizations, information technology vendors, and others from restricting patients’ access to their electronic health care data, or “information blocking.” Although the Health Insurance Portability and Accountability Act gave patients the legal right to review their medical records, the new ruling goes further by giving them the right to access their electronic health records rapidly and conveniently via secure online portals. Providers must share not only test results, medication lists, and referral information but also the notes written by clinicians. Over the past decade, this practice innovation—known as “open notes”— has spread widely, and today more than 50 million patients in the United States are offered access to their clinical notes."  https://www.opennotes.org/research/new-u-s-law-mandates-access-to-clinical-notes-implications-for-patients-and-clinicians/

I believe that Open Notes is primarily for other kinds of medical services, not psychotherapy.  The only exception may be if we are not making notes in the interoperable medical record. There may come a time when other providers or patients complain about it and we will need to make “open notes” in an interoperable record, but that is not the case now unless you are paneled in a plan that requires you make notes in an interoperable record. 

Remember that Psychotherapy Notes can be a separate file from the Medical Record which is for our use only, most commonly what we call process recordings, and are not shared with anyone else.  There is certain information which cannot be kept out of the Medical Record by being put in Psychotherapy Notes; see the CSWA website for more information.

We know that it is a clinical issue if the patient wants to see what we have written about them and it happens fairly rarely.  We also know that it is a best practice whether we are keeping notes for our own Medical Record or an interoperable one, to keep notes brief and connected to the treatment goals established for a given patient. If we stick to these practices, Open Notes should not pose a problem for clinical social workers.

Please let me know if you have any questions.

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

CSWA is concerned about a change in the Texas State Board of Social Work Examiners’ rules which allows LCSWs to refuse to provide services to clients on the basis of disability, sexual orientation or gender identity.  This change was made to make non-discrimination rules consistent with existing Texas statutes.  Governor Greg Abbott proposed the change to LCSW rules.  See the article on this issue in the Texas Tribune at https://www.texastribune.org/2020/10/14/texas-social-workers-rule-discrimination-lgbt-disabilities/#:~:text=New%20Texas%20rule%20lets%20social,conform%20with%20existing%20state%20law .

This change is completely at odds with the ethics and values of clinical social work. This kind of attack on our profession should be fought as strongly as possible whenever it occurs.  The fact that the Texas State Board of Social Work Examiners and the Texas Behavioral Health Executive Council, which oversees behavioral health boards, accepted the proposed rule without objection (on advice of counsel) is even more concerning than the fact that it was proposed in the first place. 

CSWA will be filing a complaint with the Texas Social Work Board and the Governor’s office as well as signing on to a Declaration from the Hogg Foundation for Mental Health, an organization that opposes discrimination in all forms.  To see the Declaration go to https://hogg.utexas.edu/who-we-are/racism-declaration?utm_content=82b8b13291ac3a2233b0e8193b1bb908&utm_campaign=Healthy%20Mind%20Project%20RFP&utm_source=Robly.com&utm_medium=email .

If this can happen in Texas, it can happen anywhere so we wanted to make all members aware of this situation. CSWA encourages all members to oppose any laws and rules that threaten our values and the rights of all clients to our services. 

A new extension of the State of Emergency has been signed by Alex Azar. This extends coverage of telemental health services and audio only services until January 20, 2021.

Click here for the Memo

Let me know if you have questions at lwgroshong@clinicalsocialworkassociation.org

Laura Groshong, LICSW, Director, Policy and Practice