The Aware Advocate

Laura Groshong, LICSW, Director of Policy and Practice

June 15, 2020

The Supreme Court issued a wonderful decision today, BOSTOCK v. CLAYTON COUNTY, GEORGIA, today that guarantees LGBTQ citizens to have the right to work regardless of their sexual orientation or gender.  This decision holds that an employer who fires an individual merely for being gay or transgender violates Title VII. CSWA is in complete support of equal rights for LGBTQ people and we are delighted at this decision.  It is notable that the majority decision was issued by Justice Neil Gorsuch, who was widely seen as having conservative views that might have made him unlikely to lead this decision.  To read the complete decision go to https://www.supremecourt.gov/opinions/19pdf/17-1618_hfci.pdf .

In an incredible and terrible coincidence, HHS issued a rule last Friday that undoes an Obama-administration policy that had redefined “sex” to include “gender identity” and “termination of pregnancy” for purposes of nondiscrimination under the Affordable Care Act.

Section 1557 of Obamacare prohibited discrimination on the basis of race, color, national origin, sex, age, or disability in health-related programs or activities. Near the end of President Obama’s second term, his HHS Department released a regulation redefining “sex” for the purposes of Section 1557 to include “gender identity” and “termination of pregnancy.” As a result of the rule that HHS released, that regulation has been reversed and “sex” once again refers only to biological sex.  This entire new rule may be found at https://www.hhs.gov/about/news/2020/06/12/hhs-finalizes-rule-section-1557-protecting-civil-rights-healthcare.html  This rule will almost certainly be challenged, especially in light of the Supreme Court decision today.

Finally to end on a more positive note, please read the CSWA statement on “Stopping Aggression in our Communities” by CSWA President Britni Brown at https://www.clinicalsocialworkassociation.org/Announcements/9010566 CSWA will be doing many webinars and statements to address the ways that black lives are demeaned, attacked, and harmed.

Another article that calls attention to these issues by Linda Michaels, PhD, Co-Chair of the Psychotherapy Advocacy Network (PsiAN) is ”@Whatsinahashtag@We’reallinthistogether?” which can be found at https://medium.com/@psian/whats-in-a-hashtag-we-reallinthistogether-7928adf5d756?sk=9276106ac0a81675e27e67f54751a8f8  It succinctly and heartbreakingly illustrates the ways that black Chicagoans have had decades of inferior public services, culminating in a much higher incidence of death among black citizens. 

Stay safe and well in these perilous times.

 

Laura Groshong, LICSW, Director, Policy and Practice

www.clinicalsocialworkassociation.org

Clinical Social Work Association
The National Voice of Clinical Social Work

It was a pleasure to ‘meet’ with many of you virtually this weekend about the changes to our practices in the time of COVID-19 which has restricted our in-office practices.  I hope the discussions about how to move to telemental health, the confusion regarding coverage by insurers and how to code for our services, and many other issues were helpful to you.

One of the topics we talked about was advocacy to get Medicare – as well as private insurers – to cover telephonic sessions.  To accomplish this goal we will need an all-out effort, not just to CMS and HHS, but to members of Congress, state legislators, and state Insurance Commissioners. Use your own words to convey the following message:

“I am a constituent and a member of the Clinical Social Work Association. I have patients who are unable to meet with me in person for psychotherapy because of the COVID-19 crisis and do not have access to a smart phone or computer. The Centers for Medicare and Medicaid Services have not expanded coverage of psychotherapy to telephonic sessions, only videoconferencing; however, the only way I can provide services to these beneficiaries is by telephone. 

Some enlightened insurers like Cigna and Aetna have already allowed temporary coverage of telephonic psychotherapy sessions.  Some states such as Maryland, Texas, and Ohio have also required temporary coverage of telephonic psychotherapy sessions by private insurers.

Please tell CMS [and/or private insurers for state legislators and Insurance Commissioners] to approve coverage of telephonic psychotherapy sessions, sorely needed in these fraught times, for Medicare beneficiaries [and other enrollees privately insured] who may be isolated, emotionally fragile, and in need of mental health services."

You can find contact information for members of Congress at https://www.house.gov/representatives and https://www.senate.gov/general/contact_information/senators_cfm.cfm .  You can find email addresses for your state legislators and Insurance Commissioners by going to your state websites.

Finally, send a letter to CMS Administrator Seema Verma and HHS Secretary Alex Azar at the addresses below:

The Honorable Seema Verma

Secretary Administrator

U.S. Department of Health & Human Services Centers for Medicare & Medicaid Services

200 Independence Avenue, S.W. 200 Independence Avenue, S.W.

Washington, D.C. 20201 Washington, D.C. 20201

 

The Honorable Alex Azar  

Secretary

U.S. Department of Health & Human Services  

200 Independence Avenue, S.W. 200 Independence Avenue, S.W.

Washington, D.C. 20201

 

This is a lot of work, but we need to help the millions of patients who have lost their ability to get psychotherapy because they cannot get coverage for telephone sessions.

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

Stay healthy and let me know if you have any other questions.

Laura Groshong, LICSW, Director, Policy and Practice

www.clinicalsocialworkassociation.org

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

A bill for Phase 3 Emergency Relief of COVID-19 is due to be passed TODAY.

Unfortunately, it does not include the needed coverage of telephonic sessions through Medicare. 

Please send the following message to your members of Congress: "I am a member of the Clinical Social Work Association and a constituent.  I have patients who are unable to meet with me for psychotherapy because of the COVID-19 crisis and do not have access to a smart phone or computer. The only way I can provide services to them is by telephone.  Please approve coverage of telephonic psychotherapy sessions, sorely needed in these fraught times."

You can find contact information at https://www.house.gov/representatives and  https://www.senate.gov/general/contact_information/senators_cfm.cfm .

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

Laura Groshong, LICSW, Director, Policy and Practice
www.clinicalsocialworkassociation.org

As you know, CSWA has been calling attention to the unethical and damaging practice of ICE and ORR asking therapists to violate the privacy of minor immigrants.

Thanks to the many letters sent to members of Congress by CSWA members and others and the letter sent by the Mental Health Liaison Group, which CSWA signed, Congress is taking action to stop these egregious actions.  Today the Washington Post published an article describing the ways in which Congress intends to stop this practice which can be found at https://www.washingtonpost.com/national/bill-would-end-practice-of-using-confidential-therapy-notes-against-detained-migrant-children/2020/03/04/0ab73d52-5e46-11ea-9055-5fa12981bbbf_story.html

The MHLG letter which was sent to Congress can be found at https://www.apa.org/news/press/releases/2020/02/confidentiality-immigration-letter.pdf .

CSWA will keep you apprised of the progress of bills which will prevent confidentiality violations as it evolves.

This is very good news!

Dear CSWA Members,

In addition to the letters to your members of Congress about the confidentiality violations of immigrant minors, there is now a petition that CSWA members can sign to let the Office of Refugee Resettlement (ORR) and  Immigration and Customs Enforcement (ICE) know that we oppose these unethical practices.

The petition is sponsored by the Psychotherapy Action Network (PsiAN) which CSWA has been working with for several years. To sign the petition go to https://www.thepetitionsite.com/379/862/396/tell-orr-and-ice-stop-using-psychotherapy-notes-to-betray-and-endanger-children/

Thanks to all of you who have already notified your members of Congress. 

Laura Groshong, LICSW, Director, Policy and Practice, Chair, Government Relations Committee

Clinical Social Work Association
The National Voice of Clinical Social Work

The Washington Post article (see below) sent to you yesterday on the confidentiality violation of migrant children in detention has generated many responses and a call for what we can do to stand up for LCSW ethical standards.

CSWA recommends sending the following message to your members of Congress.  You can find their email addresses or contact information at https://www.congress.gov/members?searchResultViewType=expanded&KWICView=false

A suggested message is as follows:

“I am a constituent and a member of the Clinical Social Work Association.  Please take action to end the way that immigrant minors being held in detention have no right to confidentiality when seeing a clinical social worker for psychotherapy.  This fundamental ethical principle of psychotherapy is currently being violated by the Office of Refugee Resettlement according to the Washington Post (see article at https://www.washingtonpost.com/graphics/2020/national/immigration-therapy-reports-ice/?utm_campaign=wp_evening_edition&utm_medium=email&utm_source=newsletter&wpisrc=nl_evening ) .  The process of psychotherapy becomes potentially traumatic without the right to confidentially. I would be happy to discuss this with you further.

Please feel free to use your own language in this message.  Contact me if you have questions or need more information.  As always, let me know when you have sent your messages. Thank you for your attention to this important matter.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Dear CSWA Members,

The abuse of immigrant minors continues.  This article from the Washington Post details how a 17-year-old who was seen by a therapist while in detention and then had his confidentiality violated with serious emotional consequences. 

The article is called "Trust and Consequences", written by Hannah Drier, and was published on February 15, 2020.  You can find it at https://www.washingtonpost.com/graphics/2020/national/immigration-therapy-reports-ice/?utm_campaign=wp_evening_edition&utm_medium=email&utm_source=newsletter&wpisrc=nl_evening  

CSWA's commitment to confidentiality includes anyone who is seen by an LCSW.  We condemn this act and will continue to work for the right to privacy of all clients

Dear CSWA Members,

The abuse of immigrant minors continues.  This article from the Washington Post details how a 17-year-old who was seen by a therapist while in detention and then had his confidentiality violated with serious emotional consequences.

The article is called "Trust and Consequences", written by Hannah Drier, and was published on February 15, 2020.  You can find it at https://www.washingtonpost.com/graphics/2020/national/immigration-therapy-reports-ice/?utm_campaign=wp_evening_edition&utm_medium=email&utm_source=newsletter&wpisrc=nl_evening  

CSWA's commitment to confidentiality includes anyone who is seen by an LCSW.  We condemn this act and will continue to work for the right to privacy of all clients

Dear CSWA Members,

I have been hearing from members who have had trouble communicating with Noridian, the Medicare Administrator for much of western United States. This post is to gather information about how widespread this problem is.

Please let me know the following if you have had any of the following difficulties in the past three months:

1. Mistakes on EOBs which cannot be corrected

2. Inability to get a person to talk to about EOBs or other problems

3. Wait times of more than 20 minutes

4. Being disconnected while on hold

Please respond by February 2. Thanks for your help. Once I have more data I will contact CMS about the problem.

Dear CSWA Members,

This post is to let you know that clinical social workers will not be required to report on the Merit-Based Incentive Payment System (MIPS) in 2020. CSWA has checked with the Centers for Medicare and Medicaid Services (CMS) to verify this. There will be no penalties and no bonuses for LCSWs through MIPS in 2020.

MIPS is the successor to the PQRS program that ended in 2016, which was cumbersome and did not always provide correct results in the penalties assessed to the LCSWs that complied with it.

Here is the rule about clinical social workers in 2020:

Are clinical social workers eligible for MIPS? Why is there a clinical social worker specialty measure set?

No. Clinical social workers continue to be excluded from MIPS in the 2020 performance period. However,we have finalized a clinical social worker measure set to help these clinicians prepare in the event that they are added to the definition of a MIPS eligible clinician through future rule making.

To review the whole final rule, click here.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Below is updated information on the CMS Proposed Rules changes.

At this point, the 800 pages of Proposed Rules for LCSWs are mainly about our being included in the Merit-based Incentive Payment System (MIPS), the successor to PQRS.  CMS has asked CSWA for recommendations on the measures which we can logically keep records on.  The CSWA-recommended 16 measures are included in the attached document.

We also encourage you as individual members – whether or not you are Medicare providers - to send comments to CMS about these proposed rules.  A strong showing from the LCSW community can make a difference.  Remember, these proposed rules are not about reimbursement rates, just the inclusion of LCSWs as Medicare providers in the MIPS system.  If you believe LCSWs should not be included in MIPS or that inclusion would affect your willingness to be a Medicare provider, feel free to say so. 

Suggested language:

Re:  Proposed rules CMS-1715-P

I am a licensed clinical social worker and a member of the Clinical Social Work Association.  I am hoping that the reporting requirements will be simpler and clearer than the ones that were required for PQRS, and more carefully monitored. [Or, I oppose the inclusion of LCSWs in the MIPS system.]   Many LCSWs [I was, if you were] had their reporting rejected although it was in compliance with the PQRS measures.  Many LCSWs [I decided, if you did] decided not to remain part of the Medicare provider network because of these onerous reporting requirements.  Such requirements seem particularly unfair given the reimbursement rate for LCSWs at 25% less than for others providing the exact same services.

How to submit comments:

Your comments should be submitted to https://www.regulations.gov/document?D=CMS-2019-0111-0092. Click on the “Comment Now” box on the right side to submit your comment.  All comments must be submitted by Friday, September 27, 2019, 5 pm EDT.

Comments sent by CSWA:

If you would like to read the more extensive comments sent by CSWA, you can find them at CSWA - CMS Comments on Medicare Proposed Rules (Final) - 9-24-19.pdf. CSWA will keep members apprised of the final decision on these proposed rules.

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September 20, 2019

I have received several messages from you about the new CMS proposed rule to lower the Medicare reimbursement for psychologist services.

It appears from the proposal (found in the Federal Register at https://www.govinfo.gov/content/pkg/FR-2019-08-14/pdf/2019-16041.pdf ) that the reduction for psychologists is a higher reduction than for clinical social workers , i.e., 7% vs. 6%.

The proposed rule also asks for recommendations for measures that could be used to include LCSWs in MIPS, the new PQRS, in 2022. 

We are in contact with NASW and hoping to submit joint comments on this proposed rule.

CSWA will be responding to all of these proposals shortly and asking members to do so as well.  You can start reviewing the extensive rule now. Comments must be in by September 27, 2019.

CSWA will have our comments by early next week for your consideration.

Let me know if you have any questions.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair