October 29, 2025

For those of you who have been following the development of the Social Work Compact, the Compact Commission's Annual Meeting, to be held on November 5, 2025 from 9 am to 5 pm ET, is an opportunity to hear more details about the progress being made. The Compact Commission oversees the creation of the Social Work Compact. Delegates from the 32 states that have passed legislation to join the Compact will be attending. 

To register to attend the Annual Meeting, please visit https://swcompact.org/meetings/full-commission-meetings/.

Please contact CSWA Director of Policy and Practice, Laura Groshong, LICSW, with any questions at lwgroshong@clinicalsocialworkassociation.org.

October 24, 2025

Regarding our update sent on 10/22/25 which stated that Kaiser Permanente as an insurer is requiring a yearly in-person visit for patients receiving telemental health services: this only applies to Medicare Advantage enrollees whose benefits are managed by Kaiser Permanente. It appears this notice was sent to LCSWs in the states of Washington and Oregon.

To our knowledge, CMS has required all Medicare Advantage plans – overseen by commercial insurers – to implement the in-patient requirement. If you receive a letter from Kaiser or other commercial insurers regarding the requirement, please let Laura Groshong, LICSW, Director of Policy and Practice, know at lwgroshong@clinicalsocialworkassociation.org. The Clinical Social Work Association is seeking clarification from CMS on how this affects the Medicare Advantage plans.

October 22, 2025

Here are two additional pieces of news related to the Medicare Telemental Health changes. First, the good news! CMS has decided to eliminate the hold on payment of claims for mental health treatment (though not for other health care services) so claims will be paid on the usual basis, i.e., about 14 days after being submitted. Below is the message that was sent yesterday from CMS (yellow highlight mine):

Claims Hold Update

"CMS instructed all Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service of October 1, 2025, and later for certain services impacted by select expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025 (Pub. L. 119-4, Mar. 15, 2025). This includes claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and Federally Qualified Health Center (FQHC) claims. This includes telehealth claims that CMS can confirm are definitively for behavioral and mental health services. CMS has directed all MACs to continue to temporarily hold claims for other telehealth services (i.e. those that CMS cannot confirm are definitively for behavioral and mental health services) and for acute Hospital Care at Home claims.

Beginning October 1, 2025, for services that are not behavioral health services, many of the statutory limitations on payment for Medicare telehealth services that were, in response to the COVID-19 Public Health Emergency, lifted, and subsequently extended, through legislation again took effect. These include prohibition of many services provided to beneficiaries in their homes and outside of rural areas, and hospice recertifications that require a face-to-face encounter. In the absence of Congressional action, practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage (ABN). Further information on use of the ABN, including ABN forms and form instructions: https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn. Practitioners should monitor Congressional action and may choose to hold claims associated with telehealth services that are currently not payable by Medicare in the absence of Congressional action. For further information: https://www.cms.gov/medicare/coverage/telehealth."

Now for the not so good news: Kaiser Permanente has decided to start requiring the in-person meeting with patients once during every 12-month period that Medicare implemented on October 1. We can expect other commercial insurers to follow suit. Please let Laura Groshong, LICSW, CSWA Director of Policy and Practice, know if you get any information about this from insurers that you work with by contacting her at lwgroshong@clinicalsocialworkassociation.org.

October 15, 2025

Here is an update on the ongoing issues which have been raised around telemental health since October 1 when the in-person requirement went into effect for LCSWs and other mental health clinicians.

To recap, there is now a requirement that we see all NEW Medicare patients – after October 1 – at least once in-person before starting virtual treatment. After that, we need to see them once a year in-person. The hope is that this rule will be stopped permanently, or that exemptions will be again extended, when the government reopens. For LCSWs that have given up their offices, this will create a problem. Many are using the offices of colleagues; others are reconsidering finding an office of their own again. The advantages of not paying rent have to be weighed against the problem of not having a place to see patients in person.

There is an exemption for new Medicare patients who cannot be seen in-person. This must be explained and entered into the Medical Record. A template has been created for your use. It can be found in the Members-Only section of the CSWA website.

Another consideration, which will be hard on those of us who see many Medicare patients, is that there is a recommendation from the Mental Health Liaison Group (MHLG) Telehealth Group that we not file claims until after the government reopens. They will be denied because they cannot be processed and would have to be filed as an appeal once the government reopens. This will be a real hardship for us but there is no solution at the moment. This will NOT apply to Medicare Advantage patients unless the commercial insurers that offer those plans refuse to pay claims as well. None have announced that they plan to do so at this time.

Please continue to notify your members of Congress about the hardship this will present for you and let me know when you have done so by emailing Laura Groshong, LICSW, CSWA Director of Policy and Practice at lwgroshong@clinicalsocialworkassociation.org.

October 1, 2025

This guidance on telehealth was published today by CMS on the status of telemental health. All telehealth services will return to the status of non-coverage that was in place before the pandemic, except for mental health services. This was what CSWA was expecting.

CMS made no change to the in-person requirement that goes into effect today. To review, it means that we need to see virtual Medicare patients once a year in-person. There is an option to document that the in-person requirement will interfere with ongoing treatment and waive it. It is unclear whether it is possible for new virtual patients to have the in-person requirement waived as of today.

Additionally, there will be a 10-day hold on payments for traditional Medicare. Claims can continue to be submitted but will not be processed for 14 days. Here is the guidance (yellow highlight is that of Laura Groshong, CSWA Director of Policy and Practice):

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) Wednesday, October, 1, 2025 Update on Medicare Operations: Telehealth, Claims Processing, and Medicare Administrative Contractors Status During the Shutdown When certain legislative payment provisions (“extenders”) are scheduled to expire, CMS directs all Medicare Administrative Contractors (MACs) to implement a temporary claims hold. This standard practice is typically up to 10 business days and ensures that Medicare payments are accurate and consistent with statutory requirements. The hold prevents the need for reprocessing large volumes of claims should Congress act after the statutory expiration date and should have a minimal impact on providers due to the 14-day payment floor. Providers may continue to submit claims during this period, but payment will not be released until the hold is lifted. Absent Congressional action, beginning October 1, 2025, many of the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 Public Health Emergency will take effect again for services that are not behavioral and mental health services. These include prohibition of many services provided to beneficiaries in their homes and outside of rural areas and hospice recertifications that require a face-to-face encounter. In some cases, these restrictions can impact requirements for meeting continued eligibility for other Medicare benefits. In the absence of Congressional action, practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage. Practitioners should monitor Congressional action and may choose to hold claims associated with telehealth services that are not payable by Medicare in the absence of Congressional action. Additionally, Medicare would not be able to pay some kinds of practitioners for telehealth services. For further information: https://www.cms.gov/medicare/coverage/telehealth. CMS notes that the Bipartisan Budget Act of 2018 allows clinicians in applicable Medicare Shared Savings Program Accountable Care Organizations (ACOs) to provide and receive payment for covered telehealth services to certain Medicare beneficiaries without geographic restriction and in the beneficiary’s home. There is no special application or approval process for applicable ACOs or their ACO participants or ACO providers/suppliers. Clinicians in applicable ACOs can provide these covered telehealth services and bill Medicare for the telehealth services that are permissible under Medicare rules during CY 2025, irrespective of further Congressional action. For more information: https://www.cms.gov/files/document/shared-savings-program-telehealth-fact-sheet.pdf. MACs will continue to perform all functions related to Medicare Fee-for-Service claims processing and payment.

Please continue to let members of Congress know that the in-person requirement will be a hardship for many patients. Let Laura Groshong, LICSW, CSWA Director of Policy and Practice, know if you have any more questions about the changes to telemental health coverage at lwgroshong@clinicalsocialworkassociation.org.

September 29, 2025

By Laura Groshong, LICSW, Director of Policy and Practice

The post on telemental health that went out last week prompted many questions which I will try to answer here:

1. Are clients who are currently being seen virtually need to be seen in person once a year? If the patient has not been seen in-person prior to 10/1/25, they will need to be seen once a year in-person. If the patient has been seen virtually prior to 10/1/25, they will likely be exempt from the in-person requirement. (https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf, p. 10)

2. Where are the citations for the in-person requirement? The citation in #1 and the following citation, both from CMS, are the information I am using. (https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf, p. 6)

3. Do we know if this same restriction will apply to psychiatrists and psych NPs? We do not have an answer to this as it is outside of our scope.

4. Won’t the predicted continuing resolution (CR) again extend COVID era telehealth variances? For context, during the COVID-19 pandemic, Congress and federal agencies gave temporary flexibility for telehealth. Each time Congress has passed a CR, they’ve often tacked on an extension to include those flexibilities.

The continuing resolution to maintain funding for the Federal budget is by no means definite to avoid a government shutdown. A CR must occur by Tuesday, 9/30/25 or government funding for most functions will stop. Healthcare cuts are one of the ways that this administration planned to fund the huge bill passed this summer.

5. How do we define existing patient? An existing patient is someone who has been seen virtually prior to 10/1/25.

6. How will commercial insurers respond to the in-person requirement? There is no clear message from commercial insurers yet. They are probably waiting to see whether the in-person requirement is delayed or not.

7. Could you advise us members whom to contact to protest this? Contact your members of Congress at https://www.congress.gov/contact-us.

8. Will we be able to have a new Medicare client who is a no-show covered, including for the initial appointment? There are a few plans, mainly ERISA, i.e., self-insured, that cover no-shows, but Medicare is not one of them. There is no plan at this time for that to change for the in-person requirement.

9. Do patients who become Medicare-eligible while we are seeing them using different insurance coverage have to be seen in person when they switch to Medicare coverage? That is likely, but I would check with your Medicare Administrative Contractor to find out for sure.

I will continue to answer questions about telemental health as they come in and as information is provided by Congress and CMS.

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

September 26, 2025

It appears that the furious effort by mental health groups to do away with the requirement that new patients be seen in person before beginning virtual mental health treatment has failed for now. Therefore, starting September 30, 2025, any new Medicare patient must be seen in-person before starting virtual treatment, and once a year after that. The good news is that current patients being seen virtually will not need to be seen in person.

If CMS does change these rules in the future, there is strong support for those changes to be retroactive. As most of you know, CMS has agreed to cover telemental health permanently, but the in-person requirements going forward will make virtual treatment much more difficult and have a chilling effect on seeing patients through telemental health. Additionally, there is the problem for LCSWs who have given up having an office where they can see patients in person.

CSWA will continue to provide information on this important topic as we receive it. Please let Laura Groshong, LICSW, CSWA Director of Policy and Practice know if you have any questions at lwgroshong@clinicalsocialworkassociation.org.

September 25, 2025

Beginning January 1st, 2026, CMS is starting a 6-year pilot project called the Wasteful and Inappropriate Service Reduction (WISeR) Model in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington State). Information can be found at https://www.cms.gov/newsroom/press-releases/cms-launches-new-model-target-wasteful-inappropriate-services-original-medicare. Under this pilot project, certain outpatient services that are thought to be prone to fraud, waste, or low clinical value will require prior authorization using artificial intelligence (AI). This would apply to traditional Medicare beneficiaries only. Currently, no mental health conditions or procedures are included in this pilot. The Prior Approval Pilot is a small example of how AI can affect our practices in ways that may be harmful to our patients and best practices.

Many members of CSWA have reached out to express concern about how this pilot project may have an impact on coverage of mental health treatment. The project will require prior approval for 17 conditions before coverage is accepted. CMS has also stated that any denials identified by AI will then be reviewed by a human. To be clear, there are NO mental health services on this list at this time, but the possibility that our services may be added is cause for concern. CSWA is providing the following information to make LCSWs aware of the way this project could affect psychotherapy, not as an imminent threat to our practices.

Prior Approval Pilot Project

The project will begin on January 1, 2026 and be applied to conditions covered by traditional Medicare only in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington State, as well as Medigap plans, such as Plan G or Plan N, if they are using traditional Medicare coverage.

The conditions that will be governed by the project include the following:

• Facet joint procedures for back pain
• Nerve and muscle tests (electrodiagnostic testing)
• TENS units and similar electrical stimulation devices
• Hyperbaric oxygen therapy
• Spinal cord stimulators
• Deep brain stimulation (commonly for Parkinson’s)
• Sacral neuromodulation (for urinary conditions)
• Transcatheter aortic valve replacement (TAVR)
• Arthroscopic knee cleaning or debridement
• Vertebroplasty/kyphoplasty for spine fractures
• Epidural steroid injections
• Non-emergency ambulance transport
• Botox injections for medical issues
• Negative pressure wound therapy pumps
• Hernia repairs
• Lumbar spinal fusion
• Skin graft substitutes for chronic wounds

The stated reason for inclusion on this list is that these services are often flagged for being overused and/or not always medically necessary (https://www.resourcemedicare.com/post/new-medicare-changes-in-2026-prior-approval-required-for-these-17-services).

CSWA has been studying the impact of AI on the work of LCSWs for the past year and stands firmly against the use of AI or large language models as an LCSW providing therapy, diagnoses, or mental health treatment. The Prior Approval Pilot is a small example of how AI can affect our practices in ways that may be harmful to our patients and best practices.

The pilot project uses AI to identify diagnoses and streamline the prior authorization process, reflecting insurers’ long-standing goal of expanding prior approval whenever possible. Minimizing approval of mental health treatment, and many other conditions, is seen as reducing costs for insurers. Here is a summary from the New York Times about this project:

“…The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections. The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients. Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence…The government may add or subtract to the list of treatments it has slated for review depending on what treatments it finds are being overused.” (New York Times, “Medicare will Require Prior Approval for Certain Procedures,” 8/28/25, https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-health-care.html?smid=nytcore-ios-share&referringSource=articleShare) .

If this approach is extended to mental health conditions, this type of prior approval approach could have a serious impact on patients having access to mental health/substance use treatment.

CSWA encourages members in the Pilot states, and all others, to send the following message to their members of Congress and Insurance Commissioners: “I am a licensed clinical social worker, a constituent, and a member of the Clinical Social Work Association. I have concerns about letting artificial-intelligence (AI) systems make prior-authorization decisions for a particular procedure or therapy is likely to limit a person’s access to needed treatment. In mental health, for example, LCSWs use interactive engagement to expertly assess an individual’s responses and affect, in ways AI cannot. Currently AI cannot reliably understand emotional health, because it cannot determine and interpret facial expressions, body language, and words. Please leave treatment decisions to licensed professionals, not to AI, in the Prior Approval Project.” You can find emails for Congress at https://www.congress.gov/contact-us .

As always, please let Laura Groshong, LICSW, CSWA Director of Policy and Practice, know when you have sent your messages at lwgroshong@clinicalsocialworkassociation.org.

September 22, 2025

Please visit the CSWA Position Papers page to view the Position Paper on Use of Artificial Intelligence. 

August 1, 2025

By Laura Groshong, LICSW, CSWA Director of Policy and Practice

As many of you know, LCSWs have had several anxious moments in the last two years as Congress has, at the last minute, approved short term extensions of Medicare coverage of telemental health.

In the always-changing world of Medicare coverage of telemental health, there is a new wrinkle to the changes that will be coming on October 1, 2025.

First, the good news. It appears that CMS is now recommending permanent coverage of telemental health services if the patient is present in their home, which we interpret to mean place of residence. Here is the citation:

“Telehealth, defined as 2-way, interactive, audio-video technology, to diagnose, evaluate, or treat certain mental health or SUDs if the patient is in their home. Practitioners must be able to provide 2-way, real-time, audio-video technology services but may use audio-only technology given an individual patient’s technological limitations, abilities, or preferences. We cover telehealth for behavioral and mental health on a permanent basis.”

(https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf, p. 7)

The not-so-good news is that we still need to see patients in person with two exceptions. Here is the citation [bracketed italicized commentary is mine]:

“Starting October 1, 2025, in-person visit requirements will apply for mental health services provided by telehealth. This includes a required in-person visit within the 6 months before the initial telehealth treatment, as well as the required subsequent in-person visits at least every 12 months.

Telehealth also applies to mental health services provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). For RHCs and FQHCs, we don’t require the in-person visit for mental health services provided through telehealth to patients in their homes until January 1, 2026.”

The regulations at 42 CFR 410.78(b)(3)(xiv) describe 2 exceptions to the in-person requirements effective October 1, 2025:

”Patients who already get telehealth behavioral health services and have circumstances where in-person care may not be appropriate [no guidance on what the “circumstances” are].

Groups with limited availability for in-person behavioral health visits have the flexibility to arrange for practitioners to provide in-person and telehealth visits with different practitioners, based on availability [no definition of what “groups” are].

Exceptions to the in-person visit requirement require a clear justification documented in the patient’s medical record.” (https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf, p. 10)

There is still confusion about the in-person visit for NEW patients “six months prior to treatment” beginning, but patients who have ALREADY been seen through telemental health prior to October 1, 2025, can continue to be seen virtually without being seen in-person. Additionally, there is an exception to the in-person requirement every 12 months if there is “clear justification” for why it is not appropriate. This should include working with patients who are in another state; an LCSW not having an office where the patient can be seen in-person; and/or seeing patients who are in the LCSW’s state but too far away to be seen in-person. This remains to be clarified but is the best interpretation I can give at this time. As we have been for the past three years, CSWA is working with members of Congress and other mental health groups to eliminate the in-person requirement completely.

We realize this is complicated. Let us know if you have any questions by contacting Laura Groshong, LICSW, CSWA Director of Policy and Practice at lwgroshong@clinicalsocialworkassociation.org.