December 21, 2024

At the last minute, Congress finally passed a bill as part of the continuing funding resolution that will allow Medicare coverage of telemental health (and all telehealth) until March 31, 2025, and keep the Federal government running. The Senate and the President signed the bill before midnight today. Thanks to all CSWA members who wrote legislators to ask that telemental health coverage be continued.

This is far less than the two-year extension that had been proposed earlier in the week, which was stopped by the incoming administration and Republicans in Congress. Instead, a new bill will have to be passed before this one runs out to extend telemental health further.

CSWA will continue to push Congress to make a more meaningful extension of telemental health. Let me know if you have any questions.

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

December 17, 2024

By Laura Groshong, LICSW, Director of Policy and Practice

Along with the concerns LCSWs have about telemental health rules, there is one additional concern that several members have asked me about, the Beneficial Ownership Information Report (BOIR) rule, which will require some paperwork for LCSWs that have incorporated as S-Corps or LLCs. However, the BOIR has been put on hold for the moment in a court order. If you want more information, please read the helpful summary of BOIR below, written by Rob Reinhardt, LMHC, of Tame Your Practice, a non-profit that offers a wealth of information on computer systems and software for LCSWs and other clinicians. ~LWG

What is BOIR?

The Beneficial Ownership Information Reporting (BOIR) rule, mandated by the Corporate Transparency Act (CTA), requires certain entities to report beneficial ownership information to the Financial Crimes Enforcement Network (FinCEN). This measure aims to enhance transparency and combat financial crimes like money laundering and tax evasion.

Who Needs to File a BOIR?

BOIR applies to many small businesses, including certain private practices and solo practitioners organized as corporations or LLCs. This also includes LLCs that are filed as sole proprietors. Generally, entities that meet the following criteria must file:

1. Existence: Formed by filing with a state (e.g., LLCs, corporations).

2. Inactivity Exclusion: Active entities are required; inactive or dissolved entities may be exempt.

3. Exemptions: Larger companies meeting specific criteria (e.g., revenue, workforce size) and certain professional services firms are excluded.

To confirm your status, refer to the FinCEN BOIR Small Entity Compliance Guide.

Impact of the Recent Court Order

A recent court order has stayed enforcement of BOIR requirements, temporarily halting the need to comply with the December 31, 2024, filing deadline. This stay means:

- No Immediate Filing Required: Until further notice, enforcement is paused, and non-compliance penalties will not apply.

- Monitor Updates: Businesses should remain informed, as the stay may be lifted, reinstating the deadline.

December 11, 2024

As we head toward the holiday recess in Congress, there is increased pressure to pass legislation that will extend the Medicare coverage of telemental health. For those of you who have sent messages to your members of Congress in the past two weeks, thank you. The over 150 messages CSWA members have sent are making a difference. It is still not too late to send a message to your members of Congress about this crucial delivery service.

There are now two possible avenues for getting the telemental health extension passed: one is connecting the two-year extension to the pharmacy benefits managers bill (no number yet); another is to ask legislators to pass H. R. 8261, which is a stand-alone bill for the telemental health extension. Please send a message to your legislators like this: “I am a clinical social worker, a member of the Clinical Social Work Association, and a constituent. Please make sure that an extension to Medicare telemental health coverage is passed before the end of the year to protect the necessary mental health treatment that has been given virtually since 2020. Attaching this provision to the pharmacy benefits managers bill or H. R. 8261 are two good options. Please protect the mental health of our citizens.”

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

- Laura Groshong, CSWA Director of Policy and Practice

December 3, 2024

By Laura Groshong, LICSW, Director of Policy and Practice

Thanks to the many CSWA members who have written their members of Congress about the need for legislative action to extend or make permanent coverage of virtual videoconferencing for telemental health treatment.

Also, thanks to the members who have sent messages about the CMS rule that may allow LCSWs to continue to receive coverage for videoconferencing treatment in 2025. The reason Medicare rules are so important is that they usually influence the coverage allowed by commercial insurers.

There is some confusion about whether this rule has to be confirmed by Congress or not. I am working to determine whether this rule can stand on its own or requires Congressional approval. Three members of Congress have responded to our message that they are working on passing a bill. The bills that would extend telemental health coverage are HE 6534 (Home-Based Telemental Health Care Act); S. 1077 (Home-Based Telemental Health Care Act); S. 3651 (Telemental Health Care Act of 2024); S. 2016 (CONNECT for Health Act), which you can mention in your messages.

I encourage CSWA members to continue to send messages to members of Congress on this issue. Some staff for Medicare have confirmed the rule to guarantee coverage in 2025, some staff have not. These mixed messages are frustrating and difficult for LCSWs.

To help resolve this problem, please contact your regional MAC office at https://www.hhs.gov/guidance/document/cms-regional-offices to find out what the rule will be in your state/jurisdiction. Additionally, prudent LCSWs should contact any commercial insurers they are paneled with and ask whether they intend to change their coverage of telemental health treatment. Let me know what results you have, if any.

As for audio only treatment, coverage should continue as it is now. Be sure to document that the patient is 1) uncomfortable with videoconferencing; 2) not able to use computer technology; or 3) unwilling to consent to using videoconferencing.

CSWA hopes to provide clarity on this issue shortly.

November 21, 2024

by Laura Groshong, LICSW, CSWA 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.

November 18, 2024

It has been almost two weeks since we received the results of our 2024 elections. While clinical social workers are by no means a political monolith, we are hearing from our members as well as our clients that many people are feeling discouraged, unsafe, and uncertain about the future.

CSWA's role will be as important as ever in these next four years. It is uncertain how a new administration will impact Medicaid, Medicare, Social Security, the Affordable Care Act, regulations protecting mental health care, disability rights, and reimbursement rates. We will continue to monitor upcoming legislative and policy changes and inform you, as well as advocate tirelessly for you as clinical social workers. This allows us to focus on our core values of clinical social work, namely service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence.

If you are so inclined, here are some ways that clinical social workers can be involved in these coming years:

1. Get to know your local and national elected representatives. Your calls, letters, and emails matter!

2. Consider joining advocacy groups that fit with your values.

3. Get to know your neighbors. Our micro-communities are important, and we need to care for each other.

4. Consider watching for advocacy opportunities for those groups who may be disenfranchised in our society, such as trans people, queer people, or undocumented immigrants.

5. Continue to read the information that CSWA sends about protecting mental health treatment. We will be your eyes and ears for our profession nationally!

CSWA is here for you. The Town Hall last week was called a “safe space” where members could talk to each other about the many feelings they had about the elections. Our next Town Hall will be on December 10th.

We're grateful for your support, today and in the future!

- Stephanie Payne, LCSW, CSWA President

November 6, 2024

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

There is some important information about changes - and potential changes - to LCSW reimbursement that we wanted to let you know about.

Physician Fee Schedule

The Physician Fee Schedule (PFS) came out on Friday, November 1, and outlines changes to reimbursement rates for the over 300 categories of Medicare providers, including LCSWs. The PFS is not finalized, but the recommendation is that there be a 4% raise in LCSW rates for all CPT codes that we are eligible to use. This is one of the largest increases suggested for any group. Of course, our rates are still much lower than other mental health clinicians, so this is only a start toward the reimbursement we should be receiving. But it is a start.

Telemental Health

Another important issue that many members are concerned about is the continuation of coverage for telemental health and audio-only psychotherapy. These delivery systems are currently scheduled to end on December 31, 2024. There are several bills in Congress that would extend coverage in some way. The most likely bill to pass is one which would continue it for two years until December 31, 2026, when it would be reviewed again. The likelihood is that nothing will happen until after elections are counted, so probably next week at the earliest. We will keep you posted on developments as they occur.

Optum Audits

Finally, Optum, without explaining why they engaged in audits of LCSWs, is reporting that the audits of LCSWs (and others) who received overpayments are over. If you are still having problems with reimbursement as a result of the Optum error, please let us know.

October 11, 2024

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

On November 12, 2024, at 5:30 pm ET, CSWA will hold its 50th Town Hall. These zoom meetings, which began in August of 2020, have become a great way to connect with other CSWA members and find out what is happening in the profession. Hope to see you then!

It has been a while since the last The Aware Advocate was published, primarily because so much of my work for CSWA has been focused on the creation of the Social Work Compact. Here is a summary of the past few months about issues that affect LCSWs, including the current status of the ASWB exams; the current status of the Compact; recent MHLG sign-ons to Congressional bills and letters; information on the Compact Commission development; a KQED report on lower reimbursement for LCSWs doing outpatient work compared to those working in hospitals; and LCSW problems with insurance.

ASWB Update

ASWB held a Work Force Coalition meeting last month, attended by CSWA President Stephanie Payne and CSWA Deputy Director of Policy and Practice Judy Gallant, that reviewed the results of the Social Work Census and explained the work that is being done to address disparities in pass rates for the clinical, master’s, and bachelor’s examinations. As a follow-up to the August 2022 ASWB Report, which first identified these disparities, another report was released which goes into more detail about the disparities by schools which social workers have attended. To view this report please visit https://www.aswb.org/exam/contributing-to-the-conversation/exam-performance-reports-for-social-work-schools-and-programs/.

In addition to the disparities in pass rates for the clinical exam between Black and white social workers, those with English as a second language and a primary language, and older social workers compared to younger social workers, there are also disparities between other minority groups of social workers and white social workers, male and female social workers, and other breakdowns of the pass rates. A detailed analysis of this new data is being developed which will be sent to CSWA members as soon as it is available.

The changes that ASWB is making to improve the test-taking process so that those who fail can have additional help and adjustments to exam structure were also discussed. The harm being done to certain groups who do not have the training and education to pass the test needs to be corrected.

Compact Commission Update

The first meeting of the Interim Social Work Compact Commission was held on September 17. There were representatives in attendance from all 22 states that have passed the Compact bill into law at the 5-hour meeting. In addition, there were about 75 members of the public. I was asked to chair this meeting and will also chair the next meeting which will be held in January 2025. At that meeting, the Executive Committee – Chair, Vice-Chair, Secretary, and Treasurer – will be elected by the delegates; I am not eligible for these positions because I represent a national organization, not a state. CSWA will have a representative as an ex officio member or as a public member at future meetings.

It is likely that the Commission will be running by fall of 2025 or winter of 2026, at which time all individual LCSWs in states that have joined the Compact, can join the Compact individually and work with clients in all 22 states. Other states are still eligible to join the Compact if they pass the bill.

Mental Health Liaison Group (MHLG)

Here are recent letters that CSWA has signed on to through MHLG or by request from sponsors:

Sign-On in Support of the Stabilization to Prevent (STOP) Suicide Act

Sandy Hook Promise is circulating a FY 25 letter of support for increased STOP School Violence Act

Sign-on Letter on Mental Health Parity and Addiction Equity Act

Endorsement Opportunity: Improving Seniors’ Timely Access to Care Act

Workforce Working Group Leading Letter on Bipartisan Workforce Policies

The CSWA Government Relations Committee has reviewed about 20 letters and bills in the past eight months for sign-ons.

Request from KQED on Clinical Social Work Reimbursement

A reporter from NPR station KQED contacted CSWA for information about the disparity in California reimbursement rates for in-hospital work and out-patient work. While the article was not focused on private practitioners, it was related to the pay disparities for LCSWs which we are very familiar with. To view the article please visit https://www.kqed.org/news/12007779/sf-frontline-workers-who-help-people-on-streets-in-shelters-call-for-fair-pay.

Insurance Issues

Problems with insurance reimbursement are numerous but the most challenging ones are the way that some insurers are engaging in “clawbacks” which are a demand that payments made be returned to the insurer, sometimes many months after they have been made. The most recent example is the way that a company called Change Healthcare made payments that were at the wrong (higher) rate for LCSWs. Another issue is the refusal of insurers to pay for more than one session a week, questioning the use of 90837 regularly, or seeing a patient for more than a year, all of which can lead to audits. Finally, there is an increase in “prior authorizations” for some kinds of treatment by some insurers, a practice that had not been active for several years.

These issues have been around for about 10 years but have had an uptick in the past year. This increase could be due to the likelihood that mental health parity rules are being made more stringent and that insurers will have to comply with more coverage of mental health conditions that they have avoided until now. CSWA will be offering a webinar on these issues in January of 2025.

Please let me know if you have questions or comments about any of these issues.

September 11, 2024

A notice about new Mental Health Parity rules to implement the long-standing Mental Health Parity and Equity Act (2008), which has been languishing since it was first enacted, was put out this week. The recent articles from ProPublica may have influenced the release of these rules at this time.

A review of the history of the MHPAEA can be found at https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity. The basic premise is that mental health treatment and substance use treatment be covered as fully as medical/surgical treatment. The primary areas where this applies include inpatient in-network; inpatient out-of-network; outpatient in-network; outpatient out-of-network; emergency; and prescription drugs. The problems in applying these reasonable standards is that there is no formula for what they should actually be, and reimbursement is not included in the areas that must be at parity for mental health treatment.

While any attempt to get insurers to cover mental health and substance use is worthwhile, until real enforcement is built into the rules – which is still not the case in the new rules – there will likely be little change to the ways that insurers currently limit coverage of mental health treatment.

Note that these new rules will go into effect in phases, with some being enacted in 2025 and some in 2026.

Please let me know if you have any questions.

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

September 3, 2024

ProPublica has released an additional white paper on mental health. This companion piece to the article sent last week (see previous announcement) reviews the ways that states do or do not have regulations about coverage for mental health treatment. This is based on the same problems identified in the paper titled, “Why I Left the Network.”

To read the entirety of the additional paper, written in collaboration with NPR, please visit https://www.propublica.org/article/mental-health-wiltn-states. To read the NPR summary, go to https://www.npr.org/sections/shots-health-news/2024/08/23/nx-s1-5084256/insurance-mental-health-care-coverage-legal-protection?utm_source=pocket-newtab-en-us.