March 15, 2021

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 | CSWA President & Education Committee, Social Work Consultant

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

February 25, 2021

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:

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, CSWA Director of Policy and Practice

February 18, 2021

Below is an excellent summary of the legal protections for telehealth services, including behavioral health treatment, in all 50 states and District of Columbia (seven states do not have laws about telehealth coverage including AL, ID, PA, NC, SC, WI, WY) put together by the law firm of Foley and Lardner. The link is https://www.foley.com/-/media/files/insights/publications/2021/02/21mc30431-50state-telemed-reportmaster-02082021.pdf.

The areas covered include state laws about coverage for telehealth and audio-only treatment; reimbursement requirements; how long coverage will last; the actual language of the laws in each state; and more.

Even if you think you know your state’s laws about telemental health, this is a good review and offers ways to improve telemental health laws based on what other states have done.

Let me know if you have any questions about this information.

- Laura Groshong, LICSW, Director, Policy and Practice

January 26, 2021

CSWA is thrilled to see President Biden’s new executive orders today which will be huge steps toward anti-racism and true equity in our country. They are:

• To require fair housing policies and eliminate ‘red-lining’ of housing for BIPOC individuals and families
• To end private prisons which have consistently promoted discriminatory policies and actions toward BIPOC incarcerated individuals
• To combat the xenophobia that exists toward Pacific Islanders and Asian Americans
• To strengthen nation-to-nation relationships with Native Americans and Alaska Natives

In addition, President Biden is embedding racial equity in all Federal agencies. The President wants his team to serve as a model on diversity, including hiring, purchasing, data and access. He has called racial inequality one of the four “converging crises” facing the nation.

To hear the President’s complete remarks on his new policies go to https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/01/26/remarks-by-president-biden-at-signing-of-an-executive-order-on-racial-equity/.

CSWA is about to begin a series of six presentations on “Racism and the Clinical Process” in a virtual collaborative format on Wednesday evenings. For more information go to https://www.clinicalsocialworkassociation.org/event-4134868.

CSWA encourages all members to join us in the anti-racism effort which is finally being addressed at the Federal level.

- Kendra Roberson, PhD, LCSW, CSWA President

January 8, 2021

Below is a summary of the way that the CMS Physicians’ Fee Schedule Rule will impact Medicare psychotherapy reimbursement and telemental health services for LCSWs in 2021. The final Rule was implemented at the end of December 2020.

CPT Code Reimbursement Changes

*Group Psychotherapy, 90853, has been added to the permanent list of telemental health services.

In short,

Telemental Health Services

Telemental health videoconferencing services have been extended indefinitely which is great news. Audio only telemental health services, however, will only be covered through the Public Health Emergency, currently scheduled to end on January 20, 2021. CSWA is working with the Mental Health Liaison Group to have Congress make audio only treatment covered indefinitely as well. CMS believes that Congress must make a legislative change before audio only services can be covered. It is likely that the Public Health Emergency will again be extended past January 20th but has not been extended yet.

In summary, the cuts were not as severe as had been planned for individual psychotherapy, but somewhat more difficult for family and group therapy and psychoanalysis. To reiterate: Stay tuned for the extension of the Public Health Emergency, which will allow the continuation of audio only treatment, but videoconferencing has been extended indefinitely.

January 6, 2021

Given the chaos of the situation in Washington, DC, I wanted to let you know that CSWA is thinking of our many members who live in and around the area. It is very disturbing and frightening to watch from a distance; it would be exponentially worse to be in proximity to the destruction that has been inflicted on the heart of our democracy.

Please take care of yourselves. We hope this misery will come to a quick conclusion. On top of the pandemic, this traumatic situation will only escalate the anxiety and depression we are seeing in our practices. We must take care of ourselves so that we can take care of others. CSWA is here for you.

- Kendra Roberson, LICSW, CSWA President

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

January 6, 2021

CSWA leadership has been trying to come to terms with the hatred unleashed by our President and his followers on January 6, the very real threat to our democracy, and the blatant racist actions that were on full display.

CSWA first reached out to our members, mindful of the traumatic impact experienced by those near the riot and desecration of the Capitol and of the secondary trauma affecting those watching on TVs, phones, and computers. The immediate message was a reminder that we must take care of ourselves, emotionally and physically. As we all know, unless we take care of ourselves, we will have difficulty continuing to treat our patients.

What the so-called “racial-reckoning” of the past summer taught us, was that unjust, unfair treatment of Black and Brown people has, tragically, always been an issue in America. The country, with its obvious privileges for White citizens, has a shaky foundation built on the premise that it is acceptable to colonize and steal Indigenous land, enslave Africans and subjugate anyone non-White, or otherwise marginalized, to second class citizenship. This foundation allowed Trump’s rhetoric and hate speech to be successful in riling a literal lynch mob to storm the Capitol. The Confederate flag, the White supremacy slogans, and the disturbingly tepid response of the Capitol police to the rioters all conveyed these ideas. As more comes to light, CSWA will continue working to learn, to educate, to advocate, and to stand with you against institutional and systemic racism and for undisputed equity.

Our actions now must be to hold the President accountable for his role in promoting the riot, in promoting racism, in promoting police and National Guard brutality in BLM protests throughout 2020, and in undermining the electoral process. Impeachment will thus create a lasting record of his unlawful behavior and prevent him from holding further federal office. CSWA encourages all members to notify their members of Congress immediately that the President be impeached for his actions.

Here is a possible way to send that message: “I am a member of the Clinical Social Work Association and a constituent. Given the President’s reckless fomenting of destructive acts on the Capitol, police and our elected officials, I believe he should be impeached.“ Email addresses and phone numbers can be found at https://www.congress.gov/members?q={%22congress%22:117}&searchResultViewType=expanded

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

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

December 30, 2020

Since The Aware Advocate article, Nine Months into the Pandemic: Practical Telemental Health for LCSWs, came out yesterday, I’ve received several questions about whether LCSWs are essential workers and when will they be eligible to get the COVID vaccines. I hope this will clarify this complicated situation.

The Centers for Disease Control and Prevention (CDC) has made recommendations about who should have access to the vaccines and in what order.

There are two Phases, but Phase 1 is divided into three parts when it comes to rolling out the vaccines:

These recommendations can be found at https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations.html.

Note: LCSWs are considered essential workers but whether we fall in 1a, 1b, or 1c depends on where we work and the way that the state we live in is organizing the vaccinations. If we work in a hospital or skilled nursing facility it is pretty clear we would be in the 1a group. Those of us who are over 75 are clearly in the 1b group. But all the other factors that affect us make it impossible to say for sure when we you will get be eligible to be vaccinated.

I recommend that everyone google “COVID Vaccination in [your state/jurisdiction]” and find out which state agency is organizing the distribution and policies for how the vaccines will be available. It may also be prudent to contact your PCP and ask when they may be able to vaccinate you. As you know, some of the vaccines require special refrigeration and may not be storable in doctor’s offices.

Keep in mind vaccination alone may not necessarily make us immune to COVID, but it may certainly help. Keep following all guidelines for masking, staying 6 feet apart, washing hands, and not spending time in closed spaces with people you do not live with until CDC/HHS say it is safe to stop these practices. To those of you who have reservations about getting vaccinated, use your judgment and if you choose not to get the vaccine, keep following all the guidelines above.

We will get through this pandemic and are getting closer, even though we may be many months away. Happy new year to all.

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

December 14, 2020

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 of Policy and Practice

December 14, 2020

Since the Affordable Care Act went into effect in 2011, there have been new forms of treatment reviews through Medicare called Comparative Billing Reports (CBRs). They are designed to identify which LCSWs are considered “outliers” in psychotherapy practice; psychologists and psychiatrists are also receiving CBRs for psychotherapy. This paper is designed to explain how CBRs are developed, what areas are being used in preparing CBRs, and offer suggestions as to how LCSWs may want to respond to them.

There are several companies, called Health Information Handlers (HIHs), which create CBRs for the 14 Medicare Administrative Contractors (MACs) in the country, including CIOX, Ability Network, Chartfast, and others. For more information see https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/ESMD/Information_for_Providers .

As LCSWs know, psychotherapy treatment can take several months or even years of weekly psychotherapy sessions. There can be great variation in the areas assessed by CBR companies. These include 1) how frequently a patient is seen; 2) the average number of sessions for each beneficiary; and 3) how long each session is/how much reimbursement has occurred. For LCSWs, these areas are primarily determined by the diagnoses a patient has as found in the DSM-5, and the treatment methods the LCSW uses to treat these conditions. For example, complex PTSD and complex grief can take longer to treat than adjustment disorders; cognitive behavioral therapy generally takes less time in treatment than psychodynamic psychotherapy.

To find information on the three areas noted above, the HIH preparing the CBRs reviews all psychotherapy provided by providers for a given MAC. All LCSWs are compared to all other LCSWs providing psychotherapy. Any LCSW who is in the top 10% in at least two categories, who sees at least 10 Medicare beneficiaries for psychotherapy, is sent a CBR notifying the LCSW. Additional documentation may be required to explain the reasons for the high level of service and/or reimbursement.

There are numerous evidence-based psychotherapeutic methods which treat different kinds of mental health or substance use disorders. It is safe to say that the majority of Medicare beneficiaries are senior citizens who qualify for Medicare based on age. LCSWs who understand the senior population’s emotional difficulties are likely to specialize in this kind of psychotherapeutic work and see more Medicare beneficiaries. It would be a false dichotomy to see LCSWs who see a high number of Medicare beneficiaries as outliers; this is their area of expertise and practice.

Another difficulty for LCSWs in the development of the CBRs is the comparison of all mental health conditions to all other mental health conditions. As noted above, there are numerous mental health diagnoses, some of which take longer to treat than others. Diagnoses should be “apples to apples” if these comparisons are being made.

Thus, the LCSWs who are most likely to receive a CBR are those who see a large number of Medicare beneficiaries; who see these patients in long-term therapy; and who use 90837 more often than other CPT codes. Long-term psychotherapy has been shown to have multiple benefits. Some studies that have validated this point of view are:

CSWA hopes that this paper is helpful to LCSWs in understanding the CBR and responding to them.

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