October 5, 2020

A new source of funds for behavioral health/mental health providers who have worked with anyone affected by the COVID-19 pandemic is now open. Phase 3 of the CARES Act Relief Fund will be available starting today, October 5, 2020, to any LCSWs who have met the criteria listed below until November 6, 2020. Any LCSW who meets one of the yellow outline requirements in the first section may apply. All criteria in the second section must be submitted. The link to apply is also listed below.

To be eligible to apply, the applicant must meet at least one of the following criteria:

Additionally, to be eligible to apply, the applicant must meet all of the following requirements:

Note: Receipt of funds from SBA and FEMA for coronavirus recovery or of Medicaid HCBS retainer payments does not preclude a healthcare provider from being eligible.

To apply go to https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html#how-to-apply.

Let me know if you have any questions.

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

October 5, 2020

Today, October 5, is the last day that comments about the possible Medicare cuts by CMS to LCSWs will be accepted. If you have not yet sent your comments to CMS, or messages to your members of Congress, please do so by TODAY at 5 pm ET or they will not be included.

As always, please let me know when you have sent these messages at lwgroshong@clinicalsocialworkassociation.org.

September 24, 2020

On September 16, you should have received a Legislative Alert to members of Congress regarding the proposed cut to Medicare reimbursement for LCSWs scheduled for January 1, 2021 ( copied below). Many thanks to the hundreds of members who have sent these messages. If you have not done so, it is not too late. While the issue of Medicare cuts is being opposed in the House through Rep. Rush’s letter, it is fine to send your message to Senators as well. All messages must be sent by October 5, 2020.

Now I am asking you to send another message directly to CMS (Centers for Medicare and Medicaid Services), the organization that oversees reimbursement rates for all Medicare providers, including LCSWs. Both messages are necessary to make our position on this issue clear by October 5, 2020. Send the following message (use your own words if you like) to the following link: https://www.federalregister.gov/documents/2020/08/17/2020-17127/medicare-program-cy-2021-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part.

“I am a Medicare provider [if you are] and wish to express my concern about the proposed rate reduction for Clinical Social Workers set to begin on January 1, 2021. Clinical Social Workers are already paid 25% less than other mental health providers for the same CPT Codes as other mental health providers. Though some psychotherapy CPT codes have increased, the 10.6% cut will result in a net reduction of about 7%. My fixed costs have not changed and I cannot afford this reduction in my fees for my mental health services.

The onslaught of COVID-19 has increased the need for mental health services. Please make it possible for me to continue to provide them by eliminating the proposed Medicare reimbursement cut.”

As always, let me know when you have sent both messages at lwgroshong@clinicalsocialworkassociation.org. Thanks for your help.

- Laura Groshong, LICSW, CSWA  Director of Policy and Practice, Government Relations Chair

September 19, 2020

2020 has been a challenging year for everyone. The pandemic has increased anxiety, fear, isolation and grief, leading to declining mental health and increased substance use in our communities that will only continue to get worse.

In July, the Federal Communications Commission (FCC) made the historic announcement that it had unanimously voted to designate 9-8-8 as the universal three-digit dialing code for the National Suicide Prevention Lifeline.

Unfortunately, the bipartisan, non-controversial National Suicide Hotline Designation Act is stalled in Congress, putting at risk the promise that this easy-to-access, three-digit dialing code for the life-saving services 9-8-8 could provide.

To date, the House and Senate have each approved similar, but not identical, bills establishing 9-8-8 as the dialing code and supporting the new hotline by establishing a funding mechanism through states and wireless phone carriers. But that legislation is not yet over the finish line. Without this bill becoming law, our communities will not be able to respond to the increasing demand for needed suicide prevention services.

CSWA urges you to call all your Members of Congress by tomorrow to help pass the National Suicide Hotline Designation Act. Go to https://www.contactingcongress.org/ to get their emails or phone numbers and leave the following message: “I am a member of the Clinical Social Work Association and a constituent. Please pass the National Suicide Hotline Prevention Act and save lives. The pandemic and other natural disasters have increased the number of citizens who have hopeless helpless feelings leading to suicidal thoughts. They need ways to access mental health treatment which the over 250,000 clinical social workers can provide.”

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

- Laura Groshong, LICSW, CSWA Director of Policy and Practice, Government Relations Chair

September 16, 2020

There is a proposed cut to Medicare reimbursement for many health care providers, including LCSWs, scheduled for January 1, 2021. This 7% cut is connected to Evaluation and Management services, for diagnostic and treatment services that LCSWs provide. It is imperative that all LCSWs contact their members of Congress as soon as possible to let them know how damaging this would be for LCSWs.

We are fortunate to have the support of Rep. Bobby Rush (D-IL) and 93 members of Congress in stopping this cut. Please check the letter they wrote to Congressional leadership at https://rush.house.gov/sites/rush.house.gov/files/documents/Letter%20to%20Leadership%20on%20EM%20Code%20Cuts%20General.pdf and thank your legislator if he or she signed on.

Even if you are not a Medicare clinician, please send the following message to your members of Congress at https://www.contactingcongress.org:

“I am a member of the Clinical Social Work Association, a Medicare provider [if you are], and a constituent. Maintaining budget neutrality on the backs of clinical social workers and other mental health providers is a burden that I will not be able to bear. I am already paid 25% less than other mental health providers for the same diagnostic and treatment services as other mental health providers. My fixed costs have not changed. The onslaught of COVID-19 has increased the need for mental health services. Please make it possible for me to continue to provide them by eliminating the proposed Medicare reimbursement cut.”

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

- Laura Groshong, LICSW, CSWA Director of Policy and Practice, Government Relations Chair

August 12, 2020

There have been several opportunities for LCSWs who are Medicare, Medicaid or CHIP providers to access additional funds if our income has been affected by COVID-19. Through the Coronavirus Aid, Relief, and Economic Security (CARES-donation) Act and the Paycheck Protection Program and Health Care Enhancement Act (PPPCHE-loan), and the Provider Relief Fund (PRF-donation), the federal government has allocated $175 billion in payments to be distributed through HHS (administered by Optum).

Yesterday the fourth option was announced, the Provider Relief Fund Phase 2, which includes funding for LCSWs, and is detailed below. This is called the Phase 2 General Distribution funding. This is a way to make up lost income, not a loan. To apply for these funds go to https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html#key-facts-providers and complete the 6-step application process.

To date only a fraction of the $175 billion in funds has been claimed. Therefore, CMS is extending access to these funds, which was supposed to end on August 9 for all behavioral health providers and other health care providers, including for LCSWs, until August 28, 2020. The funds distributed will be up to 2% of all income from Medicare, Medicaid or CHIP in tax years 2017, 2018, or 2019 (not all three, just the highest one).

HHS will host a webinar on Thursday, August 13, at 3PM EDT. Register here to learn more about the application process, which is somewhat cumbersome.

You need to be able to document lost income due to COVID-19 and provide the income that you received from Medicare, Medicaid or CHIP per your tax returns for one of three previous years to 2020.

I hope this will be somewhat helpful to members who work in these areas and help give some relief for those who have seen a decline in revenue during these difficult times.

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

July 29, 2020

Regardless of how we feel about providing psychotherapy through telemental health, LCSWs are currently in the position of having to continue to use telemental health or audio only mental health treatment for many months to come. Since mid-March, the vast majority of LCSWs who used to have an office where they met in person with patients, have been working from home. We have mostly made peace with the frustrations and, occasionally, surprising advantages, of working from home online or on the phone.

Returning to the Office – The conditions that would allow us to return to our offices without major changes to the air flow and air cleaning, use of masks, plastic shields, are not easy to create and there will be a high level of risk in some areas that is potentially harmful to many of us. That is why it is so important that Secretary Azar extended the public emergency declaration to October 23, 2020, this week to allow the use of telemental health to continue to be covered by Medicare. Be aware that this does not guarantee that private insurers will continue to cover telemental health.

Legislative Goals – Other immediate goals are to make telemental health a permanent option through Congressional laws; to make reimbursement for telemental health at the same level as for in office visits; and to compare the use of in office and telemental health treatment delivery methods. There are about 10 bills that would impact some or all of these issues. CSWA will keep you aware of the progress of these bills as they affect LCSWs.

Inter-state Telemental Health Practice – There continue to be variation in state rules that allow LCSWs in one state to see patients in another state through telemental health. This is especially difficult for ongoing patients who were seeing a patient in office from a state in which the LCSW was not licensed. I hope this chaos will resolve soon, but for now check on current laws and rules for practicing telemental health in states where you are not licensed with the state Board.

Self-Care – Please know that telemental health is more tiring for many LCSWs than office work and build in ways to give yourself more down time, whether it is through seeing fewer clients in a day; having longer breaks between clients; and having some time for relaxation, exercise, and other self-care.

Many of us have been paying for an office the past five months that we only use for billing or our own research. More and more requests to sublease offices are showing up. This painful decision is affecting all of us. The webinar given last month “To Be or Not To Be: LCSWs Returning to the Office” offers a template for helping make this decision and can be found at the CSWA website in the Members Only Section.

Be safe, stay well, and let CSWA know if there is any way we can help.

July 21, 2020

CSWA is pleased to see that the Office for Civil Rights has issued guidance on compliance with civil rights laws during the COVID-19 pandemic. The health disparities between Black, Indigenous, and People of Color (BIPOC) citizens and white citizens has been a major concern of CSWA. We hope this guidance will improve the underlying problems that are barriers to mental health care for BIPOC citizens. The lack of attention to LGBTQ citizens in this guidance is a glaring omission which we hope will be corrected in future guidance.

To read the whole OCR Bulletin, please visit: Title VI Bulletin - PDF

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OCR Issues Guidance on Civil Rights Protections Prohibiting Race, Color, and National Origin Discrimination During COVID-19

Yesterday, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) issued guidance to ensure that recipients of federal financial assistance understand that they must comply with applicable federal civil rights laws and regulations that prohibit discrimination on the basis of race, color, and national origin in HHS-funded programs during COVID-19. This Bulletin focuses on recipients' compliance with Title VI of the Civil Rights Act of 1964 (Title VI).

To help ensure Title VI compliance during the COVID-19 public health emergency, recipients of federal financial assistance, including state and local agencies, hospitals, and other health care providers, should:

OCR is responsible for enforcing Title VI's prohibitions against race, color, and national origin discrimination. As part of the federal response to this public health emergency, OCR will continue to work in close coordination with our HHS partners and recipients to remove discriminatory barriers which impede equal access to quality health care, recognizing the high priority of COVID-19 testing and treatment.

Roger Severino, OCR Director, stated, "HHS is committed to helping populations hardest hit by COVID-19, including African-American, Native American, and Hispanic communities." Severino concluded, "This guidance reminds providers that unlawful racial discrimination in healthcare will not be tolerated, especially during a pandemic."

"Minorities have long experienced disparities related to the medical and social determinants of health – all of the things that contribute to your health and wellbeing. The COVID-19 pandemic has magnified those disparities, but it has also given us the opportunity to acknowledge their existence and impact, and deepen our resolve to address them," said Vice Admiral Jerome M. Adams, Surgeon General, MD, MPH. "This timely guidance reinforces that goal and I look forward to working across HHS and with our states and communities to ensure it is implemented."

July 7, 2020

I have heard from many members about letters that they have received from a number of insurers in what is being called a “treatment review”. You will recall that these reviews were part of the process that was put in place when the Affordable Care Act went into effect in 2010. The basis for these reviews was left up to the judgment of the insurers. These reviews generally occur every two years.

The last time this came up was in 2018 when Global Tech mailed out 10,000 letters to Medicare LCSWs, questioning their practice based on three areas: how often a patient was seen; how long a patient was seen; and whether the 90837 CPT code was used regularly. We are being compared to all other LCSWs in the insurance plan and identified as being ‘outliers’ in one or more of these areas. As with the last round of reviews, this process is flawed as it does not take into account the conditions being treated.

The current letters are being sent by a number of private insurers including Anthem, Carefirst, and OPTUM (UBH). Some of the companies are separate entities, such as CIOX like Global Tech. Some are directly from the insurer. It is necessary to comply with these reviews to avoid being penalized.

If you have received one of these letters and would like some citations to support length and frequency of treatment, here are some examples:

Data on why it is necessary to use 90837 instead of 90834 is harder to come by, since there is only one minute difference between them.

While it is possible that there may be some audits after the treatment review, this affected a small number of LCSWs in 2018. The treatment review itself is not an audit.

This process is a frustrating and anxiety-producing one, especially with the difficulties most of us have had moving to telemental health and dealing with the pandemic. CSWA continues to work with CMS to accept the variations in practice without requiring these reviews. It may require Congressional action as the ACA was approved by Congress.

Let us know if you have any other questions about this process. Stay safe and healthy.

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

June 24, 2020

A hearing for about 20 mental health bills in the House of Representatives Energy and Commerce Committee was scheduled yesterday on June 30. Unfortunately, the bill that CSWA has been sponsoring for about 7 years in various forms, H.R. 1533, has not been included in the bills to be heard. This is the bill that would increase Medicare reimbursement to LCSWs and allow us to again work independently in skilled nursing facilities.

We need an all-out effort to get the bill included. Please send the following message to your representative, ESPECIALLY if they are on the E&C Committee. To check whether you representative is on the Committee, go to https://energycommerce.house.gov/about-ec/membership. Feel free to send messages to other members of the Committee as well.

Dear Rep. ___________,

I am a constituent and a member of the Clinical Social Work Association.

Please consider adding HR 1533 to the agenda for the Energy and Commerce Hearing on June 30. This bill, Improving Access to Mental Health Act, would greatly improve the access of Medicare beneficiaries to mental health services provided by clinical social workers. As the largest group of mental health providers in the country, clinical social workers are currently a key part of the treatment of behavioral disorders in Medicare and across the country.

I notice that HR 945, which addresses mental health counselors and marriage and family therapists, is included in this hearing, a sister bill to HR 1533. The goals of these bills are similar, to allow Master’s level mental health clinicians to provide independent services in skilled nursing facilities and give beneficiaries much needed access to mental health services. Currently, HR 945 does not include clinical social workers. It would make sense to include all Master’s level mental health providers at this hearing.

Thank you for your attention to HR 1533.

Sincerely,

[your name, license, email]

CSWA appreciates your help and continued partnership. As always please let me know when you have sent your messages.

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