March 16, 2024

There have been many questions about how to establish a telemental health practice as we address COVID-19. Here are some ideas about what to consider.

• Take a course to understand the basic skills that are needed to provide telemental health videoconferencing. The TBHI Courses offered by Marlene Maheu are excellent and can be found here. There are many others, but Dr. Maheu has based hers in part on the ethical standards for clinical social workers.
• Read the Technology in Social Work Standards, that CSWA helped develop, which can be found here.
• Find a platform to use for your videoconferencing work. There are several available but the ones that seem to be the best are VSee, Zoom, doxy.me (which has some service problems from recent reports), Simple Practice and Theranest. Most have a monthly charge. Some are more reliable than others. To see comparisons of the platforms, go to Rob Reinhardt’s website www.tameyourpractice.com.
• Find a payment method for videoconferencing. The ones that seem to be the best are Zelle and Paypal. Zelle is bank related and have privacy protections; you will need to get the patient’s bank account number. I believe Paypal will sign a BAA.
• Develop an Informed Consent form for videoconferencing. CSWA has developed a template which can be found at CSWA - Telemental Health Informed Consent - 3-20.docx.
• Check with all third party payers as to whether your patients will be covered for videoconferencing or telephonic sessions. Medicare patients await guidance from CMS and HHS which should be forthcoming in the next two weeks. If patients are not covered, see if arrangements for private pay can be made.

If you have any other questions, please let me know.

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

March 15, 2020

There have been many questions about the status of the telemental health expansion of Medicare and private insurers as the COVID-19 crisis itself has rapidly expanded. Here is what CSWA knows so far.

The emergency bill signed on March 6 allows for an expansion of Medicare telehealth services of all kinds, once guidance from CMS and HHS is made available. There is no definite date when this will happen, but we hope to have it within two weeks.

CSWA, NASW, and the American Psychological Association will be sending a letter to CMS and HHS tomorrow encouraging them to allow a temporary expansion for patients that we have been seeing within the past three years. The option that is currently being discussed per the March 6 bill is videoconferencing only, not telephonic sessions. Of course CSWA hopes that telephone sessions will be allowed as well, but it is unlikely that it will be as soon as videoconferencing is covered. It is a possibility that when videoconferencing is expanded by CMS, it will be retroactive to February, 2020.

As for private insurers, there is confusion about what they are willing to cover through videoconferencing and telephonically at this time. Most companies that offer coverage are doing it for in-network providers only, who must use a specific telemental health platform and accept the fee offered. This is generally less than LCSWs are used to being paid by these insurers for in-person sessions. Out-of-network providers may or may not have the option of being covered for videoconferencing or telephonic sessions. It is VERY important to check with any private insurers you have been reimbursed by, if you want to know the facts about their policies at this time. Having patients call to find out what their policies are and request videoconferencing and/or telephonic coverage if necessary, is a good idea as well.

Another question is coverage for patients who live in a jurisdiction in which you are not licensed, for example, a patient has previously come to your office in Washington, DC, but lives in Maryland. You are licensed in Washington, DC, not Maryland, so would be practicing without a ;license if you treat the patient through videoconferencing while they are in Maryland. I recommend calling the Social Work Board in any state in which a patient resides in which you are not licensed, to ask what their policy is on videoconferencing with patients (or telephonic sessions) who reside there. Again, there may not be good solutions here if the state insists that you be licensed in the state in which the patient resides. Have patients call the Social Work Board in their state and ask for an exemption.

Finally, there is the question of what to do if you have already moved to videoconferencing or telephonic sessions to protect you and your patients from becoming infected by COVID-19; it is problematic if you want to continue getting reimbursed by third party payers who currently do not cover videoconferencing. You can continue to provide sessions through videoconferencing with the hope that they will be covered eventually; take a break while this is sorted out; or make arrangements with patients to pay privately. None are ideal.

I hope we will have some clarity on telemental health expansion soon and will keep you posted. This is a unique and troubling time for LCSWs, all mental health professionals, and our patients. CSWA will do everything possible to give us the ability to continue providing our needed services.

March 10, 2020

On Friday, the President signed into law a $8 billion emergency funding bill that included $500 million towards Medicare telehealth, including telemental health services, because this is a declared emergency. There are a few caveats (see below).

The good news: this bill allows the HHS Secretary to waive current Medicare telehealth restrictions (originating/geographic sites) on telemental health during the COVID-19 public health emergency, so that care can be provided regardless of where a patient is located, including at home.

The other news: a qualifying provider, like licensed clinical social workers, needs to have provided a service to an eligible beneficiary in the last three years—so this can only be applied to existing, or recent, patients. Additionally, the telemental health services can only be provided through videoconferencing, not telephone only.

Place of service should be 02 for telehealth. The GT modifier is no longer necessary, but 95 is still needed. CPT codes should be as for an office visit.

This is overall good news and CSWA will work to make it a permanent option.

March 9, 2020

I just received guidance from CMS on whether we can be reimbursed for telemental health beyond the accepted treatment in rural areas. Their response is attached.

Basically the answer is no at this time. I recommend calling CMS at1-866-288-8912, x3 to ask for more guidance.

CSWA is developing a Legislative Alert to send to members of Congress to request an expansion of coverage for telemental health during this health crisis.

CSWA - Medicare on Distance Sessions - 3-9-20.docx

March 8, 2020

Below is an update on the COVID-19 epidemic.

It appears that the number of cases is spreading, close to 500 with the Seattle area being the heaviest hit (128 cases, 19 deaths as of this writing). We really don't know when the situation will improve as various cities are just starting to see cases and the tests for confirmation of COVID-19 are still hard to get.

I wanted to pass on some things that members are doing to protect themselves and their patients in addition to the list I sent out last Monday. Some are cover fabric chairs and couches, even leather ones, with plastic/vinyl material which is easier to clean with antiseptic spray.

It is important to make sure that any DIY hand antiseptic is at least 70% alcohol, the rest aloe vera gel, with some drops of aromatic oils like tea tree or lavender; unfortunately, many areas are completely out of alcohol and aloe vera. Amazon can send in a week.

Those most at risk of being harmed by COVID-19 are people with underlying health conditions and those over 65. Traveling is not recommended for this group in particular.

Many members have asked about whether Medicare will cover telemental health sessions. The bill signed on Friday provides $8.3 billion for a variety of ways to address the virus but there is no clear guidance on whether CMS will expand their coverage of telemental health yet. I will let you know when this becomes available. Sen. Ron Wyden did get a provision in to support telemental health but no specific enforcement. As for private insurers there is no clarity there either. I suggest having patients request that telemental health be covered if they have private insurance; that is the most likely way to get coverage.

This is a time of anxiety in our personal and professional lives. We should try to remember that we are all in this together and hopefully can help each other get through it.

March 4, 2020

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!

March 3, 2020

The Covid-19 virus is spreading and LCSWs need to anticipate the impact that this may have on our patients and our practices. Many of the suggestions below were gathered from the World Health Organization and other sources. CSWA hopes we may be helpful to you as this health crisis evolves.

More information can be found at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen

Another comprehensive article can be found at https://www.washingtonpost.com/health/2020/02/28/what-you-need-know-about-coronavirus/?arc404=true

Clinical Practice Action Plan:

- Develop a plan for limiting in-person sessions if there is a public health recommended limitation for being in public places, or a perceived need for such limitation

- Review the CSWA Technology Standards for Social Workers if you have not done so recently (https://www.clinicalsocialworkassociation.org/Social-Work-Technology-Standards)

- Check with insurers as to coverage of telephone or videoconferencing

- Make sure that any videoconferencing platform you use is HIPAA compliant (VSee, Zoom, etc.)

- Decide if patients with symptoms should have sessions by telephone or videoconferencing

- Decide if you should be working if you have symptoms

- Discuss a plan with patients in advance of the need to limit in-person contact, including arranging for phone or video sessions

- Sanitizing doorknobs and other surfaces touched by patients

- Be aware of own anxieties and try to contain

- Be prepared to acknowledge the anxieties of patients, should they occur

Public Health recommendations to reduce infection from flu or Covid-19:

- Perform frequent hand washing and use of hand sanitizer after being in public spaces

- Cough into elbow or shoulder, not covering your mouth with your hand

- Stay more than 6 feet away from individuals who are coughing or otherwise appear ill

- Avoid social ways of touching others, including handshakes

- Avoid touching your own face as much as possible

- Avoid public transportation such as buses or trains if recommended distance cannot be maintained

- Use hand sanitizer after going through TSA if flying by plane

- Use sanitizing wipes on plane armrests and tables and rental car keys and steering wheels

- Be aware of countries and cities where Covid-19 virus is increasing if traveling

- Engage in immune enhancing activities, i.e., get enough sleep, reduce alcohol intake, get exercise)

- Do not go to an emergency room unless absolutely essential; for a cough, fever, or other respiratory issues contact your primary care doctor first.

- Self-quarantine at the first sign of illness and wear an N-95 face mask in public spaces

Helping Children with Meaning of Restrictions Due to Covid-19

Suggestions can be found at https://onedrive.live.com/view.aspx?resid=D589777FC7C86E35!118&ithint=file%252cdocx&authkey=!ALcOpxBYPPJR_h4.

Striking a balance between being overly cautious and overly optimistic may not be easy but as clinical social workers, I think we can achieve it. As you may know, here in Seattle we have a cluster of Covid-19 cases and two deaths, so I will be applying these principles to my own practice.

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

February 18, 2020

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, CSWA Director of Policy and Practice, Chair, Government Relations Committee

February 18, 2020

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, CSWA Director of Policy and Practice, Government Relations Chair

February 17, 2020

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/.

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.