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.

January 25, 2020

I have been hearing from members who have had trouble communicating with Noridian, the Medicare Administrator for much of western United States. This post is to gather information about how widespread this problem is.

Please let me know the following if you have had any of the following difficulties in the past three months:

1. Mistakes on EOBs which cannot be corrected

2. Inability to get a person to talk to about EOBs or other problems

3. Wait times of more than 20 minutes

4. Being disconnected while on hold

Please respond by February 2. Thanks for your help. Once I have more data I will contact CMS about the problem.

December 28, 2019

I want to call your attention to a terrific article called 'The War for the Future of Psychotherapy". on the conflict in psychotherapy regarding manualized algorithms as the basis for treatment and the treatment alliance as the basis for treatment. The article is by Todd Essig, PhD, a psychologist/psychoanalyst, who writes a column in Forbes Magazine and can be found here

This is not a new battle between short term and in-depth treatment but according to the article, there is new support for using algorithms to guide treatment from the American Psychological Association Guidelines.

CSWA has members who provide all methods and lengths of treatment but the human connection is seen as primary, not one-size-fits-all research. I urge all members to read the article and send me your thoughts, which I will share with other members.

This article came out of the Psychotherapy Action Network (PsiAN) Conference which was held in San Francisco the past month. Full disclosure: I spoke at the conference on clinical social work education in schools of social work (diminishing) and psychotherapy advocacy (time-consuming). Let me know if you want information about those topics. It was heartening to see the many LCSWs in the audience.

Here's to a happy productive new year for clinical social workers.

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

December 11, 2019

MHLG 2019 Hill Staff Champion Awards, given to the members of Congress for their outstanding support of the goals of the Mental Health Liaison Group. These legislative aides are identified below. Peeking out of the second row is our own Margot Aronson, LICSW, CSWA Deputy Director of Policy and Practice.

• Joseph Ciccone, Office of Representative Grace F. Napolitano
• Jennifer Tyler, Office of Representative John Katko
• Jeff Morgan, Office of Representative Paul Tonko

October 1, 2019

The American Foundation for Suicide Prevention and the Suicide Prevention Resource Center have put together some excellent materials which may be helpful to members.

Here is a general overview of the scope of suicide, costs, vulnerable populations and more. The link is http://www.sprc.org/about-suicide.

Here is a summary of the guidelines which states use to prevent suicide. The link is http://www.sprc.org/stateInfrastructure/tools.

Here is a summary of the number of suicides that occur each year by state and the ranking per capita of the states. The link is https://afsp.org/about-suicide/state-fact-sheets/.

November 20, 2019

This post is to let you know that clinical social workers will not be required to report on the Merit-Based Incentive Payment System (MIPS) in 2020. CSWA has checked with the Centers for Medicare and Medicaid Services (CMS) to verify this. There will be no penalties and no bonuses for LCSWs through MIPS in 2020.

MIPS is the successor to the PQRS program that ended in 2016, which was cumbersome and did not always provide correct results in the penalties assessed to the LCSWs that complied with it.

Here is the rule about clinical social workers in 2020:

Are clinical social workers eligible for MIPS? Why is there a clinical social worker specialty measure set?

No. Clinical social workers continue to be excluded from MIPS in the 2020 performance period. However, we have finalized a clinical social worker measure set to help these clinicians prepare in the event that they are added to the definition of a MIPS eligible clinician through future rule making.

To review the whole final rule, click here.

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

September 24, 2019

Below is updated information on the CMS Proposed Rules changes.

At this point, the 800 pages of Proposed Rules for LCSWs are mainly about our being included in the Merit-based Incentive Payment System (MIPS), the successor to PQRS. CMS has asked CSWA for recommendations on the measures which we can logically keep records on. The CSWA-recommended 16 measures are included in the attached document.

We also encourage you as individual members – whether or not you are Medicare providers - to send comments to CMS about these proposed rules. A strong showing from the LCSW community can make a difference. Remember, these proposed rules are not about reimbursement rates, just the inclusion of LCSWs as Medicare providers in the MIPS system. If you believe LCSWs should not be included in MIPS or that inclusion would affect your willingness to be a Medicare provider, feel free to say so.

Suggested language:

Re: Proposed rules CMS-1715-P

I am a licensed clinical social worker and a member of the Clinical Social Work Association. I am hoping that the reporting requirements will be simpler and clearer than the ones that were required for PQRS, and more carefully monitored. [Or, I oppose the inclusion of LCSWs in the MIPS system.] Many LCSWs [I was, if you were] had their reporting rejected although it was in compliance with the PQRS measures. Many LCSWs [I decided, if you did] decided not to remain part of the Medicare provider network because of these onerous reporting requirements. Such requirements seem particularly unfair given the reimbursement rate for LCSWs at 25% less than for others providing the exact same services.

How to submit comments:

Your comments should be submitted to https://www.regulations.gov/document?D=CMS-2019-0111-0092. Click on the “Comment Now” box on the right side to submit your comment. All comments must be submitted by Friday, September 27, 2019, 5 pm EDT.

Comments sent by CSWA:

If you would like to read the more extensive comments sent by CSWA, you can find them at CSWA - CMS Comments on Medicare Proposed Rules (Final) - 9-24-19.pdf. CSWA will keep members apprised of the final decision on these proposed rules.

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September 20, 2019

I have received several messages from you about the new CMS proposed rule to lower the Medicare reimbursement for psychologist services.

It appears from the proposal (found in the Federal Register at https://www.govinfo.gov/content/pkg/FR-2019-08-14/pdf/2019-16041.pdf) that the reduction for psychologists is a higher reduction than for clinical social workers , i.e., 7% vs. 6%.

The proposed rule also asks for recommendations for measures that could be used to include LCSWs in MIPS, the new PQRS, in 2022.

We are in contact with NASW and hoping to submit joint comments on this proposed rule.

CSWA will be responding to all of these proposals shortly and asking members to do so as well. You can start reviewing the extensive rule now. Comments must be in by September 27, 2019.

CSWA will have our comments by early next week for your consideration.

Let me know if you have any questions.

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

September 24, 2019

Centers for Medicare and Medicaid Services, Director Seema Verma, http://www.regulations.gov

RE: CY 2020 Revisions to Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies, CMS–1715–P

Dear Director Verma:

The Clinical Social Work Association (CSWA) is happy to provide these comments on the proposed Medicare rules for 2020. There are over 250,000 licensed clinical social workers (LCSWs) in the country, the largest group of behavioral health providers. We are proud to be able to participate in the Medicare program and serve the mental health needs of beneficiaries.

As we understand the proposed rules for LCSWs, they are similar to the Physician Quality Record Systems (PQRS) which were in place from 2010-2017 for LCSWs. When the Merit-based Incentive Payment System (MIPS) was created in 2018, LCSWs were not asked to report on the measures that were part of that system. The proposed rule, CMS-1715-P, is specifically considering that clinical social workers now be included in the MIPS reporting. The PQRS rule had many difficulties for LCSWs with denied reporting and we hope that if the MIPS measures are applied to LCSWs that the processing of the reporting will be improved.

CSWA understands that the Medicare Economic Index (MEI) is subject to change, and is hopeful that the proposed 6% decrease in overall RVUs for LCSWs may change as well. As has long been the case, we have concerns about the way that LCSWs, who use the same behavioral health codes as psychologists and psychologists for psychotherapy, have nonetheless been reimbursed at 25% less than the other two groups. We know this will take legislative change. This disparity continues to be patently unfair; groups doing the same work using the same codes should not have different reimbursement rates. CSWA encourages our members to become Medicare providers and serve this vulnerable population. However, decreasing reimbursement rates and increasing the paperwork burden could lead to fewer LCSWs choosing to do so.

As requested on p. 460, CSWA would like to offer the following comments on the Clinical Social Work specialty set, in the event clinical social workers are proposed for inclusion in the definition of a MIPS eligible clinician in future rulemaking. Measures which CSWA finds would fit with the clinical social work scope of practice are marked “ACCEPTED”. Measures which are not included, but recommended by CSWA, are marked “PROPOSED”.

B.41 Clinical Social Work (p.664)

Measures in MIPS

#130, Medications for every patient listed in the Medical Record in each session ACCEPTED

#134, Depression Screening, once a year, followup treatment plan if positive screening ACCEPTED

#181, Elder Maltreatment Screening, once a year, with followup treatment plan if positive screening ACCEPTED

#182, Functional Outcomes Assessment, as needed, followup treatment plan if positive screening ACCEPTED

#226, Tobacco Cessation, once every two years or sooner if positive screening ACCEPTED

#281, Dementia Cognitive Assessment, once a year regardless of age, followup treatment if positive screening ACCEPTED

#283, Dementia Psychiatric Screening, once a year if positive cognitive assessment for dementia, for behavioral/psychiatric disorders, followup treatment if positive screening ACCEPTED

#286, Dementia Physical Safety Screening, as needed if danger to self or others because of physical limitations, followup treatment if positive screening ACCEPTED

#370, Adolescent Depression Remission Percentage at 12 months for 12-17 year old patients who have a positive screening for depression ACCEPTED

#382, Assessment of Suicide Risk for children/adolescents who have diagnosed suicidality with followup plan for continued suicidality ACCEPTED

#383, Assessment of adherence to anti-psychotic medication as needed for patients who have a diagnosis of schizophrenia or schizoaffective disorder and followup plan if positive screening for non-adherence ACCEPTED

#402, Assessment of tobacco cessation for adolescents 12-20 as needed with followup plan if cessation not achieved ACCEPTED

#431, Assessment of Unhealthy Alcohol Use for adults every two years with followup plan for cessation if not achieved ACCEPTED

PROPOSED: Assessment of Unhealthy Alcohol Use for adolescents 12-20 every year if cessation not achieved

PROPOSED: Assessment of Unhealthy Drug Use for adults every two years with followup plan for cessation if not achieved

PROPOSED: Assessment of Unhealthy Drug Use for adolescents every two years with followup plan for cessation if not achieved

Thank you again for the opportunity to offer our comments to CMS on these proposed rules. We are happy to discuss them with you further.

Sincerely,

Britni Brown, LCSW, President, Clinical Social Work Association, bbrown@clinicalsocialworkassociation.org

Laura Groshong, LICSW, Director of Policy and Practice, Clinical Social Work Association, lwgroshong@clinicalsocialworkassociation.org

cc:

Margot Aronson, LICSW, Deputy Director of Policy and Practice, Clinical Social Work Association, maronson@clinicalsocialworkassociation.org

Donna Dietz, CSWA Administrator, Clinical Social Work Association, administrator@clinicalsocialworkassociation.org