March 6, 2025

The Clinical Social Work Association is continuing to monitor the threat to continuation of telemental health coverage that we communicated to you about on February 25th and 28th. However, patients may not be aware that there is a chance that continued coverage of telemental health by Medicare and commercial insurers is at risk. The Clinical Social Work Association would encourage clinicians to consider asking clients to share their concerns with their elected officials. We are offering this message and legislative alert wording, included below, as a way to educate patients about letting members of Congress and state legislators know that this is something they oppose.

Here is a summary of what could happen if Congress does not acts in different ways to extend telemental health by March 31, 2025.

Possible Congressional Actions

Congress could extend telemental health through a stand-alone bill. This would achieve the goal of allowing insurance payments to continue but seems very unlikely.

Congress could attach telemental health to other bills that are moving, the most likely one being the Congressional Resolution, which will be needed to pass a budget to keep the government running as of March 14. This is a possibility.

Congress will address continuing coverage of telemental health after the March 31 deadline, but there will be a delay of a few weeks, which may cover the time when there was no coverage. This is a possibility but would cause confusion and uncertainty.

Congress will do nothing and there be no Medicare or private insurance coverage of telemental health. This is unlikely.

LEGISLATIVE ALERT

It is a good time to let your members of Congress know that you and your patients want a prompt continuation of telemental health in Medicare. Here is a template your patients can use: “I am a constituent who is concerned about the lack of Medicare telemental health coverage after March 31, 2025. It will be very harmful to people like me who rely on telemental health to resolve the mental health and/or substance use problems I face. I have received excellent care using telemental health and would be harmed if it ended. Additionally, it would be impossible for me to meet with my clinical social worker in person, so I ask that the requirement that I meet with mental health clinicians in person every 6 or 12 months be eliminated. I urge you to extend Medicare telemental health coverage permanently as soon as possible.” Ask your patients to send their messages to their senators and representative at https://www.congress.gov/contact-us. If you haven’t already, when you send a message to your Senators and Representative, identify yourself as a Clinical Social Worker and let them know how providing telehealth has impacted your patients positively, and how destructive losing that treatment could be to their constituents.

CSWA hopes this is helpful to patients being seen virtually currently or in the future. Thanks to you and your patients for help with this crucial issue.

Contact: Laura Groshong, LICSW, CSWA Director of Policy and Practice at lwgroshong@clinicalsocialworkassociation.org

March 3, 2025

Linked here, please find the comments which CSWA has submitted to DHHS and OCR regarding the new proposed HIPAA Security Rules which would significantly increase our responsibility for preventing breaches of any information we store electronically. Sole practitioners are being asked to develop the kinds of software protections that large institutions have in place. CSWA is not in support of these Rules and has explained why in the statement linked above.

If you would like to send your own comments to OCR, whether in support of CSWA’s position or not, feel free to do so. Use your own words or the language in our statement. Send comments to https://www.federalregister.gov/documents/2025/01/06/2024-30983/hipaa-security-rule-to-strengthen-the-cybersecurity-of-electronic-protected-health-information#open-comment by COB on March 7, 2025.

February 28, 2025

Below is a follow up to the message on this topic that was sent earlier this week.

Thanks to all of you who contacted your members of Congress (150 and counting)! This is the best way to confirm continuation of Medicare coverage. Please continue to send messages if you have not done so.

As was noted in the first post, there are differing opinions on whether Medicare telemental health is already covered. CSWA is taking a conservative approach and making sure that members of Congress have this on their radar, regardless.

Another issue which some members raised was the concern about seeing patients once every six or twelve months in-person. There is a way to avoid this in CMS Calendar Year (CY) 2023 Centers for Medicare and Medicaid (CMS) Physician Fee Schedule, page 69464, which reads as follows:

Are there exceptions for the subsequent in-person visit every 12 months?

Yes, for both established and new patients. In the CY 2022 CMS PFS final rule CMS stated: “Specifically, if the patient and practitioner agree that the benefits of an in-person, non-telehealth service within 12 months of the mental health telehealth service are outweighed by risks and burdens associated with an in-person service, and the basis for that decision is documented in the patient’s medical record, the in-person visit requirement will not apply for that particular 12-month period. For example, situations in which the risks and burdens associated with an in-person service may outweigh the benefit could include, but are not limited to, instances when an in-person service is likely to cause disruption in service delivery or has the potential to worsen the patient’s condition(s). The risks and burdens associated with an in-person service could also outweigh the benefit if a patient is in partial or full remission and only requires a maintenance level of care. Other examples of such instances may include the clinician’s professional judgment that the patient is clinically stable and/or that an in-person visit has the risk of worsening the patient’s condition, creating undue hardship on self or family, or if it is determined that the patient is at risk for disengagement with care that has been effective in managing the illness. Practitioners must also document that the patient has the ability to obtain any needed point of care testing, including vital sign monitoring and laboratory studies. Practitioners must note the exception for any applicable 12-month interval.”

This exception should allow LCSWs to claim it would be detrimental to treatment goals if a patient was required to come see the therapist in person. Be sure to document this in the Medical Record.

As always, please let Laura know if you have any questions and when you have sent messages to Congress by emailing her at lwgroshong@clinicalsocialworkassociation.org.

February 25, 2025

We know many of you are worried about continued coverage of telemental health by Medicare which, if discontinued, will likely lead to changes in coverage by commercial insurers. It is a difficult situation as many LCSWs have gone to fully telehealth practices. Here is what we know about what may happen in the next month.

Medicare and Me

Several members have told Laura Groshong, CSWA Director of Policy and Practice, about the statement in the Medicare and Me manual which says that mental health and substance use will continue to have telemental health coverage in 2025. That does not appear to be the case at the moment, as discussions of telehealth coverage include mental health treatment. Congress needs to pass a law that will make all telehealth coverage continue.

Possible Congressional Actions

All of the options below have been proposed by different members of Congress.

- Congress could extend telemental health through a stand-alone bill. This seems very unlikely.

- Congress could attach telemental health to other bills that are moving. The most likely one would be the Congressional Resolution, which will be needed to pass a budget to keep the government running as of March 14. This is a possibility.

- Congress will address continuing coverage of telemental health after the March 31 deadline but there will be a delay of a few weeks, which may cover the time when there was no coverage. This is a possibility.

- Congress will do nothing and there be no Medicare coverage of telemental health. This is unlikely.

LEGISLATIVE ALERT

Now is a good time to let your members of Congress know that you want a prompt continuation of telemental health in Medicare. Here is a template you can use to send them: “I am a licensed clinical social worker, a member of the Clinical Social Work Association, and a constituent. It will be very harmful to vulnerable patients with serious mental health and substance use problems if they cannot continue to work with me using telemental health. Many patients who were unable to get help in person have done very well using this delivery system. I urge you to extend Medicare telemental health coverage permanently as soon as possible.” Send your messages to your senators and representative at https://www.congress.gov/contact-us.

As always, please let Laura know when you have sent your messages and/or if you have any questions by emailing her at lwgroshong@clinicalsocialworkassociation.org. 

February 14, 2025

In an attempt to respond to the Executive Order on best practices regarding treatment of transgender individuals quickly, the Clinical Social Work Association (CSWA) provided a statement that cited the Cass Review, which according to several specialists working with this population, is not reputable.

CSWA stands by its beliefs that LCSWs have a fundamental ethical responsibility to honor and support patients’ rights to self-determination. We also continue to affirm the right of transgender individuals to express their gender identity in a manner that promotes their mental health.

CSWA is therefore retracting the original Statement and will continue to learn more about the ways that transgender individuals can be supported by LCSWs. A new statement will be issued in the near future.

CSWA apologizes for the reference to the Cass Review and appreciates members who provided us with earnest feedback.

February 10, 2025

Elections for the Social Work Compact Commission’s Executive Committee were held on February 5, 2025. This group will govern the Compact going forward, with the help of Council of State Governments (CSG). The results were as follows:

- Chair: Hank Cecil, Kentucky

- Vice-Chair/Chair-Elect: Kelli Willis, South Dakota

- Secretary: Jana Johansen, Utah

- Treasurer: Kevin Fowler, Ohio

- Member at Large: Dr. Deborah Sills, Georgia

- Member at Large: Dr. Hyacinth Mckee, Louisiana

- Member at Large: Justin Bennet, Missouri

The Social Work Compact Commission is made up of delegates from all 22 states that have passed the Compact bill; future states that pass the Compact bill will also have delegates to the Commission.

Additionally, after lengthy discussion and deliberation, three of the six groups that applied to become Ex Officio members were named in the Commission’s bylaws as having permanent Ex Officio (non-voting) seats at meetings of the Commission’s Executive Committee – CSWA, NASW, and ASWB. Laura Groshong, CSWA Director of Policy and Practice, was pleased to be named by CSWA President Stephanie Payne as the delegate from CSWA. The Ex Officio delegates will attend the Executive Committee meetings and have direct input into the decisions made by the Executive Committee for how the Compact will be run.

CSWA will keep its members informed on the progress of the Compact.

February 6, 2025

Please visit the CSWA Position Papers page to view the Position Paper on Protecting Patients from Deportation.

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