April 17, 2019

Much excitement has been generated in the mental health community since “the UBH decision” – that is, the decision in the US District Court in Northern California case of Wit et al versus United Behavioral Health, filed March 5, 2019 - found UBH liable with respect to the denials of benefits claims. The clarity and detail of Chief Magistrate Judge Joseph Spero’s 106-page Findings of Fact and Conclusions has provided us with an extraordinary resource for moving forward.

At the same time, there are clear limits to this big win: this is not the end of insurance denials and parity violations. UBH will surely be appealing the judgment, and other judges may or may not uphold the present ruling. Further, the insurance arena is complex. Each state has its own insurance regulations, and each type of plan (ERISA, Medicare, Medicaid, Exchange Plans, or private) has a different source/s of oversight. (CSWA has posted information to clarify the differences in the Clinical Practices section of our website.)

How, then, can we use this decision effectively to affect access to mental health and substance use treatment? At the individual level, if your client is being denied care that you deem critical, the detailed court document provides a list of “generally accepted standards of care” that may prove very helpful in your discussion with the insurance representative.

Judge Spero spent considerable time during the hearing determining what is meant by generally accepted standards of care. Many sources exist, and CSWA will post the judge’s summary of these on our website. The standards listed below were agreed upon by both plaintiffs and UBH; the wording is taken from the court document itself:

The nine plaintiffs whose cases were reviewed during the ten-day bench trial included denials of residential treatment for substance use disorder, for rehab, for mental health treatment, and, in two cases, for teenagers with substance issues, as well as denials of outpatient mental health treatment two to three times per week, and Intensive Outpatient Treatment (IOP) for a minor with SUD. The Judge provided detail for each case considered, noting the discrepancy between the UBH stated standard of care and the actual guidelines that the reviewers was expected to follow. His descriptive language throughout, when referring to the UBH testimony, tended toward generous use of the words “evasive” “even deceptive” and “not credible”.

Given the widespread interest in this case, LCSWs may want to be assertive in appealing denials of care, especially where there is any failure to meet the standards. As you present your argument - even if you are dealing with a different insurer and a different type of plan - a mention of the UBH case will likely have an effect on the discussion. (The CSWA website has an Appeals template in the Members-only section; the generally accepted standards of care list will also be there, as well as a description of the five types of insurance plans.)

Another important avenue for LCSWs may be their state insurance laws/regulations and then perhaps their legislators. The plaintiffs came from different states, and three of these states – Illinois, Connecticut and Rhode Island - have legislation mandating use of the American Society of Addiction Medicine (ASAM) Standards in their insurance laws/regulations; it was not difficult to demonstrate that the UBH denials violated the state laws/regulations. A fourth state, Texas, has Department of Insurance criteria for standards of care; this proved equally effective.

Summary

The UBH decision is a good step toward making mental health and substance use parity a reality but is far from the end of making this happen. For now, we can speak out strongly on standards of care, ensure that standards in the client’s policy is being respected in any review process, and feel comfortable noting the UBH loss in court based on violation of these standards, as a basis for appealing a denial of care. As for the next steps, LCSWs should look to state laws/regulations governing insurance, including any standards of care or enforcement of parity. (Such information may be online at the website of the Office of the Insurance Commissioner). Insurance is a state-based system and it may be possible to make a legislative proposal about mental health and substance use that would appeal to your state legislators. Watch for more information from CSWA on this topic soon.

Footnote: Case 3:14-cv-02346-JCS Document 18 (Findings of Fact and Conclusions of Law). Heard and ordered UBH liable 2/28. Filed 3/05/19. 106 pages. United States District Court, Northern District of California.

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

November 26, 2018

You may have already heard that the CSWA Webinars on the Merit-Based Incentive Payments (MIPS) which were to be held on November 29 and 30 have been canceled. This post explains why.

Clinical social workers were among the 12 additional practitioner groups that were to be included as eligible providers (EPs) for the MIPS bonus of 2% a year in 2019 if reports on quality, cost, improvement in treatment, and increased use of health care records were met. There were some options that would have allowed LCSWs to be eligible if they had less than $90,000 in Medicare claims and less than 200 Medicare beneficiaries as clients with less reporting. Most LCSWs who are sole practitioners would be in this category. There would have been no penalties for LCSWs who did not submit data in the areas described above.

Two weeks ago CMS took LCSWs off the list of EPs who would be included in 2019 for the bonus. While this certainly will cut down on the administrative work MIPS would have required, it also takes the option for a bonus away from LCSWs. So is the glass half empty, or half full? That depends on how you feel about the loss of the bonus option.

One other note of interest: it appears that there will be a 2-3% increase in reimbursement for psychotherapy services in 2019. The exact amount will vary by region.

In January, CSWA will be presenting a webinar on the ins and outs of Medicare, a complicated topic about which I receive questions regularly. Watch for the announcement next month on “Everything LCSWs Need to Know about Medicare Practice”.

Please let me know if you have any questions on the MIPS changes.

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

November 16, 2018

With all the other issues that have been demanding our attention this election season, the effort by the administration to detain immigrants indefinitely flew under the radar.

The administration has proposed new regulations that, among other things, would expand its powers to detain immigrant families indefinitely, as compared to the current situation where there is a limit to how long they can detain minors. The proposed rule, Apprehension, Processing, Care, and Custody of Alien Minors and Unaccompanied Alien Children, would allow the federal government to open its own detention centers with unlimited detention. Currently, these centers must be licensed by states with state oversight. As you know, the administration has been trying to implement this policy by ignoring the states and keeps losing in court. That is why this attempt to bring the policy under Federal oversight is being made.

PLEASE send the message below to the Regulations.gov website at https://www.regulations.gov/comment?D=ICEB-2018-0002-0001 TODAY by 5 pm EST.

“I am a clinical social worker and a member of the Clinical Social Work Association. Please do not pass the proposed rule 2018-19052 which would allow immigrants to beheld indefinitely. This is very harmful to children and adults. The states need the freedom to continue managing this complex situation.”

Thanks for your help and apologies for the late notice.

September 10, 2018

I am pleased to send you the latest installment of “The Aware Advocate,” a quarterly report on legislative activity and advocacy being tracked or conducted by the Clinical Social Work Association This is not meant to be a complete summary of all activities, but a review of what I see as current highlights.

***SPECIAL ALERT – Global Tech Review for Medicare***

The Global Tech review identified 10,000 LCSWs who are Medicare providers as providing more psychotherapy than 50% of the LCSWs in their state or nationally. The review also compared the psychotherapy done by LCSWs to the psychotherapy done by psychiatrists. CSWA has written a letter to CMS Administrator Seema Verma rebutting these criteria along with a detailed description of psychotherapy as practiced by LCSWs. To find these items, go to the CSWA website at www.clinicalsocialworkassociation.org.

The Big Picture – Federal News Affecting LCSWs

Proposed Medicare Rule

CSWA just sent in comments on the proposed Medicare rule to charge the same amount for an office visit, no matter what condition is being treated. CMS-1693-P, part of the FY 2019 Physician Fee Schedule, Medicare Shared Savings Program, Quality Payment Program, and Medicaid Promoting Interoperability Program, could seriously limit the access of Medicare beneficiaries to needed psychotherapy. This rule could have a chilling effect on the different psychotherapy codes available to LCSWs, which have already been rejected by some insurers (90837). Many other medical groups have sent in comments as well. The comments will be reviewed in the next month and a decision about implementing this rule will be made. Stay tuned.

Tricare and Humana

Ever since Humana was named as the administrator for veterans on the eastern side of the country, there have been problems with the processing of claims; difficulty contacting a liaison at Humana; lowered reimbursement; higher copays; and a definition of clinical social work that is quite unclear, i.e., no distinction between casework and psychotherapy. CSWA, led by Government Relations member Susan Horne-Quantannens, LCSW, has been working with the Health Defense Agency to solve the myriad problems LCSWs are facing in this important realm of clinical social work practice.

On the Home Front – Legislative Action in the States

Washington State

There are three areas of activity that will positively affect LICSW practice if enacted in Washington State. The first is the long-sought ability to provide psychotherapy for injured workers who are struggling with emotional distress. A Task Force has been established by Labor and Industries to begin a pilot project allowing LICSWs to provide these services beginning in 2019.

Additionally, there is a project to allow LICSWs to perform mental health evaluations on those incarcerated who may have mental health problems. These people have waited months to get an evaluation about whether they are competent to stand trial, represent themselves, and whether they can be treated in the community. More clinicians are needed to speed up the evaluations. It appears that Department of Social and Health Services has a plan to include Masters clinicians to do evaluations. Details can be found at https://www.disabilityrightswa.org/cases/trueblood/#anchor.

Finally, there is a lawsuit that has been brewing in which an LICSW and an LMHC sued Group Health/Kaiser for refusing to cover psychotherapy for out-of-network providers in an ERISA plan. This was heard in the 9th circuit after four years of wending its way through state and federal courts and sent back to state court where it has a much better chance of a positive result. If you want to read a summary of the case, go to Law360 at https://www.law360.com/articles/1079535/erisa-doesn-t-bump-providers-state-law-suit-9th-circ-says. Congratulations to member Karen Hansen, LICSW, who is one of the plaintiffs.

I hope anyone with knowledge of legislative matters that affect LICSWs in your state will let me know so I can include them in this quarterly report.

Now – what I know you’ve been waiting for – your next Licensure Tip:

Record Retention – since HIPAA passed in 2003, there has been increasing confusion about how long clinicians should keep records following the termination of treatment. Each state has its own laws about record retention as do Medicare and HIPAA. Currently Medicare requires that records be retained for 5 years; the HIPAA Notice of Privacy Practices (NPP) for 6 years; clinical social work state laws and rules require retention anywhere from 3 to 8 years. Be sure to check your state to make sure you are in compliance on record retention for clinical social workers. In addition, the prudent clinician will make sure that record disposal is in compliance with HIPAA requirements, meaning that paper records are shredded to microscopic bits and that discarded computer hard drives are totally cleaned.

June 28, 2018

Here is your reminder that there are over 700 events this Saturday to promote returning the over 2300 immigrant children separated from their parents. Find the one near you at https://www.familiesbelongtogether.org/. CSWA encourages all members to support this crucial effort. Keep in mind some advocacy agencies are suggesting that protests NOT occur at the shelters where children are being housed. The police need to be called for crowd control, prevent attorneys and others from meeting with the children, and further traumatize the children.

Here is a summary of what else you can do to support getting families reunited:

Call the following numbers with the message below:

DHS main number: 202-282-8000

DHS Public Comment line: 202-282-8495

HHS main number: 877-696-6775

HHS Office of the Secretary: 202-690-7000

“I am a member of the Clinical Social Work Association and live in [your state]. Please make all efforts to get immigrant children reunited with their parents immediately and give them all due process in determining whether they are eligible to stay in the US.”

Now that the President has agreed to reunite families, we must keep up the pressure on the Administration to follow through. It is not too late to call your legislators with the above message as well.

As always, let me know when you have made your calls.

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

June 26, 2018

As the chaos of how immigrant children and their parents will get reunited continues, there is an ongoing need to plan to attend the rallies that will support this goal. Five major humanitarian advocacy organizations - ACLU, MoveOn, Human Rights Campaign, National Domestic Workers Alliance, and The Leadership Conference - are planning 130 rallies around the country next Saturday, June 30 to stop the damage being done to immigrant families. To find the rallies in your area go to https://act.moveon.org/event/families-belong-together/search/?source=ndwa.

NEW INCARCERATION PLAN: There is a new plan for immigrant children and their parents to be housed at military bases in Texas (https://www.military.com/daily-news/2018/06/25/pentagon-says-2-military-bases-house-immigrants.html). It appears that there will also be a renewed effort to separate children and parents, a plan that was temporarily stopped due to the massive opposition over the past two weeks. It is crucial to continue to let our voices be heard.

ACTION: Please send the following message to ALL MEMBERS of the House or Senate ASAP (emails and phone numbers can be found at https://www.congress.gov/members?q={%22congress%22%3A%22115%22}: “I am a member of the Clinical Social Work Association and a constituent. Please oppose the practice of housing of immigrant children and parents on military bases. It appears that there is still a strong effort to keep immigrant children separated from parents in such settings, causing trauma to them. Tell ORR and DHHS to stop the cruel methods being used on immigrant children and their parents now.”

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

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

June 21, 2018

CSWA is so committed to stopping the cruel immigrant policies of this administration toward children and families that we are going to send an action item a day for the next two weeks. If the damaging policies are still in place, we will continue. Some posts are from other groups, some are from our Government Relations Committee. Do your part and follow through with calls and emails.

As always, let me know when you have made your call or send your email.

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

June 20, 2018

Thanks to everyone who sent the Legislative Alert and CSWA Position Paper on “Rights of Immigrant Children” to their members of Congress. I know from the almost 100 confirmations I received that we did our part to inform Republican legislators about the harm being done to immigrant children from their parents.

LCSWs have a moral and professional responsibility to insure that any vulnerable people in our country receive the care they deserve. It was stunning to learn that before the terrible “zero tolerance” policy, there were already 10,000 immigrant children being held in custody by the Office of Refugee Resettlement. If one positive thing came out of the misery caused over the last 2-1/2 months, it is the awareness that there are many more children who need to be protected from the ‘shelters’ by untrained people that they are in. The so-called “tender age” shelters for children under 5 are nothing short of child abuse and need to be stopped.

You may have noticed that social workers were named as some of the workers overseeing the welfare of the children in these shelters. I am still trying to get confirmation of what that means. As we know, the term is often used without any social work education behind it or any clinical social work training on human development. Any qualified social worker who is engaging in this work is violating social work codes of ethics.

There are still unsolved problems. There is a law that says children cannot be kept in custody (the recent policy change aside) for more than 20 days. That could lead to further separations as immigrants wait for their court dates. The whole issue of the “Dreamers” and DACA is in need of a plan. CSWA will continue to work on these issues which are so connected to our values and our practices.

Please let me know if you have any questions.

November 15, 2017

As you may have heard, the Senate Finance Committee moved to partially fund the tax reform bill by attaching a repeal of the individual mandate to the tax bill yesterday. The individual mandate – a penalty for mainly healthy people who choose not to get insurance – is a significant part of what makes the Affordable Care Act affordable. Ending the penalty for not having health insurance will disrupt the insurance markets and raise premiums by allowing healthy people to choose not to buy health insurance.

According to the nonpartisan Congressional Budget Office (CBO), this proposed policy –the end of individual health coverage requirements – would save the federal government $338 billion by taking health insurance away from 13 million people and raising health care premiums at least 10% higher than they are currently. There have been other estimates that predict higher premiums of as much as 40%.

The House has already agreed to add this repeal to their own tax reform bill.

This development is one that CSWA strongly opposes. Please notify your members of Congress at https://www.house.gov/representatives/ and https://www.senate.gov/general/contact_information/senators_cfm.cfm with the following message: “I am a constituent and a member of the Clinical Social Work Association. I strongly urge you to oppose adding a repeal of the Affordable Care Act individual mandate to the tax reform bill in the Senate Finance Committee. Depriving 13 million citizens of health care they can afford is going to cost all of us more in emergency care and premiums. Tax breaks for the wealthy should not be at the expense of the health of many Americans. Vote against the repeal of the individual mandate.”

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

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

November 12, 2017

CSWA is part of more than 200 Groups Support Alexander-Murray Bipartisan Short-Term Legislation to Stabilize Premiums, Protect Access to Insurance.

View the letter submitted by the Mental Health Liaison Group (MHLG).