January 19, 2017

As you heard in the previous email, the Democratic caucus is asking us to contact our members of Congress to let them know that we want a reasonable replacement for the ACA before it is repealed. Here is what House Minority Leader Nancy Pelosi is asking of us at this time:

1. Send the following message to your own legislators: “I am a member of the Clinical Social Work Association and a constituent. Please oppose the repeal of the ACA without a replacement that includes mental health and substance use treatment as a continued essential benefit. Lack of access to mental health and substance use treatment leads to incredible suffering and loss of productivity. We have just included mental health and substance use at parity with medical care for the past year. Don’t bankrupt families with mental health needs by withdrawing the coverage they need and should have. [Name, Degree, License, Address]”.

You can find the contact information with your legislators at http://www.house.gov/representatives/ and http://www.senate.gov/general/contact_information/senators_cfm.cfm

2. Start collecting stories of patients, family members or personal experiences of how the ACA has made it possible to have access to mental health/substance use treatment or medical care that otherwise would have led to severe financial distress, personal suffering, family suffering, or loss of productivity at work. I will be sending you a list of legislators to send these stories to shortly.

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

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

January 19, 2017

CSWA was honored to be invited with other members of the Mental Health Liaison Group to attend a meeting about the fate of the Affordable Care Act last Friday. We were represented at the 2-hour meeting by our superb MHLG Delegate, Margot Aronson, LICSW, Deputy Director of Policy and Practice, along with representatives from American Psychological Association, Mental Health America, Families USA, NASW, American Foundation for Suicide Prevention – altogether nearly 50 health and mental health stakeholders.

Minority Leader Pelosi opened with her conviction that a strong and immediate grass roots effort can prevent the “Repeal and Replace Later” plan that is moving to a vote. There is no question that Repeal without a reasonable replacement will jeopardize coverage in current plans and throw the insurance market into chaos; a responsible approach to repeal would be to wait until a replacement plan has been developed, reviewed, and accepted. The great majority of Americans have indicated a preference for this approach: more than 49% want to keep the ACA (Kaiser Foundation) with some changes to improve coverage.

Representing CSWA, Margot spoke to the significant savings in healthcare and safety net costs down the road when mental health and substance abuse treatment are finally accessible and affordable when needed.

We need to show legislators how ACA coverage “prevented my family from losing our home because of a medical crisis”; how “a life-saving treatment was out of reach before the ACA but now I’m in full recovery and back at work”; and how “I was terrified if I got sick before I had ACA coverage” . Such stories – especially from constituents - resonate with members of Congress. Please gather these stories if you can and be prepared to send them soon.

Another email follows this one about what to do right now. We hope you are glad that CSWA is participating in the effort to protect health insurance (including mental health treatment!) for 30 million citizens through the ACA.

January 10, 2017

(N=248) Survey taken 12/10/16-12/28/16

Below are the results of the Survey sent to CSWA members to get their views on what they would like CSWA advocacy priorities to be in 2017. We asked people to choose one or two areas for each issue, realizing that our resources are limited. The percentages are how many of the respondents chose a given issue.

Choose one or two of the areas below as the primary place(s) advocacy efforts should be made around mental health parity and reform legislation.

Other (please specify):

Choose one or two of the areas below as the primary place(s) that advocacy efforts should be made around the Affordable Care Act.

Other (please specify):

Choose one or two of the areas below as the primary place(s) that advocacy efforts should be made around Medicare and Medicaid.

Choose one or two areas below as the primary place(s) that advocacy efforts should be made around diversity and civil rights.

Choose one or two areas below as the primary place(s) that advocacy efforts should be made around mental health treatment.

Please add any other comments or issues that you think should be considered.

Because of low reimbursement rates, it is very difficult to obtain an appt with a psychiatrist who accepts insurance. Those who do make up for this by scheduling far more appts than they can be competent with.. It is very difficult to find a therapist who works with more specialized diagnostic categories like trauma and accepts insurance because if reimbursement rates.

Hard to choose only 2 in each of the categories, but I think you're doing a terrific job of knowing both what's important and what CSWA can accomplish.

It's difficult to prioritize these lists as all these issues are important, now more than ever. I do believe that any reversal of prohibitions on conversion therapy would be extremely detrimental.

Stress that Treatment of mental disorders is prevention for other physical disorders and that focus on mental can reduce money needed for physical

Please consider that all members did not vote democrat and that some of us have much hope for positive changes with the new administration. Sometimes it feels like both the NASW and the LCSW society assume that all members stand on the left. I fall in the middle and would like to see many things change in our country. I live in a home where we are both self employed. I am tired of paying 1k a month for health care and this year going up to a 10k deductible, while politicians have 70 some percent of their insurance paid for. I am concerned that social workers really need to consider a role of advocating for a more empowered, anti-victim, self responsible approach to helping people. I believe he is for LEGAL immigration and for preventing the immigration of dangerous people, taking care of America first, as there are millions suffering here in our country. I did not renew my NASW membership because they represent the extreme left. I am in need of renewing my CSWA membership and I am unsure if I want to do so for the same reasons. Thank you for considering my comments.

Oppose challenges to mental health parity and changes that violate ethical standards and scope of practice within integrated healthcare system modalities.

Trump has alienated all or almost all minorities. I can't believe there will come a day that I would be literally afraid of the President and the rest of government

Insure parity for the treatment of mental health disorders--increase the embracement of compassion for all civil rights issues!

Thank you – 25

Please guide us on how to proceed - 3

I think all of these areas are incredibly important.

I think many more things are important than just one or two in each category, especially in light of the incoming administration.

Enforce parity in mental health care and use of pre-authorization in Medicaid programs. Major concerns for small businesses and cost of health care. Many of these citizens are mental health providers in private or small group practices. These individuals do not qualify for any reduced health care costs or grants.

I was not aware that some of these ideas were even being considered. Wow! Social workers need to work hard to keep human rights a part of our country in the coming years.

All of these are important; choosing is impossible. Most important maybe is protecting AND CONTINUED FUNDING for what mental health and substance abuse support we have now?

I am completely overwhelmed by all of the urgent and essential advocacy and human rights issues on our plates. It is virtually impossible for me to pick where to focus our efforts. I would advise us to pick issues where we think we can join with other groups and really make an impact.

Too much focus on negatives, need to focus on what to promote - 4

The new administration is a threat to mental health. We must do everything we possibly can to fight the reactionary provisions that would roll back the advances made in human rights and rights for the mentally ill. - 5

I think it is important that Medicare and Medicaid payments be comparable to private insurance "allowed amounts' for comparable mental health services.

Advocate fully funding for addiction tx in CARA Act

Standing up as a group against any continued public statements of hate or attempts at normalization of racism, sexual harassment, and anti- LBGTQ or immigrant threats. We have an obligation as health professionals, to point out the damaging effects of this rhetoric and demand that our highest leaders behave in ways that do not harm others in our country. Thank you for doing this survey and preparing!

Re: the ACA section: I would love to oppose complete overturn of ACA, but trust you have a better sense of whether that is a practical and achievable goal. Given the possibility that it's not practical, I picked the parts of it that seem most urgent to me. Though they do all seem important.

It's hard to choose only one or two options. I want to check all if the above - 7

While I would like to think that there will not be many changes, I think the focus for right now will have to be defensive to just keep what we have...at the same time, starting to design other studies and doing other research to lay the groundwork for best practices could be powerful with the right administration...who are our cheerleaders in the house and senate right now..

Increasing collaborative mental health services such as pharmacy, dietician, physical therapy, ministry in mental health facilities. Advocate for stricter rules to accredit mental hospital, including provider licensure review with continued education audit, increase advocacy for American psychiatrists, increase advocacy for 21st century cures, get more people discharged and healthier from mental facilities, not allow state mental hospitals to be a lifetime residence.

FIGHT LIKE HELL

Support expansion of Medicare – 5

Medicare is a great program. Most seniors seem fairly happy with it & believe it to be well run.

December 17, 2016

I am delighted to inform you that Margot Aronson, LICSW, CSWA Deputy Director of Policy and Practice and CSWA Vice-Chair of the Government Relations Committee, has been elected to the Mental Health Liaison Group Board of Directors.

MHLG is the premier mega-coalition nationally of mental health groups, having over 70members and affiliates. Margot has graciously and articulately presented CSWA’s positions on a wide variety of topics at MHLG for the past 10 years, building many relationships that have helped CSWA become an influential voice in this major mental health network. This dovetails well with the lobbying work that Margot and I do on behalf of CSWA with members of Congress, the White House, DHHS, CMS, and many other federal bodies that affect clinical social work practice. Congratulations, Margot!

On a related note, Margot and I ask everyone to take the 2017 Advocacy Survey which will help us develop CSWA priorities for advocacy work in 2017. There are many potential threats to our ability to provide clinical social work services and we need your help to make these almost impossible choices of where to put our energy. If you have already taken the Survey, thank you. If not, please do so by December 28 at https://www.surveymonkey.com/r/63CMWMF

As we face a difficult time for our country and clinical social work, CSWA is here to make sure our voices are heard.

We wish you happy and fulfilling holidays.

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

December 9, 2016

We have no doubt that the incoming administration will make changes in policies, laws, and regulations affecting clinical social workers and our clients. It is possible that some changes will make for long needed improvements. Others, however, may make it difficult for individuals needing mental health or substance use treatment to obtain care. Some may conflict with the ethical principles set out in our Code of Ethics. Still others could affect the cost of insurance, our reimbursement rates and the viability of our agencies and small businesses.

Even though the changes we anticipate now will be shifting and evolving as the new administration takes shape, CSWA is trying to begin formulating our strategy for advocacy.

The major areas below - based only what we have heard so far during the campaign and transition - are designed to provide context for considering how changes might affect our practices and our patients in the Trump administration. CSWA wants to hear from our members about which issues are of most concern in these areas.

You can access the Survey at https://www.surveymonkey.com/r/PPY8CQN. Please identify the two issues that cause you the most concern in each area, and add other concerns at the survey using this link by December 28. The results will be made available after January 1, 2017.

Thanks for your help in developing CSWA’s Legislative Agenda in 2017.

November 16, 2016

Thank you so much for the many messages that have already been sent to the Trump Transition Team. Margot Aronson and Laura Groshong greatly appreciate your letting them know when you have sent your message. If you have not yet done so, send your message as soon as possible; let Margot and Laura know when you have.

Many Society members who are not CSWA members have asked how they can help besides sending this message. One way to help is to join CSWA. As an independent organization, CSWA relies on individual members to continue our work.

If you are a member of the Societies that underwrite CSWA dues, you can take advantage of the way that these Societies have defrayed the cost of joining CSWA for their members. 

If you would like to have your Society offer this discounted rate, please have your leadership contact Karen Hansen, CSWA Society Liaison.

We must make our voices as clinical social workers heard. Join us in standing up for social justice and access to mental health treatment!

Regards,

Melissa, Johnson, LCSW, CSWA President

November 14, 2016

Certain statements made by President-elect Trump during the campaign for the presidency have been at odds with the Code of Ethics (2016) of the Clinical Social Work Association. Cultural competence and social justice are fundamental principles underlying the work clinical social workers do to improve the mental health and daily lives of everyone. Here are key concepts from the CSWA Code of Ethics:

II.5.a) The social work profession has a strong commitment to social justice. As such, clinical social workers shall strive to maintain awareness, knowledge, and skills with regard to cultural competence and its influence on human behavior and society.

II.5.c) Clinical social workers shall seek to become culturally competent and understand the effects of trauma caused by institutional and individual oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical disability.

VI. a) Clinical social workers do not, in any of their capacities, practice, condone, facilitate, or collaborate with any form of discrimination on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, socioeconomic status, or physical or emotional disability.

We believe that without adherence to these principles, our country will remain divided and polarized. Economic prosperity alone cannot overcome beliefs that condemn or reject some citizens based on ethnicity, religion, sexual orientation or other differences.

CSWA will continue to take an active role in support of legislation that would benefit the mental health community through our participation in the Mental Health Liaison Group and our advocacy on the Hill. We will continue to work with members of Congress on legislation that affects our patients and clinical social work practice.

CSWA urges all clinical social workers to participate in a broad grass roots effort to make the President-elect aware of our views. We need to let Mr. Trump know that we expect him to respect and protect the freedoms and rights of all Americans. Here is some suggested language, but we encourage everyone to express what is most important to them:

“I am a licensed clinical social worker in [your state]. I am concerned about troubling comments made by Mr. Trump during the campaign based on ethnicity, race, and religion. Our professional Code of Ethics does not condone any discrimination on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, socioeconomic status, or physical or emotional disability. I ask that your transition team develop policies that include respect for all our citizens as guaranteed by our Constitution. [Name, Title, Address, Email Address]”

Visit his transition team website and tell him your concerns. The stronger the grassroots presence we establish now, the better we will be better able to confront problems as they arise.

CSWA would like to hear from all clinical social workers who send a message to the transition team. Please contact Laura Groshong, CSWA Director of Policy and Practice, lwgroshong@clinicalsocialworkassociation.org or Margot Aronson, CSWA Deputy Director of Policy and Practice, at maronson@clinicalsocialworkassociation.org when you have sent your message.

October 27, 2016

As you know, CSWA has been involved in the Mental Health and Substance Use Disorder Parity Task Force (MHSUDPTF ) created in March, 2016, by President Obama. The goal of this Task Force is to look at the overall failure to enforce the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The Rules for MHPAEA, which become the basis for enforcement, were not implemented until 2014.

Today the MHSUDPTF issued its report. In addition to the 34-page report that was released, there was a 20- page report for consumers about their rights to mental health and substance use treatment. Both are worth reading. The authors of the Report, in addition to the President, included Departments of Treasury, Defense, Justice, Labor, Health and Human Services, Veterans Affairs, Office of Personnel Management, and Office of National Drug Control Policy. The comments submitted to the Task Force by CSWA can be found at the CSWA website (www.clinicalsocialworkassociation.org).

To find the Report go to http://www.hhs.gov/sites/default/files/mental-health-substance-use-disorder-parity-task-force-final-report.PDF.

To find the Consumer Guide go to http://store.samhsa.gov/shin/content//SMA16-4992/SMA16-4992.pdf.

While this is not a complete answer to the problems that many CSWA members and our patients have faced with coverage, it is a help. Remember that the Federal Government has oversight for ERISA – self-insured – plans. Private insurance plans, like Blue Cross, United, Aetna, etc., are overseen by the Insurance Commissioners in each state. This report only applies to ERISA plans, though it is likely to have an impact on private plans.

Members may have a special interest in #4 of the Consumer Guide which addresses how usual and customary out of network reimbursement rates are determined and how they can be questioned.

As always, please let me know if you have any questions about these documents.

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

September 27, 2016

Mental Health First Aid Act (H.R. 1877) passed the House yesterday by voice vote. This Act will be extended through 2021 through block grants to train first responders, law enforcement and teachers to assist anyone in a mental health crisis, and reduce stigma toward them.

The bill will expand grant eligibility for the SAMHSA program to include programs to train veterans and law enforcement on how to recognize and respond to persons with mental illness. The program previously only focused on teachers and emergency responders.

The Senate passed a similar bill (S. 1893) in January, 2016. The Senate version, introduced by Sen. Lamar Alexander (R-Tenn.), focused on youth mental health services.

The House and Senate hope to soon create a unified bill in conference they can send to the President Obama soon.

LCSWs may have opportunities to help provide this training. CSWA will provide more information as it is available.

This is the first of several bills that CSWA hopes will increase access to mental health treatment and support services in the next few weeks.

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

September 7, 2016

Changes to Medicare for LCSWs in 2017

As all CSWA members know, since 2012 LCSWs have been subject to the Physician Quality Reporting System (PQRS) which has affected reimbursement rates in a cumbersome and difficult way for the past 5 years. While the penalties that have been given for failure to comply with PQRS measures were relatively small (1-2% a year), the challenges of keeping track of the yearly changes to measures that LCSWs were supposed to report on have been a source off anxiety and frustration.

The good news is that for 2017 and 2018, LCSWs will not have to continue reporting PQRS measures. The PQRS measures are being rolled in to a new plan called Merit-Based Incentive Payment System (MIPS) which is part of the new Medicare formula for reimbursement, Medicare Access and CHIP Reauthorization ACT (MACRA) that replaced the very problematic Sustainable Growth Rate (SGR).

Though all LCSWs are free of the new reporting systems for now, it may be helpful to understand the changes that are coming to physicians and may be applied to LCSWs in 2019. They will apply to quality of care; cost of care; use of electronic record keeping; and activities that attempt to reduce the cost of care while improving quality in Medicaid.

The Quality measures for physicians and nurses in 2016 are currently defined as follows:

It is notable that Medicare describes the covered groups (physicians, nurses, physician assistants) as the “vast majority of behavioral health providers” in Medicare (http://www.thenationalcouncil.org/wp-content/uploads/2016/08/MACRA-Quality-PP-web-Final.pdf). There are 38,000 LCSWs that are currently Medicare providers, probably a much smaller group than the current number of primary care physicians and others providing psychotropic medication.

Keep in mind that LCSWs are still required to submit PQRS information for 2016 and will receive a Medicare reimbursement deduction in 2018 for failure to comply with PQRS reporting; see the CSWA website for 2015 measures which are the same as 2016 measures.

In the meantime, look forward to some time off next year if you are a Medicare provider from the PQRS measures. CSWA will continue to keep you informed about other changes to these reporting requirements.

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