May 17, 2022

The Improving Access to Mental Health Act (S.870), which CSWA has been supporting since 2012, has provisionally been included in the omnibus mental health legislation package being developed by the Senate Finance Committee. The request from the Committee is that we find more Republican cosponsors for the bill. This needs to happen by Friday, May 20, 2022 COB.

To review the high points of this bill, they are:

The Committee members/Legislative aides that are most important to this effort are:

Sen. Mike Crapo (R-ID): Rebecca Alcorn, Senior Policy Advisor, rebecca_alcorn@crapo.senate.gov

Sen. Chuck Grassley (R-IA): Nic Pottebaum, Health Policy Advisor, nic_pottebaum@grassley.senate.gov

Sen. John Cornyn (R-TX): Alaura Ervin, Legislative Assistant, alaura_ervin@cornyn.senate.gov

Sen. John Thune (R-SD): Danielle Janowski, Health Policy Director, danielle_janowski@thune.senate.gov

Sen. Richard Burr (R-NC): Angela Wiles, Health Policy Director (HELP Committee), angela_wiles@help.senate.gov

Sen. Rob Portman (R-OH): Jack Boyd, Health LC, jack_boyd@portman.senate.gov

Sen. Pat Toomey (R-PA): Mike Weiss, Health LA, mike_weiss@toomey.senate.gov

Sen. Tim Scott (R-SC): Brianna Wood, Legislative Correspondent, brianna_wood@scott.senate.gov

Sen. Bill Cassidy (R-LA): Mary Moody, Health Policy Advisor, mary_moody@cassidy.senate.gov

Sen. James Lankford (R-OK): Cambridge Neal, Legislative Assistant, cambridge_neal@lankford.senate.gov

Sen. Steve Daines (R-MT): Rachel Green, Health Policy Advisor, rachel_green@daines.senate.gov

Sen. Todd Young (R-IN): Beth Nelson, Health Policy Director, beth_nelson@young.senate.gov

Sen. Ben Sasse (R-NE): Shannon Hossinger, Policy Advisor, shannon_hossinger@sasse.senate.gov

Sending the following message to the LAs is a good way to make contact with the senators. You can send your message even if you are not a constituent.

The suggested message is as follows (feel free to use your own language):

“I am [a constituent and] a member of the Clinical Social Work Association. Please consider becoming a cosponsor for S.870 which will provide greater access to mental health and substance use treatment, desperately needed in these difficult times. S. 870 will increase the number of LCSWs who become Medicare providers. Thank you for your consideration.”

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

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

April 27, 2022

I have received a deluge of emails from you about the use of POS “10” for Medicare and other insurers. This guidance that Medicare has provided about this policy is complicated.

The current guidance from CMS is that:

• POS “11” should be used until the end of the Public Health Emergency, timing of which is currently unknown, even though this is not what the POS “11” is for.
• And, as of April 4, 2022, there is some variation according to Medicare Administrative Contractors (MACs) about whether or not to move to POS “10” as initially stated by CMS.
• Check with YOUR MAC to clarify which POS code is being accepted currently if the patient is being seen through telemental health in their home; for example, technically, if a patient is in their car, the POS code should be “02”.
• You can find your MAC contact information at the CSWA website under “Clinical Practice”.
• The Medicare Modifier for POS codes is still 95. This may seem counterintuitive as 95 is supposed to be for telemental health but it is the only combination that currently works.

Be sure to check with EACH private insurer for a patient to find out what combination of POS and Modifier are being requested so that claims will not be denied.

I hope this resolves the confusion about POS codes. Let me know if there are any other questions.

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

April 24, 2022

There has been some confusion about what Point of Service (POS) Codes should be used for Medicare and other insurers as of April 1, 2022.

As you know, there were changes to POS codes that were announced as of January 1, 2022 to be “available” for Medicare as of April 1, 2022. POS “10”, a new POS code for telemental health services that are provided when the patient is in their home, and the LCSW is in their office or elsewhere. Other POS Codes are “2” which is used when a patient is not in their own home and receiving telemental health services from an LCSW or “11” which is used when seeing a patient in the LCSW’s office.

The Medicare modifier is 95 for any of the above codes.

It appears that the POS 10 is now being used instead of POS 2 for Medicare for reimbursement. All other insurers, public and private, should be contacted about the POS codes that are required for reimbursement of claims. The same goes for which modifier is being used – check with the individual insurer.

For more information, go to https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set If you have other questions, contact me at lwgroshong@clinicalsocialworkassociation.org.

March 28, 2022

Transgender children have been in the crosshairs of conservative groups in the legislature and elsewhere for the past decade. Amongst legislative attempts to discriminate against them, there have been attempts to ban them from gender-specific bathrooms or from participating in sports consistent with their gender identity. Support for transphobic attitudes and actions has grown. Now there is an attempt in Texas to lay blame on parents who affirm their child’s gender identity. This bill is one of the most harmful to trans children, but is the tip of the iceberg; there have been over 235 state-based bills that limit the rights of trans children in 2022 (https://www.msn.com/en-us/news/us/nearly-240-anti-lgbtq-bills-filed-in-2022-so-far-with-most-targeting-trans-people/ar-AAVhMSa). The current law that has passed in Texas, abhorrently describes parental support of trans children as child abuse; though, for now, it has been placed on hold by a Texas appeals court.

CSWA believes that gender identity is an integral aspect of our intersectional identities and that children’s rights to express their identities, and to participate in everyday activities of childhood, regardless of this expression, should be protected. LCSWs work with trans-children and adults who have been harmed because their trans identities. To our affiliated colleagues in the Texas Society for Clinical Social Work, we send our support and encouragement to stand strong. No law can persuade us to ignore our ethical stance on respecting the identity of any individual child, and for parents that support and affirm their children. Also notable, the Texas law does nothing to prevent the violence directed toward trans BIPOC youth for being themselves. This violence has increased at alarming rates in the last few years.

As reported by Forbes, 30 trans youth were killed in 2020, including 23 that were BIPOC youth. (Forbes, “Transgender America: 30 Killed And Fatally Shot Already In 2020”, 10/2/20, https://www.forbes.com/sites/jamiewareham/2020/10/02/30-trans-woman-have-now-been-violently-murdered-in-america-in-2020/?sh=296cb38564a4). The work of groups like GLAAD (glaad.org), the Trans Youth Equality Foundation (http://www.transyouthequality.org/), and the Transgender Law Center (https://transgenderlawcenter.org/) are crucial to educating the public and advocating across multiple domains to prevent transphobic violence and discrimination against trans youth and their parents. CSWA supports the work of these groups in preventing harm and protecting trans children.

March 1, 2022

President Biden’s State of the Union address tonight will have a major focus on the need for more mental health funding and services. A few of the areas he will discuss are:

To see a complete summary of what the President will discuss regarding mental health go to: https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/

CSWA will provide a message to send to Congress, who will have to approve the funding and policy measures regarding mental health, on the issues that most affect clinical social workers following the State of the Union speech.

February 1, 2022

As you have no doubt heard, the Public Health Emergency (PHE) will end on May 11, 2023. Continued coverage for telemental health treatment may depend on the insurance your patient holds when the PHE ends. Here is what we know currently.

Federal Government

CMS, which oversees Medicare and Medicare Advantage, has already announced that these programs will cover telemental health through December 31, 2024. CMS is reviewing the use of telemental health treatment and will make a decision, along with DHHS, about the future of expanded telemental health coverage after the end of 2024.

Some members of Congress are wanting to end the PHE immediately. The Senate and the President will not agree to this, so it is extremely unlikely that this will happen. Regardless, it will not affect the coverage of telemental health by Medicare and Medicare Advantage at this time.

Medicaid

All 50 states and DC expanded coverage and/or access to telehealth services in Medicaid during the PHE. When the PHE ends, coverage for telehealth services may be tied to federal and/or state PHEs. Most states have made, or plan to make, some Medicaid telehealth flexibilities permanent.

Commercial Insurers

It is likely that some commercial insurers will no longer cover telemental health after May 11, 2023. I have heard that LCSWs have been told that telemental health will no longer be covered by commercial insurers NOW. Those companies should be reported to your Insurance Commissioner. As long as the PHE is in effect, telemental health should be covered.

Communication about commercial insurance has been spotty, so have patients check with their insurers. Some states, but not all, are putting laws into effect that will require commercial insurers to cover telemental health treatment.

Free Vaccines and COVID-19 Tests

Separate from the coverage of telemental health, the end of the PHE creates changes about who may receive free vaccines and COVID-19 test kits. A good summary of the changes that are coming has been put together by Kaiser Family Foundation at https://www.kff.org/coronavirus-covid-19/issue-brief/what-happens-when-covid-19-emergency-declarations-end-implications-for-coverage-costs-and-access/#coverage-costs-and-payment.

The Possible Impact on LCSWs

Many of us have converted our practices to exclusively provide telemental health and some us no longer have physical offices. The end of the PHE may require us to reconsider these decisions if telemental health does not continue in the way that we have been using it.

There is a lot of uncertainty at the moment, and CSWA will do our best to give you timely and accurate information about the situation.

January 26, 2022

I hope everyone is feeling well informed about the Good Faith Estimate rule, part of the No Surprises Act, which went into effect on January 1. There have been several webinars on this topic and one was listed on the CSWA website in the Members Only Section.

CSWA is working on two fronts to get LCSWs exempted from the GFE. One is a letter we co-wrote with the Psychotherapy Action Network (attached). The other is a campaign to let members of Congress know about the fact that LCSWs in private practice do not need to be part of the GFE; we already do everything that it requires and there are vanishingly low numbers of LCSWs who have had actionable complaints filed against them for surprise billing.

Please send your members of Congress at www.Congress.gov the following message: “I am a constituent and a member of the Clinical Social Work Association. The No Surprises Act requires me as a Licensed Clinical Social Worker to give my patients a Good Faith Estimate. I am in private practice and have patients pay me directly. The GFE interferes with the mental health treatment process (detailed in the attached letter). Please exempt LCSWs from the Good Faith Estimate requirements.”

NSA Letter to CMS (fin.) - 1-25-22.pdf

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

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

January 20, 2022

In the rush to figure out the Good Faith Estimate, another important issue has been on the back burner.

As you know, the No Surprises Act also had a provision that we see every patient at least once every 12 months. This was extended from the previous rule which required this provision every 6 months.

With recent guidance from CMS, it is now clear that this requirement will go into effect after the end of the Public Health Emergency (PHE). That is not likely to be before the end of 2022 at the earliest.

CSWA is hoping to work with many other mental health groups to eliminate this rule. We will keep you posted.

December 20, 2021

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

There are a number of issues that are affecting LCSW practices in the waning days of 2021, particularly in the area of Medicare (which we know affects commercial insurance heavily). These issues are: 1) giving patients a “Good Faith Estimate” of what the treatment we provide will cost; 2) elimination of 2022 cuts to Medicare reimbursement; 3) telemental health coverage; and 4) DCEs. Discussion of each of these follows.

Good Faith Estimates

This rule requires us to give a “good faith estimate” (GFE) to a patient of what our services will cost and how long they may last. While this policy is part of most of our informed consent forms, signed by the patient already, it is prudent to review what the GFE is more formally requesting we include in our information to the patient. The main difference about past practices and the GFE is that it applies to private pay patients as well as insured patients and uninsured patients.

Medicare Cuts Stopped

LCSWs can take a deep breath as Congress has acted to prevent the trio of Medicare payment cuts that were set to take effect at the beginning of 2022—a 3.75% cut due to scheduled changes in the Medicare Physician Fee Schedule (“PFS”), a 2% cut for Medicare sequestration, and a 4% Statutory Pay-As-You-Go Act (“PAYGO”). These Act cuts would have slashed Medicare payments by nearly 10% during a tumultuous time for healthcare. Instead, The Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) was approved by the U.S. House of Representatives on December 7 and passed the U.S. Senate on December 9, 2021. The bill has been sent to President Biden’s desk for his signature.

The Protecting Medicare and American Farmers from Sequester Cuts Act includes:

This is the second year that a last-minute change stopped a substantial reimbursement cut for LCSWs. CSWA will be encouraging CMS and Congress to stop these attempts to balance the Medicare budget on the backs of clinicians moving forward.

Telemental Health Coverage

As you know, CMS issued a new rule last month to expand telemental health and audio only psychotherapy through 2023. You also know we are still unable to practice across state lines unless we are licensed in the state where the patient resides and/or there is still increased reciprocity in the state where the patient resides. CSWA is still working with Department of Defense and the Council of State Governments to create a “Compact” that will make it much easier to work across state lines; it should be ready to begin implementing in early 2023.

The requirement that LCSWs see patients in person every 6 months has been extended to every 12 months. This is still a hardship for some patients and LCSWs who have given up a physical office. CSWA will be working to eliminate this requirement.

Medicare Direct Contracting Entity

Over the past decade, over 50 models of delivering health care through Medicare have been explored, with the goals of lowering costs for dual-eligibles; eliminating access to care, based on economic disparities; and, moving away from a fee for service (FFS) payment model. The last goal has an impact on LCSWs in private practice who have used the FFS model for some time.

A new model has been emerging called the Medicare Direct Contracting Entity (MDCE). It is similar to the Accountable Care Organizations that have been in use for the past five years but is run by commercial for-profit agencies. CMS has started to ‘assign’ beneficiaries who are in traditional Medicare to MDCE plans without consent. There is concern that this could lead to the privatization of Medicare which would have the same difficulties that commercial insurance for-profit plans have, i.e., the focus on profit leads to diminished health care services.

Surgeon General Report on Youth Mental Health

U.S. Surgeon General Vivek Murthy, MD, released an advisory statement on December 7 to highlight the urgent need to address the nation’s youth mental health crisis, “Protecting Youth Mental Health” (PDF, 1.01MB). This excellent document outlines the COVID-19 pandemic’s harm to the mental health of America’s youth and families, as well as the mental health challenges that had accumulated before the pandemic began. CSWA is delighted to see the Surgeon General paying attention to this increasingly difficult situation.

CSWA wishes you a happy and healthy holiday season!

December 14, 2021

I want to call your attention to a new rule from CMS that will go into effect on January 1, 2022. This rule requires us to give a “good faith estimate” (GFE) to a patient of what our services will cost and how long they may last. While this policy is part of most of our informed consent forms, signed by the patient already, it is prudent to review what the GFE is more formally requesting we include in our information to the patient about the course of their treatment. The main difference about past practices and the GFE is that it applies to private pay patients as well as uninsured patients.

There is a CMS template for providing this information which can be found at good faith estimate (PDF, 130KB). However, this 8-page document is more applicable to hospital stays and procedures. It may be more helpful for LCSWs to make sure they have the following information in their informed consent or verbally transmitted and documented.

Here is a list of what belongs in the GFE (which can also be part of an informed consent or disclosure statement) for private practitioners:

This information can be transmitted orally but should be given to the patient as soon as possible. For ongoing patients, there should be a new informed consent or GTE statement provided with the information above. CSWA will provide a template for this shortly.