clinical social work association

Update - Social Work Interstate Compact

January 2023

Laura Groshong, LICSW, CSWA Director of Policy and Practice

Judy Gallant, LICSW, CSWA Deputy Director of Policy and Practice

As most of you know, CSWA has been working for over 2 years on a project funded by the Department of Defense and led by the Council of State Governments to develop the Interstate Compact for Social Workers for occupational licensing portability. Representatives from CSWA, NASW and ASWB have been working with the National Center for Interstate Compacts (part of the Council of State Governments) on the framework and language for a Compact to be put into place.

One question that has come up frequently is which levels of social work practice will be covered by the Compact. The answer is that all forms of licensed social work practice will be eligible to join the Compact, i.e., licensed clinical social work; licensed associate social work; and licensed bachelor social work practice. The only way a licensed social worker will be eligible to work through the Compact is to abide by the scope of practice established in the Compact language. For clinical social workers this means having met the standards for clinical social work licensure in their home state.

Another question that has come up often is whether LCSWs who have not taken the ASWB Clinical Examination will be able to join the Compact. If an LCSW was grandparented into licensure in their home state without taking the Examination, they do not need to take the examination to join the Compact.

The Compact, once finalized, will be distributed to stakeholders in each state and a campaign started to inform state legislatures and Boards of Social Work about the compact. The Compact will need to become law in at least 7 states in order for Social Workers to be able to participate in states that agree to accept it. Once we have a finalized document, we will also be informing you, our members, how you can best help advocate for this to be enacted within your state.

Unfortunately, even though we were expecting the Compact to be finalized by the beginning of 2023, this has not yet happened. Kendra Roberson, PhD, CSWA President, and Laura Groshong, LICSW, CSWA Director of Policy and Practice, along with others who have been working in the Technical Assistance Group, will be attending a meeting in DC in early February in order to finalize the Compact language. We are hopeful that the Compact will be sent to all states and jurisdictions shortly after that.

Because many state legislatures meet for limited amounts of time, frequently at the beginning of each year, it is unlikely that legislatures will be able to approve the Compact within 2023. It is more likely that legislatures will be considering, and hopefully, voting the Compact into law, in 2024. Once at least seven states have voted to approve the Compact, a Commission will be formed for the administration of the Compact. After the Commission is formed, additional states can still join the Compact.

Although this is not the timeline we would have hoped for, the compact is slowly but surely moving in the right direction. CSWA will update you as we get more information.

There are two issues which have been causing some confusion in the past couple of weeks that I would like to clear up:

1. Compact Delay – as you know, the Social Work Compact, which would allow LCSWs to practice in any state that joins the Compact, has been in development since October of 2021. CSWA President, Kendra Roberson, and I are members of the Technical Assistance Group (TAG) which has provided information about what the Compact should look like, along with representatives from other clinical social work and social work organizations. The process is being overseen by the Department of Defense and Council of State Governments. DoD and CSG had told us that the document, which will be submitted as bills to state legislatures, would be ready at the end of 2022. Unfortunately for several reasons, that deadline could not be met. Correspondingly, Kendra Roberson and I will be attending a meeting in Washington, DC in early February to finalize the document. We are hopeful that the document will be ready by early spring and will keep you posted on how to support the compact in your state legislatures when it is ready. CSWA knows how many members are looking forward to the Compact, as is CSWA.
2. Medicare Rules – there are two issues regarding new Medicare rules that have caused confusion. First, the need for in-person meetings with patients will not be put in place until 151 days AFTER the end of the Public Health Emergency. With many regions seeing increases in COVID and other viruses at this time, it is unlikely that the PHE will end any time soon. Second, the ability to see Medicare beneficiaries across state lines will not be in place until the end of the PHE as well. Please keep this in mind.  We are all looking forward to the ability to work across state lines. CSWA will let you know when that becomes a reality.

Please let me know if you have any questions on these issues.

Laura Groshong, LICSW, Director, Policy and Practice  
lwgroshong@clinicalsocialworkassociation.org

UPDATE: Medicare Coverage and Parity Changes for LCSWS

There continue to be questions about the change to Medicare policy about treating patients across state lines. Different regions have different policies in this regard. Look at the section in yellow below and call your MAC to get information about a region you wish to practice in. Here is more detailed information on the telehealth changes: https://telehealth.hhs.gov/providers/billing-and-reimbursement/medicare-payment-policies-during-covid-19/

Telehealth Policy Changes

The federal government announced a series of policy changes that broaden Medicare coverage for telehealth during the COVID-19 public health emergency.

Some important changes to Medicare telehealth coverage and reimbursement during this period include:

• Location: No geographic restrictions for patients or providers
• Eligible providers: All health care providers who are eligible to bill Medicare can bill for telehealth services, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
• Eligible services: See the list of telehealth services from the Centers for Medicare & Medicaid Services
• Cost-sharing: Providers can reduce or waive patient cost-sharing (copayments and deductibles) for telehealth visits
• Licensing: Providers can furnish services outside their state of enrollment. For questions about new enrollment flexibilities, or to enroll for temporary billing privileges, use this list of Medicare Administrative Contractors (MACs) to call the hotline for your area
• Modality: The 2022 Physician Fee Schedule has codified the ability for behavior health services to do audio only. It is still required to complete an in-person appointment every 6 months.

Mental Health Parity

There is one more piece of good news in the omnibus bill. You may recall that when the parity act passed in 2008 there was a loophole that allowed public plans to opt out of having a mental health benefit at all. That meant that they did not have to have a benefit AT PARITY with medical/surgical benefits. That loophole has been closed in the omnibus bill. This means a million more people will have mandated mental health treatment. More information can be found at https://www.thekennedyforum.org/blog/these-major-employers-have-opted-out-of-providing-adequate-mental-health-addiction-coverage/

H.R. 432, Mental Health Access Improvement Act

The Mental Health Access Improvement Act passed as part of the omnibus bill. This means that LMFTs and LPCs are now Medicare providers. Their reimbursement rates will be 75% of psychologist rates, like LCSWs, or 80% of their usual and customary rates, whichever is less. This is possibly more than what LCSWs are paid and CSWA will be looking into keeping LCSWs at the same reimbursement level.

These changes were passed by the House this morning so the President should be signing the bill shortly.

Happy Holidays!

Laura Groshong, LICSW, Director, Policy and Practice  
lwgroshong@clinicalsocialworkassociation.org

Congress just passed a $1.7 trillion spending bill which has some impact on LCSWs through Medicare coverage. Now it is up to the President to sign it. Here are the ways that our practices will be affected if all these changes take place on January 1, 2023:

This two-year extension is not without future implications. The bill instructs the Secretary of Health and Human Services to study how telehealth has affected Medicare beneficiaries’ overall health outcomes and whether there are geographic differences in use. It also calls for a review of medical claims data. The initial report is due by Oct. 1, 2024. 

One more item – the Good Faith Estimate is supposed to be given to patients every year so look at when you gave your patients their first GFE and prepare to repeat the process.

Please let me know if you have any questions about these changes.

Laura Groshong, LICSW, Director, Policy and Practice  
lwgroshong@clinicalsocialworkassociation.org

UPDATE: The rule addressing working across state lines is for LCSWs who are Medicare paneled and working with Medicare beneficiaries. This does not apply to LCSWs who are opted out, or not opted in or out. The rule does not apply to commercial insurers. 

CSWA would like to clarify information about the rules that CMS and Congress will be putting into place when clinicians provide telemental health treatment under Medicare when the Public Health Emergency ends.

No one knows when the Public Health Emergency (PHE) will end.  When it does, the following rules go into effect 151 days after the PHE ends.

1. Until 151 days after the PHE ends, you do not need to see anyone in person in order to provide telemental health treatment. After that time, CMS Guidelines require that you see a new patient one time in person before beginning to see that patient virtually. After that, you will need to see the patient in person once a year.
2. For patients you already see through telemental health treatment, you need to have seen them at least once in person within the past 6 months in order to continue seeing them virtually. If you have not seen them in person within the past 6 months, you will need to do so the first time you see them when the rules go into effect. After that initial in person session, you will need to see them again in person at least once per year.

While there is no requirement that the rules will apply to commercial insurers, they often follow the Medicare rules. At this time, there are no insurers who have said they will require the above rules.

Some of us no longer have a physical office anymore, are concerned about getting COVID, or want to avoid in-person meetings for other reasons. CSWA is working with the Mental Health Liaison Group (MHLG) and Congress to eliminate the requirement to see patients in person.

In short, there is no need to see patients in person currently. CSWA will let members know when or if this requirement goes into effect.

Happy holidays,

Laura Groshong, LICSW, Director, Policy and Practice  
lwgroshong@clinicalsocialworkassociation.org

LIST OF CHANGES TO MEDICARE TELEHEALTH SERVICES:

January 1, 2023  (updated November 1, 2022)

Here is some new information on Medical Telemental Health Coverage in 2023.

Postponing the Effective Date of the Telemental Health In-Person Six-Month Rule

In 2020, Congress imposed new conditions on telemental health coverage under Medicare, creating an in-person “exam” requirement alongside coverage of telemental health services when the patient is located at home. Under the rule, Medicare will cover a telehealth service delivered while the patient is located at home if the following conditions are met:

1. The practitioner conducts an in-person exam of the patient within the six months before the initial telehealth service starting 151 days after the end of the Public Health Emergency.
2. The telehealth service is furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder (other than for treatment of a diagnosed substance use disorder (SUD) or co-occurring mental health disorder); and
3. The practitioner conducts at least one in-person service every 12 months of each follow-up telehealth service starting 151 days after the Public Health Emergency.

While there is no requirement that this will apply to commercial insurance, they often follow the Medicare rules. At this time there are no insurers who have said they will require the above rules.

Behavioral Health
A new proposal is being finalized to create a new HCPCS code (G0323) describing General Behavioral Health Integration performed by clinical psychologists (CP) or clinical social workers (CSW). This code is to account for monthly care integration where the mental health services provided by a CP or CSW are serving as the focal point of care integration.

New Telemental Health Codes (Audio Only)
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

The following is a list of behavioral health ICD-10 codes that CMS will cover by audio-only through 2023 OR for 151 days after the end of the Public Health Emergency (PHE). To read the CMS statement go to the link above. Videoconferencing will be covered during the Public Health Emergency for the same codes that are used for in-person and also have 151 days after the end of the Public Health Emergency (PHE). 

There are two new codes – 0362T And 0373T – which are connected to integrated medical and behavioral health care.

Code     Short Descriptor of Telemental Health Codes for Audio-Only CPT Codes   

0362T   Bhv id suprt assmt ea 15 min      Available Through December 31, 2023       

0373T   Adapt bhv tx ea 15 min                Available Through December 31, 2023     

90785   Psytx complex interactive            Available Indefinitely            

90791   Psych diagnostic evaluation        Available Indefinitely   

90832   Psytx w pt 30 minutes                 Available Indefinitely 

90834   Psytx w pt 45 minutes                 Available Indefinitely 

90837   Psytx w pt 60 minutes                 Available Indefinitely 

90838   Psytx w pt w e/m 60 min             Available Indefinitely 

90839   Psytx crisis initial 60 min             Available Indefinitely 

90840   Psytx crisis ea addl 30 min         Available Indefinitely 

90845   Psychoanalysis                           Available Indefinitely 

90846   Family psytx w/o pt 50 min         Available Indefinitely 

90847   Family psytx w/pt 50 min            Available Indefinitely 

90853   Group psychotherapy                 Available Indefinitely 

Please let me know if you have any questions about these changes to Medicare mental health coverage.

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

The Aware Advocate is an occasional summary of issues that affect LCSWs. Comments and updates are courtesy of CSWA Director of Policy and Practice, Laura Groshong, LICSW.

There are many issues affecting clinical social workers at this time, some of which are still being determined. This summary will address the recent issues that members have had questions about, even if the outcomes are not clear.

National Elections

At this point, the election results for the House of Representatives are still not complete. The Senate will remain in Democratic hands. This means there will be a better chance that the two issues which CSWA has been working on for LCSWs, i.e., improving the CMS RVU rates for Medicare and getting student loan forgiveness for CSWs will have a better chance of passage.

CMS Coverage of Telemental Health

The bills which are addressing telemental health will continue to be developed but are not clearly defined yet.

The current policy of CMS is that coverage of psychotherapy through videoconferencing and audio only will continue for 151 days after the end of the Public Health Emergency (PHE). There is no imminent attempt to end the PHE, as COVID continues to mutate and is still a major problem in many areas. It is unlikely that the PHE will end before next spring at the earliest.

BetterHelp

Many CSWA members have been receiving requests to join the BetterHelp panel, as well as being bombarded with ads to use BetterHelp clinicians on NPR, in magazines, on TV, and just about everywhere. While the short-lived partnership with CareDash that BetterHelp formed last summer has ended, there have been other problems with the way that BetterHelp provides services. Dr. Marlene Maheu, the Executive Director of Telebehavioral Health Institute, has found that BetterHelp is a multi-billion dollar company despite putting most of the burden of liability on the clinician (TBHI Newsletter, 11/22).

Social Work Compact

After a few months of little activity on the Compact – which would allow participating clinicians to be automatically licensed in other states – it appears that the draft bill that will need to be passed in any state that wants to participate will be ready by the beginning of 2023! I will be sending you the bill and some information on how to get the bill through state legislatures.

I hope you all have a wonderful holiday season!

Licensed Clinical Social Workers (LCSWs) are the largest group of licensed mental health clinicians in the country, working in the public and private sector, providing psychotherapy and counseling on an individual, family and group basis in every state and jurisdiction. The acronyms below are the titles used in each state/ jurisdiction to designate independent clinical social work practice in that state.

Here is a list of the number of LCSWs in each state with the exact title used in that state. This data was collected from state social work Boards and administrators in September 2022. All LCSWs have requirements of two-three years post-graduate supervised experience and have taken a national examination. Most LCSWs are licensed to diagnose all mental health disorders in the Diagnostic and Statistical Manual-5-TR and future editions, and treat these disorders when appropriate. 

The following letter from the Council on Social Work Education (CSWE) was sent to all social work schools, programs and social work regulators on October 3, 2022.

As you know, CSWA has taken a stand on the recent ASWB report which noted alarming, disparate pass rates between white and Black MSWs, as well as between younger and older MSWs and between English speaking and bilingual MSWs (the whole position paper can be found here: https://www.clinicalsocialworkassociation.org/Announcements/12908309). While we believe that a Clinical Examination must be kept in place and that the CSWE recommendation that new MSWs no longer take the examination for new graduates be carefully reviewed, we are actively working toward engaging social work stakeholders and identifying viable and equitable solutions to this critical issue.

Please let us know if you have any questions about the ASWB controversy and/or recommendations about how to address these disparities.

Kendra Roberson, PhD, LICSW, President
Clinical Social Work Association  
president@clinicalsocialworkassociation.org

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

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October 3, 2022

As president and chief executive officer of the Council on Social Work Education (CSWE), I write to you on behalf of social work education programs across the country. As you are likely aware, the Association of Social Work Boards (ASWB) recently released a report documenting examination pass rates across different levels of the social work profession.

Although the data needs further analysis, the descriptive statistics suggest alarming disparities for exam takers in several categories. The most egregious disparity impacts Black test takers. In addition, Indigenous, and other People of Color also pass at lower rates than White test takers; those that speak English as a second language pass at lower rates than native English speakers; and older test-takers pass at lower rates than younger ones.

Given that the ASWB exam is the only national licensing examination available, these data raise grave concern that the need for a diverse health, behavioral health, and social service workforce (of which social workers are a considerable portion of providers1) is being significantly impeded.

As the national body for social work education in the United States, Puerto Rico, and Guam, the CSWE urges you to:

a. Suspend the use of the ASWB exam until a thorough analysis has been completed which will suggest evidenced based recommendations to correct for inequities.

b. Consider graduation from a CSWE Accredited social work education program evidence of beginning competence to practice social work as a professional social worker (granting all graduates licensure or pre-licensure status).

c. The only exception to the above involves the license to practice clinical social work. CSWE supports the need for a post-graduate process to license practice at this level, however if the ASWB exam remains central to this process, further analysis of the descriptive data must also occur for this category to identify possible issues.

d. Consider the action taken by the state of Illinois (January 1, 2022) through the Public Act 102-0326, whereby a licensing examination is no longer required for licensure as an Illinois Licensed Social Worker (LSW).

e. Consider decoupling the Interstate Compact, currently in development, from the ASWB licensure exam.

Thank you for your consideration. I would be happy to engage with you further about the concerns and/or recommendations I offer.

Sincerely,

Darla Spence Coffey, PhD, MSW  
President and Chief Executive Officer  
dcoffey@cswe.org

1 U.S. Bureau of Labor Statistics (bls.gov) 2020 report indicates there are 715,600 social workers that work in Child, Family, School, Healthcare, Mental Health, and Substance abuse treatment settings.

The U.S. House of Representatives just passed the Mental Health Matters Act, a bill that could significantly improve access to mental health and addiction care in this country.

There are two critical provisions within the bill: Strengthening Behavioral Health Benefits Act (Title VI) and the Employee and Retiree Access to Justice Act (ERISA, Title VII):

• The Strengthening Behavioral Health Benefits Act (Title VI) would provide civil monetary penalty authority to the U.S. Department of Labor (USDOL) to enforce the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which required insurers to cover mental health and addiction treatment at parity with treatment for physical health. The problem is that USDOL currently has one investigator for every 12,500 plans. USDOL has asked Congress to give it this authority with more funding for investigators.
• The Employee and Retiree Access to Justice Act (Title VII), would better protect the 136 million Americans enrolled in private sector employer (ERISA) health plans. This legislation would prohibit ERISA plans from inserting mandatory arbitration provisions into plan policies that prevent consumers from using the courts to challenge wrongful coverage denials. The Employee and Retiree Access to Justice Act also addresses “discretionary clauses” into their plan policies, which allows plans to decide what treatment is medically necessary when they consider adjudicating benefits under these policies.

Hopefully the Senate will take up this bill and we will see the kind of changes that are necessary to make mental health parity a reality. I will let you know when we need to support the bill in the Senate.

To see a summary of the Act go to: https://edlabor.house.gov/imo/media/doc/mental_health_matters_act_fact_sheet2.pdf

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