The Aware Advocate: Focus on 2022 Medicare Changes
December, 2021 Laura Groshong, LICSW, CSWA Director, 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.
For more information and a template of what belongs in a GFE, go to the CSWA website under “Templates” in the Members Only section.
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, tThe 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 a still a hardship for some patients and LCSWs who have given up a physical office. CSWA will be working to eliminate this requirement.
For more information go to the CSWA website under “Legislative Alerts”.
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 privatizing 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!
Laura Groshong, LICSW, Director, Policy and Practice Clinical Social Work Association
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.
Laura Groshong, LICSW, Director, Policy and Practice Clinical Social Work Association email@example.com
Next Tuesday the Senate Finance Committee will have a hearing on funding for mental health and substance use programs. While this does not affect Medicare reimbursement or private insurance rates directly, increased funding will be helpful in those areas.
Please read the attached statement which CSWA developed with other mental health groups. We will keep you posted on the outcome of the hearing.
Laura W. Groshong, LICSW, Director, Policy and Practice
Report on Social Work Compact Meetings – October 4-5, 2021 Laura Groshong, LICSW, Director, Policy and Practice
The first in-person meeting of the Social Work Compact Technical Assistance Group (TAG) took place in the Hall of States in Washington, DC. Kendra Roberson, PhD, LCSW, CSWA President, and I were the representatives from CSWA. The development of a social work interstate Compact is sponsored by the Department of Defense and the Council of State Governments, a non-partisan agency which has many projects that work to facilitate interstate cooperation. What began as a way for military spouses to take a social work license to another state when a spouse was redeployed will become inclusive of all licensed clinical social workers. For more information on CSG go to https://Compacts.csg.org/Compacts/
Compacts require that the home state for an LCSW be the state of residence, not the state of practice. Currently, if an LCSW wants to have licensure in a state separate from their state of residence, they must become licensed in that state. Under the Compact, if a clinical social worker is licensed in a home state that is a member of the Compact, the LCSW will be eligible to apply to practice in other states that also are in the Compact.
Work of the TAG
The TAG will now meet every three weeks to:
TAG will develop the following:
All the above should be ready for the Document Drafting Team by February, 2022. TAG will meet every three weeks until Compact language is completed. I will continue to send updates on the progress of the Compact.
The Council of State Governments (CSG) is partnering with the Department of Defense (DoD) and a coalition of organizations, including the Clinical Social Work Association (CSWA), to develop new interstate compacts for the social work profession. These compacts will create agreements among participant states to reduce the barriers to license portability and employment. Participants will learn about the aspirations for the project; the function of interstate compacts and the development process; and the need for license portability in the social work profession.
Dan Logsdon: Dan is the Director of the CSG National Center for Interstate Compacts where he provides technical support and consulting regarding the development and enactment of interstate compacts. In recent years Dan has worked with a number of professional associations to develop new interstate compacts for occupational licensing portability including the American Occupational Therapy Association, American Counseling Association, and American Speech-Language-Hearing Association.
Matt Shafer: Matt is a program manager in the CSG Center of Innovation where he manages a portfolio of grant funded projects including the cooperative agreement with the Department of Defense to create new interstate compacts for occupational licensing portability. Matt also managed two Department of Labor grants focused on state occupational licensing policy and has extensive experience developing and building consensus on policy options for state leaders.
Keith Buckhout: Keith is a research associate in the CSG Center of Innovation and is primarily responsible for supporting the DoD Interstate Compacts project. Keith came to CSG after several years of working with licensure issues in state government in Kentucky.
No matter what one’s position about abortion might be, the Texas abortion law, SB 8, that became operational on September 1st must necessarily raise grave concerns. This law, prohibiting abortions as early as six weeks after conception, not only denies women in Texas their constitutional right to health care, but criminalizes the participation of anyone who “aids and abets” a woman seeking an abortion. (To read the full text of SB 8, go to https://capitol.texas.gov/tlodocs/87R/billtext/html/SB00008E.htm )
SB 8 poses an immediate threat to Texas LCSWs. Using the consulting room to help clients work through the often traumatic decision to abort may now be seen as “aiding and abetting” in Texas. Texas law is indirectly telling us that LCSWs can no longer provide a compassionate safe place for our patients to discuss difficult choices when an unwanted pregnancy occurs (no exceptions for rape or incest) without risking a $10,000 fine and attorney’s fees.
Limiting what can be talked about in the therapy session undermines our ethical standards and the confidentiality we guarantee, but there is another element of this new law that is even more chilling: enforcement of this new law is placed in the hands of private citizens, incentivizing a ‘bounty-hunter’ approach designed to intimidate. Further, a spouse or family member who perceives an LCSW as supporting an abortion could report the clinician to authorities.
Purposely drafted to make it difficult to challenge in court, SB 8 carries the stench of Jim Crow, disproportionately impacting people of color, people with low-income, and other historically marginalized communities. Nonetheless, legislatures in several other states are already drafting copycat legislation.
The disappointing refusal of the US Supreme Court in a 5-4 decision to consider the Texas law - with vigorous dissent from Chief Justice Roberts and Justices Sotomayor, Kagan, and Breyer - leaves the law in place for now. However, some of the organizations actively fighting this blatantly unconstitutional law include the Lilith Fund, Whole Woman's Health Alliance, Inc., Texas Equal Access Fund, Jane's Due Process, Clinic Access Support Network, Support Your Sistah at the Afiya Center, West Fund, Fund Texas Choice, Frontera Fund, and The Bridge Collective, and the ACLU. New challenges have already been filed.
The Aware Advocate
An occasional newsletter from CSWA on topics that are relevant to clinical social work practice
Laura Groshong, LICSW, Director or Policy and Practice
Though we are in the dog days of summer, there are many things going on that affect our clinical practices. CSWA is pleased to offer information on the following four topics that are currently affecting us: (1) ways to determine what the COVID risk is in your area are by county; (2) a template for writing letters that confirm medical necessity when insurers question the validity of our treatment; (3) an update on the Physician Fee Schedule which will affect our reimbursement in 2022; and a (4) a member survey to determine where people stand on the decision to return to in-office practice and additional topics to gauge ways to better support members.
The rise in COVID-19 cases due to the new Delta variant and others is cause for concern. But in this case, as in much of the pandemic, all concerns are not created equal. To understand the risk we face on the personal and professional level, it is necessary to get information that is specific to our location. The CDC has just created a new data base that provides the current level of infection for every county in the country. The COVID Data Tracker is updated daily and can be found at https://covid.cdc.gov/covid-data-tracker/#county-view CSWA suggests that whether you live in an area that is a hot spot for infection or one with low levels of infection, it is prudent to continue to wear masks and maintain social distance of 6 feet in public indoor areas.
The topic of whether to return to seeing patients in person is also on the minds of LCSWs. Please see the two hour webinar I recorded on July 22 to get detailed information on how to make your own decision about what is best for you. You can find it at https://www.clinicalsocialworkassociation.org/CSWA-Webinars#ToBe in the Members Only section.
To give members an overview of the way others are viewing returning to the office, CSWA is asking all members to take the short anonymous Survey to gather this information:
Please click here to complete the survey
More and more often, LCSWs are receiving letters questioning the “medical necessity” of our treatment. To address these often baseless conclusions, CSWA has developed the response template which you may use to explain the validity of your treatment decisions. Click here for the MEDICAL NECESSITY LETTER [Template]
Physician Fee Schedule
As happens every August, the Center for Medicare and Medicaid Services (CMS) has issued potential changes to the rules that govern all medical practice which includes clinical social work practice. The CSWA Government Relations Committee is developing comments on this year’s PFS and will send them to members before the August 23 deadline for review.
Thanks for your support of CSWA and have a great summer!
There is much information coming out about the level of risk we face at this time to the COVID-19 virus. There are several new variants, particularly the Delta variant, which are spreading quickly. The unvaccinated population varies widely and is a major factor in the likelihood of infection, even for those that have been vaccinated.
This surge, which just resulted this weekend in Los Angeles returning to mask-wearing in public places, comes at the same time that many LCSWs are starting to consider returning to seeing patients in person. CSWA is offering a 2-hour webinar on this complex topic on July 22, 2021, at 1 pm EDT (see www.clinicalsocialworkassociation.org to register).
While it is very difficult to fully assess the level of risk that LCSWs face in going back to our offices or other small spaces like restaurants, we can educate ourselves about our own city/region. Here are some articles to help with that process:
Currently, 48.9% of the US population has been fully vaccinated and another 7.6% have been partially vaccinated. The US COVID-19 new case and fatality rate 7-day averages have doubled in the last two weeks (see "Coronavirus in the U.S.: Latest Map and Case Count" at (https://www.nytimes.com/interactive/2021/us/covid-cases.html).
Despite growing evidence that vaccination curbs mutation (see "COVID-19 Vaccines May Be Curbing New Virus Mutations", (https://www.medscape.com/viewarticle/954621), the political (and largely regional) rift between the vaccinated and unvaccinated is growing (see "Coronavirus latest: Chicago adds Delta-variant hotspots Missouri and Arkansas to advisory list" (https://www.ft.com/content/95716f06-c92d-4f9a-b2f7-30e30ce7cb22 ).
WHO Director-General Tedros Adhanom Ghebreyesus said " The Delta variant is ripping around the world at a scorching pace, driving a new spike in COVID-19 cases and death," noting that the highly contagious variant, first detected in India, had now been found in more than 104 countries, deaths are again rising and many countries have yet to receive enough vaccine doses to protect their health workers (see " WHO Says Countries Should Not Order COVID-19 Boosters While Others Still Need Vaccines" (https://www.medscape.com/viewarticle/954643 ).
Where COVID restrictions are loosening, anxiety is increasing according to this Medscape article: https://www.medscape.com/viewarticle/954793 . New psychotherapy patient calls (already at a record high since the pandemic began) have risen dramatically during the past week.
Several members have pointed out the part of the CDC guidance that is aimed at health care providers:
“The guidance reiterates the need for health care providers to continue using personal protective equipment (PPE) in health care settings. Continuing to use telehealth strategies while maintaining high-quality patient care remains the prudent option in many circumstances.”
This guidance is likely to apply to hospitals and high-volume medical offices. In the typical LCSW office, LCSWs are vaccinated, patients are seen one at a time, waiting rooms and restrooms are often still not being used, HEPA filters are still being used in the office, and patients who are not vaccinated are not being seen in person. Under these circumstances, the risk of passing on COVID-19 by seeing patients in person who are vaccinated is low.
As noted in the previous post, LCSWs with weakened immune systems should continue to use masks and have patients do so as well, if patients are seen in person.
Laura W. Groshong, LICSW, Director, Policy and Practice Clinical Social Work Association
Today the Centers for Disease Control (CDC) announced new guidance on the use of masks indoors. This guidance has a direct impact on the way LCSWs practice psychotherapy.
The CDC now recommends that people who are fully vaccinated can meet indoors without wearing a mask or physical distancing. This is a relatively sudden shift from two weeks ago and is reflective of the increased level of vaccination that has occurred, About 117 million US citizens are now vaccinated and 154 million have received one vaccine dose. The recent expansion of vaccination for 12-15 year old children will further increase the number of citizens who are vaccinated. COVID-19 variants should be stopped by the vaccines available.
There is no mention of whether building air filtration systems or in office HEPA filters are useful. It may be a good idea to maintain the use of HEPA filters until herd immunity has been reached.
One factor that may lead to continued use of masks and physical distancing are for people who have immunosuppressed or weakened immune systems from organ transplants, cancer treatment or for other reasons. This of course applies to us as LCSWs as well as patients.
Let me know if you have any questions about the recent CDC guidance on protections against COVID-19.
Laura W. Groshong, LICSW, Director, Policy and Practice Clinical Social Work Associationlwgroshong@clinicalsocialworkassociation.org
PO Box 105Granville, Ohio 43023