The Aware Advocate
An occasional newsletter from CSWA on topics that are relevant to clinical social work practice
August, 2021
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.
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COVID Issues
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
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Medical Necessity
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]
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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
The project sponsored by Department of Defense and Council of State Governments to create an interstate compact for clinical social workers is moving along. CSWA is one of the three main stakeholders. The formal kickoff will be on May 20 at 2 pm EDT. All CSWA members are invited to attend. This meeting is informational but will be helpful in giving an overview of how the project will move forward.
The event is free but you must register which you can do at https://csg-org.zoom.us/meeting/register/tZUqdOqqpz8jE9JjZpkwTn2_gHKIuCbtRmpN
To see the original announcement of the event go to https://www.defense.gov/Newsroom/Releases/Release/Article/2537098/dod-receives-approval-for-grants-to-develop-interstate-compacts-for-licensure-p/
I hope to “see” you at this Zoom event. Let me know if you have any questions.
Laura W. Groshong, LICSW, Director, Policy and Practice Clinical Social Work Association lwgroshong@clinicalsocialworkassociation.org
CSWA "The National Voice for Clinical Social Work"Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY
We at CSWA collectively breathed a sigh of relief yesterday as the guilty verdicts for ex-officer Derek Chauvin were read by the judge. We acknowledge the monumental task of the prosecution team, the on-going protests by people around the world, each sign posted on a lawn or in a window, each hashtag crying for justice for George Floyd. This decision, after years of police murders of Black and Brown people with no accountability, is one to celebrate. The guilty verdicts serve many purposes; they break the long-standing policy of acquittal for police who have murdered Black and Brown people. They affirm what was a matter of fact – that George Floyd’s life was taken without cause. They provide a way forward that is necessary in dismantling unjust, rogue policing that has created a justifiable mistrust in institutions we all should feel protected by.
CSWA stands in support of these verdicts. We consider it the duty of all citizens, and clinical social workers in particular, to repudiate institutionalized racism and support policies that further encourage police accountability. One such potential law is the George Floyd Justice in Policing Act of 2020 introduced in June, 2020, passed by the House last month. A summary of H.R. 7120 is listed below.
This bill addresses a wide range of policies and issues regarding policing practices and law enforcement accountability. It includes measures to increase accountability for law enforcement misconduct, to enhance transparency and data collection, and to eliminate discriminatory policing practices.
The bill facilitates federal enforcement of constitutional violations (e.g., excessive use of force) by state and local law enforcement. Among other things, it does the following:
H.R. 7120 would also create a national registry—the National Police Misconduct Registry—to compile data on complaints and records of police misconduct. It establishes a framework to prohibit racial profiling at the federal, state, and local levels.
Finally, H.R. 7120 establishes new requirements for law enforcement officers and agencies, including to report data on use-of-force incidents, to obtain training on implicit bias and racial profiling, and to wear body cameras. CSWA will be advocating for passage of this bill.
Today the Department of Justice has announced a full investigation of a “possible pattern of misconduct” of the Minneapolis Police department. CSWA welcomes this investigation and hopes it will be one step forward, with many more needed, in the fight for a socially and racially just America.
Kendra Robeson, LICSW, President Clinical Social Work Association president@clinicalsocialworkassociation.org
Below is an excellent summary of the legal protections for telehealth services, including behavioral health treatment, in all 50 states and District of Columbia (seven states do not have laws about telehealth coverage including AL, ID, PA, NC, SC, WI, WY) put together by the law firm of Foley and Lardner. The link is https://www.foley.com/-/media/files/insights/publications/2021/02/21mc30431-50state-telemed-reportmaster-02082021.pdf
The areas covered include state laws about coverage for telehealth and audio-only treatment; reimbursement requirements; how long coverage will last; the actual language of the laws in each state; and more.
Even if you think you know your state’s laws about telemental health, this is a good review and offers ways to improve telemental health laws based on what other states have done.
Let me know if you have any questions about this information.
Laura Groshong, LICSW, Director, Policy and Practice Clinical Social Work Association lwgroshong@clinicalsocialworkassociation.org
CSWA is thrilled to see President Biden’s new executive orders today which will be huge steps toward anti-racism and true equity in our country. They are:
In addition, President Biden is embedding racial equity in all Federal agencies. The President wants his team to serve as a model on diversity, including hiring, purchasing, data and access. He has called racial inequality one of the four “converging crises” facing the nation.
To hear the President’s complete remarks on his new policies go to https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/01/26/remarks-by-president-biden-at-signing-of-an-executive-order-on-racial-equity/ .
CSWA is about to begin a series of six presentations on “Racism and the Clinical Process” in a virtual collaborative format on Wednesday evenings. For more information go to https://www.clinicalsocialworkassociation.org/event-4134868.
CSWA encourages all members to join us in the anti-racism effort which is finally being addressed at the Federal level.
Kendra Roberson, PhD, LCSW, President Clinical Social Work Association cswaorg.pres@clinicalsocialworkassociation.org
CSWA leadership has been trying to come to terms with the hatred unleashed by our President and his followers on January 6, the very real threat to our democracy, and the blatant racist actions that were on full display.
CSWA first reached out to our members, mindful of the traumatic impact experienced by those near the riot and desecration of the Capitol and of the secondary trauma affecting those watching on TVs, phones, and computers. The immediate message was a reminder that we must take care of ourselves, emotionally and physically. As we all know, unless we take care of ourselves, we will have difficulty continuing to treat our patients.
What the so-called “racial-reckoning” of the past summer taught us, was that unjust, unfair treatment of Black and Brown people has, tragically, always been an issue in America. The country, with its obvious privileges for White citizens, has a shaky foundation built on the premise that it is acceptable to colonize and steal Indigenous land, enslave Africans and subjugate anyone non-White, or otherwise marginalized, to second class citizenship. This foundation allowed Trump’s rhetoric and hate speech to be successful in riling a literal lynch mob to storm the Capitol. The Confederate flag, the White supremacy slogans, and the disturbingly tepid response of the Capitol police to the rioters all conveyed these ideas. As more comes to light, CSWA will continue working to learn, to educate, to advocate, and to stand with you against institutional and systemic racism and for undisputed equity.
Our actions now must be to hold the President accountable for his role in promoting the riot, in promoting racism, in promoting police and National Guard brutality in BLM protests throughout 2020, and in undermining the electoral process. Impeachment will thus create a lasting record of his unlawful behavior and prevent him from holding further federal office. CSWA encourages all members to notify their members of Congress immediately that the President be impeached for his actions.
Here is a possible way to send that message: “I am a member of the Clinical Social Work Association and a constituent. Given the President’s reckless fomenting of destructive acts on the Capitol, police and our elected officials, I believe he should be impeached.“ Email addresses and phone numbers can be found at https://www.congress.gov/members?q={%22congress%22:117}&searchResultViewType=expanded
As always, let me know when you have sent your messages.
Laura Groshong, LICSW, Director of Policy and PracticeClinical Social Work Associationlwgroshong@clinicalsocialworkassociation.org
Below is a summary of the way that the CMS Physicians’ Fee Schedule Rule will impact Medicare psychotherapy reimbursement and telemental health services for LCSWs in 2021. The final Rule was implemented at the end of December, 2020.
CPT Code Reimbursement Changes
*Group Psychotherapy, 90853, has been added to the permanent list of telemental health services.
In short,
Telemental Health Services
Telemental health videoconferencing services have been extended indefinitely which is great news. Audio only telemental health services, however, will only be covered through the Public Health Emergency, currently scheduled to end on January 20, 2021. CSWA is working with the Mental Health Liaison Group to have Congress make audio only treatment covered indefinitely as well. CMS believes that Congress must make a legislative change before audio only services can be covered. It is likely that the Public Health Emergency will again be extended past January 20th, but has not been extended yet.
In summary, the cuts were not as severe as had been planned for individual psychotherapy, but somewhat more difficult for family and group therapy and psychoanalysis. To reiterate: Stay tuned for the extension of the Public Health Emergency, which will allow the continuation of audio only treatment, but videoconferencing has been extended indefinitely.
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