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CSWA - Legislative Alert - Questions on CMS Rules - 11-4-21 - REVISED

November 05, 2021 10:53 AM | Anonymous

The announcement from CMS on rules for telemental health raised some questions which I will answer below:

  1. Does the new rule mean that LCSWs are able to freely use telemental health to see patients in states where we are not licensed? No. That is what CSWA is working on through the Compact.  All state restrictions about licensure still apply.  Check with the state social work Board if you wish to see a patient who resides in a state in which you are not licensed.  A few states still have relaxed reciprocity standards, but others are ending their willingness to extend the ability to practice without licensure.

  2. Does this mean that private insurers will also agree to coverage of telemental health and audio only psychotherapy? No. Private insurers often follow Medicare rules, but there is no guarantee.  There appeared to be some changes in the way that private insurers were going to cover telemental health before the rule was announced.  The rule may affect those changes and others going forward.  Check with individual insurers or have patients check.

  3. Does the state in which the patient resides in general still dictate the necessity of being licensed in their state to treat the patient? In general, yes.  Check with the state social work Board where the patient resides as noted in #1.

  4. Do you think the change in the CMS administration led to this positive outcome? There is no way of knowing for sure, but it is possible.

  5. Will this rule cover Medicaid as well as Medicare? All Medicaid decisions will be made by states, though this may encourage some states to cover telemental health in Medicaid.

  6. Will LCSWs still be required to see patients in person every six months as previously required? No, this requirement has now been changed to every 12 months.  CSWA will be working to eliminate this requirement as we did to eliminate the six month rule.
One correction: the coverage of telemental health and audio only treatment will now be allowed until the end of 2023.  Another decision will be made about further coverage at that time.

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

Clinical Social Work Association

CSWA - "The National Voice for Clinical Social Work"

Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY


Good news from CMS.  Yesterday CMS announced the first group of many rules regarding the Physician Fee Schedule, which CSWA, and many of you, our members, commented on in August.  Our voices made a difference.  CMS will extend coverage of telemental health and audio only psychotherapy until the end of 2023.  This was a major goal of ours and CSWA is delighted.

Now we need more clarity on eliminating the need to see patients in person every six months and the payment schedule for LCSWs in 2022.  CSWA will continue to provide information on these issues as it is available.

Here is the statement issued by CMS (key statements in yellow outline).  For the original document, go to

Expanding Use of Telehealth and Other Telecommunications Technologies for Behavioral Health Care

The final rule makes significant strides in expanding access to behavioral health care – especially for traditionally underserved communities – by harnessing telehealth and other telecommunications technologies. In line with legislation enacted last year, CMS is eliminating geographic barriers and allowing patients in their homes to access telehealth services for diagnosis, evaluation, and treatment of mental health disorders.

“The COVID-19 pandemic has highlighted the gaps in our current health care system and the need for new solutions to bring treatments to patients, wherever they are,” said Brooks-LaSure. “This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.”

CMS is bringing care directly into patients’ homes by providing certain mental and behavioral health services via audio-only telephone calls. This means counseling and therapy services, including treatment of substance use disorders and services provided through Opioid Treatment Programs, will be more readily available to individuals, especially in areas with poor broadband infrastructure.

In addition, for the first time outside of the COVID-19 public health emergency (PHE), Medicare will pay for mental health visits furnished by Rural Health Clinics and Federally Qualified Health Centers via telecommunications technology, including audio-only telephone calls, expanding access for rural and other vulnerable populations.

Thanks again to everyone who contributed to this effort. Let me know if you have any questions.


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

Clinical Social Work Association

PO Box 105
Granville, Ohio  43023

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