I am pleased to send you the latest installment of “The Aware Advocate,” a quarterly report on legislative activity and advocacy being tracked or conducted by the Clinical Social Work Association This is not meant to be a complete summary of all activities, but a review of what I see as current highlights.
***SPECIAL ALERT – Global Tech Review for Medicare***
The Global Tech review identified 10,000 LCSWs who are Medicare providers as providing more psychotherapy than 50% of the LCSWs in their state or nationally. The review also compared the psychotherapy done by LCSWs to the psychotherapy done by psychiatrists. CSWA has written a letter to CMS Administrator Seema Verma rebutting these criteria along with a detailed description of psychotherapy as practiced by LCSWs. To find these items, go to the CSWA website at www.clinicalsocialworkassociation.org
The Big Picture – Federal News Affecting LCSWs
Proposed Medicare Rule
CSWA just sent in comments on the proposed Medicare rule to charge the same amount for an office visit, no matter what condition is being treated. CMS-1693-P, part of the FY 2019 Physician Fee Schedule, Medicare Shared Savings Program, Quality Payment Program, and Medicaid Promoting Interoperability Program, could seriously limit the access of Medicare beneficiaries to needed psychotherapy. This rule could have a chilling effect on the different psychotherapy codes available to LCSWs, which have already been rejected by some insurers (90837). Many other medical groups have send in comments as well. The comments will be reviewed in the next month and a decision about implementing this rule will be made. Stay tuned.
Tricare and Humana
Ever since Humana was named as the administrator for veterans on the eastern side of the country, there have been problems with the processing of claims; difficulty contacting a liaison at Humana; lowered reimbursement; higher copays; and a definition of clinical social work that is quite unclear, i.e., no distinction between casework and psychotherapy. CSWA, led by Government Relations member Susan Horne-Quantannens, LCSW, has been working with the Health Defense Agency to solve the myriad problems LCSWs are facing in this important realm of clinical social work practice.
On the Home Front – Legislative Action in the States
There are three areas of activity that will positively affect LICSW practice if enacted in Washington State. The first is the long-sought ability to provide psychotherapy for injured workers who are struggling with emotional distress. A Task Force has been established by Labor and Industries to begin a pilot project allowing LICSWs to provide these services beginning in 2019.
Additionally, there is a project to allow LICSWs to perform mental health evaluations on those incarcerated who may have mental health problems. These people have waited months to get an evaluation about whether they are competent to stand trial, represent themselves, and whether they can be treated in the community. More clinicians are needed to speed up the evaluations. It appears that Department of Social and Health Services has a plan to include Masters clinicians to do evaluations. Details can be found at https://www.disabilityrightswa.org/cases/trueblood/#anchor
Finally, there is a lawsuit that has been brewing in which an LICSW and an LMHC sued Group Health/Kaiser for refusing to cover psychotherapy for out-of-network providers in an ERISA plan. This was heard in the 9th circuit after four years of wending its way through state and federal courts and sent back to state court where it has a much better chance of a positive result. If you want to read a summary of the case, go to Law360 at https://www.law360.com/articles/1079535/erisa-doesn-t-bump-providers-state-law-suit-9th-circ-says Congratulations to member Karen Hansen, LICSW, who is one of the plaintiffs.
I hope anyone with knowledge of legislative matters that affect LICSWs in your state will let me know so I can include them in this quarterly report.
Now – what I know you’ve been waiting for – your next Licensure Tip:
Record Retention – since HIPAA passed in 2003, there has been increasing confusion about how long clinicians should keep records following the termination of treatment. Each state has its own laws about record retention as do Medicare and HIPAA. Currently Medicare requires that records be retained for 5 years; the HIPAA Notice of Privacy Practices (NPP) for 6 years; clinical social work state laws and rules require retention anywhere from 3 to 8 years. Be sure to check your state to make sure you are in compliance on record retention for clinical social workers. In addition, the prudent clinician will make sure that record disposal is in compliance with HIPAA requirements, meaning that paper records are shredded to microscopic bits and that discarded computer hard drives are totally cleaned.
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