clinical social work association

Here is an urgent Legislative Alert to get coverage for telemental health before the end of the year. CSWA is concerned that coverage of telemental health may not be continued after the end of the Public Health Emergency.

Please send this message to your legislators BY TOMORROW, December 1, 2022, when the final legislative packages will be put in place, at https://www.congress.gov/contact-us:

“I am a member of the Clinical Social Work Association and a constituent. Please include permanent coverage of mental health services provided by videoconferencing or "audio only" after the end of the Public Health Emergency. Many patients who depend on these services will be harmed if this coverage is removed.“

As always, let me know when you have sent your messages.

Many thanks,

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

Update on CareDash

Here is an update on the CareDash/BetterHelp fiasco. Many members complained to CareDash and received the following form letter:

Sarah (CareDash)

Aug 2, 2022, 15:43 ADT

Hello,

Thanks for reaching out to CareDash! As a mental health provider, we understand your concerns regarding the importance of protecting your privacy and would be happy to help remove any personal information. We permit the redaction of a personal phone number or address and can flag profiles as retired or deceased, as needed. However, CareDash's policy is not to remove a profile since this information is of the interest to the general public.

While we provide information on healthcare providers and practices by aggregating information from various public sources, such as the NPI Registry, it is most important to us that you and your practice are appropriately represented on CareDash. The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.

We'd be happy to help you update your profile to ensure you and your practice are appropriately represented on CareDash. We permit the redaction of a personal phone number or address and can flag profiles as retired or deceased, as needed.

We've created this guide on how you can protect your privacy: https://www.caredash.com/articles/how-health-care-providers-can-protect-their-privacy. At CareDash, we're deeply committed to protecting the privacy of providers and keeping our data accurate, so please let us know if we may be misrepresenting you or your practice in any way in order for us to correct it immediately. The easiest way to ensure your data stays up-to-date is for you to take control of your profile by claiming and updating it on CareDash. Please follow the simple instructions here: https://www.caredash.com/portal.

Lastly, please visit the NPI Registry to edit the source of the public information we use: https://npiregistry.cms.hhs.gov. Many sites use this data and you may have accidentally placed personal information when registering for your NPI. Our team will periodically update our data to match what's in the NPI Registry if you choose not to claim and update your profile today. Please check back in a few weeks for your changes to be in effect.

Kind Regards,

Sarah B.

CSWA regards this letter as disingenuous, since the issue is not just where CareDash found all our information, the NPI list, but how they are using it to restrict access to our services. CSWA has also discovered that CareDash is connected to Teledoc and Nufit Media, which we are looking into.

Several members suggested that CSWA consider filing lawsuits against CareDash. We are exploring this possibility with attorneys, are examining what the legal issue or issues might be (restraint of trade, kickbacks, possibly) and are determining the feasibility of filing a lawsuit (class action, through attorneys general, etc.). In addition, we are working with PsiAN to send a letter to the FTC.

Several members have reported that they sent letters to NPR and other groups that use BetterHelp as a sponsor objecting to the policies of CareDash and BetterHelp.

Please continue to send your individual letters to your state attorney general and the FTC about your objections to CareDash and BetterHelp policies. They have already made a difference in Maryland where the consumer protection department at first refused to look into the situation but changed its mind after a flood of complaints.

I will be sending weekly updates about the progress being made and/or new actions to be taken. Thanks to the over 300 members who let me know they have sent messages on the subject. Please continue to let me know if you have done so.

I also urge you to join the discussion in the comments at this link.

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

LCSWs at Risk: CareDash and BetterHelp

CSWA would like to call to your attention a duplicitous practice which a company called CareDash is engaging in. CareDash has partnered with BetterHelp to drive potential patients to CareDash or BetterHelp affiliated therapists. It has gathered information about thousands of LCSWs and other clinicians to direct them to CareDash or BetterHelp affiliated clinicians without the permission of the non-affiliated LCSWs listed.

If the LCSW is not affiliated with BetterHelp, CareDash will say that there is no way to connect with them through CareDash, without directing them to the website of the LCSW, or noting that this is an active licensed clinical social worker. CareDash receives a commission for all patients referred to BetterHelp.

CareDash also has its own list of LCSWs which they will only use for referrals if an LSCW affiliates with them. These practices could significantly reduce the ability of patients in gaining access to LCSWs who are not connected to CareDash or BetterHelp. Please note that if you are not on the CareDash list, patients will be directed to BetterHelp. CareDash at this point refuses to take anyone off their list who is not officially connected with them or BetterHelp.

There is little doubt that the CareDash list has been compiled from public lists such as NPI, insurers, and others, then made to look as if the LCSWs listed are not being artificially limited by CareDash.

Here is what CareDash said about me:

About

Laura W. Groshong LICSW (she/her) is a clinical social worker in Seattle, WA.

For new and existing patients, please see recommendations on how to schedule an appointment with Laura Groshong online. As a clinical social worker, she may specialize in Anger Management and Anxiety, in addition to other issues.

Laura Groshong got her license to practice in Washington.

If you want to see Laura Groshong, please contact her to book an appointment. You can also see how she compares to other clinical social workers in Seattle or get matched to an online therapy provider.

When anyone clicks on “schedule an appointment” or “book an appointment” they get the following message: “Laura Groshong has not provided a way to schedule online through CareDash. However, you could get connected with an online therapist or chat with our virtual assistant to get help finding a therapist.” There are then over 1000 mental health clinicians listed as “the best” clinicians in the Seattle area, all sponsored by BetterHelp, many of which offer 20% discounts for the first month.

Here is what CSWA recommends each member do to protect your practice:

1. Go to CareDash.com and see if you are listed as a member. Unless you are working for BetterHelp and want to remain on the CareDash list, send a complaint to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. You will need the CareDash corporate address which is 614 Massachusetts Ave., Ste 400, Cambridge, MA 02139, and the BetterHelp corporate address which is 990 Villa Street, Mountain View, CA 94041.

2. You may also file a complaint with your state attorney general consumer protection department. To find the location of your state’s consumer protection department go to https://www.consumerresources.org/file-a-complaint/ .

3. A template for sending a complaint is found below:

I am a Licensed Clinical Social Worker writing to inform you that a company, CareDash, is unfairly restricting my practice as a clinical social worker. They have listed my professional information on their website without my permission and refer anyone who checks my name to another company, BetterHelp, or to their own list of clinicians. I do not wish to work with CareDash or BetterHelp. CareDash refuses to take my name off their list, claiming it is public information. Thus, CareDash is falsely marketing my services to generate online traffic for BetterHelp or itself, ultimately resulting in the selection of BetterHelp’s participating providers or its own, rather than me. This is a restriction of trade that should be stopped immediately.

CSWA encourages all members and affiliated societies to file complaints with the appropriate state and/or national organizations. Please let me know when you have done so.

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

H.R. 4040, THE ADVANCING TELEHEALTH BEYOND COVID–19 ACT OF 2021

A bill passed the House yesterday which would allow Medicare to cover LCSWs and other mental health professionals for telemental health services until 2024, including audio only treatment. Additionally, the requirement that patients be seen in person every six months was eliminated. The vote was 416-12.

This is a huge win for CSWA, clinical social work, and all of the groups in the Mental Health Liaison Group that worked to get this bill passed. The bill now goes to the Senate where it is likely to pass, as long as it is brought to a vote.

All CSWA members should send the following message to their senators at https://www.senate.gov/senators/senators-contact.htm?OrderBy=state&Sort=ASC: “I am a member of the Clinical Social Work Association and a constituent. Please ask Speaker Schumer to bring HR. 4040, The Advancing Telehealth Beyond Covid-19 Act of 2021, to a vote. Many patients struggling with mental health problems will be unable to get the help they need unless this bill is passed by the Senate. Thanks for your support on H.R. 4040.”

As always, please let me know when you have sent your messages.

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

[The Aware Advocate is an occasional newsletter sent to members with information that is relevant to Licensed Clinical Social Workers ~LWG]

This episode of The Aware Advocate will focus on POS Codes for Medicare; Public Health Emergency extension; and the Social Work Compact development.

POS Codes for Medicare

There remains a lot of confusion about which POS codes should be used for Medicare.  Here is a reminder of what Medicare and other insurers are requiring for claims:

• POS “11” should be used until the end of the Public Health Emergency, timing of which is currently the end of 2022, even though this POS “11” is for office visits.
• POS “10” was made “available” for LCSWs for telemental health treatment as of April 4; however, there is a rate cut for those who have used POS “10” so using POS “11” is a better option.
• POS “10” will be required for telemental health when the Public Health Emergency ends, currently the end of 2022.
• Check with YOUR Medicare Administrative Contractor to clarify which POS code is being accepted currently if the patient is being seen through telemental health in their home.
• You can find your MAC contact information at the CSWA website under “Clinical Practice”.
• If a patient is seen in their car, the POS code should be “02”, but POS “11” is also acceptable. 
• The Medicare Modifier for all POS codes is still 95. This may seem counterintuitive as 95 is supposed to be for telemental health, but it is the only combination that currently works.

Be sure to check with EACH private insurer for a patient to find out what combination of POS and Modifier are being requested so that claims will not be denied.

Public Health Emergency

The Public Health Emergency is predicted to be in effect until the end of 2022, possibly longer.  I will be keeping you informed on any changes that take place which may affect Medicare coverage and commercial insurance.

Social Work Compact

As you know, CSWA began working as part of the Technical Assistance Group (TAG) in October of 2021, along with representatives from ASWB, NASW, CSWE, and Department of Defense and the Council of State Governments to create a Social Work Compact.  The latter two groups listed are funding the effort to create a compact for clinical social workers that would allow us to work in any state that has joined the Compact.  The process for creating the Compact is as follows:

• States will join the Compact by passing legislation through the state legislatures after the draft legislation is approved by DoD and CSG
• The draft legislation will be open for public comment some time this summer. I will let you know how to access the draft and send in your comments when it is available
• The draft will likely go out to states in late 2022 or early 2023

Once the process is moving forward, we will need to have a legislative campaign to pass the Compact in as many states as possible.  I will be sending materials to help you make the case for the Compact in your state.

Let me know if you have any questions about any of these issues.

Laura Groshong, LICSW, Director, Policy and Practice

The Improving Access to Mental Health Act (S.870), which CSWA has been supporting since 2012, has provisionally been included in the omnibus mental health legislation package being developed by the Senate Finance Committee.  The request from the Committee is that we find more Republican cosponsors for the bill.  This needs to happen by Friday, May 20, 2022 COB.

To review the high points of this bill, they are:

• Increase reimbursement rates for clinical social workers from 75% to 85% of the psychotherapy rates for other mental health clinicians in the Physicians Fee Schedule;
• Allow LCSWs to be reimbursed independently for providing psychotherapy in Skilled Nursing Facilities; and
• Allow LCSWs to use Health and Behavior Assessment and Intervention (HBAI) codes to be reimbursed for mental health disorders in the context of medical conditions

The Committee members/Legislative aides that are most important to this effort are:

Sen. Mike Crapo (R-ID): Rebecca Alcorn, Senior Policy Advisor, rebecca_alcorn@crapo.senate.gov

Sen. Chuck Grassley (R-IA): Nic Pottebaum, Health Policy Advisor, nic_pottebaum@grassley.senate.gov

Sen. John Cornyn (R-TX): Alaura Ervin, Legislative Assistant, alaura_ervin@cornyn.senate.gov

Sen. John Thune (R-SD): Danielle Janowski, Health Policy Director, danielle_janowski@thune.senate.gov

Sen. Richard Burr (R-NC): Angela Wiles, Health Policy Director (HELP Committee), angela_wiles@help.senate.gov

Sen. Rob Portman (R-OH): Jack Boyd, Health LC, jack_boyd@portman.senate.gov

Sen. Pat Toomey (R-PA): Mike Weiss, Health LA, mike_weiss@toomey.senate.gov

Sen. Tim Scott (R-SC): Brianna Wood, Legislative Correspondent, brianna_wood@scott.senate.gov

Sen. Bill Cassidy (R-LA): Mary Moody, Health Policy Advisor, mary_moody@cassidy.senate.gov

Sen. James Lankford (R-OK): Cambridge Neal, Legislative Assistant, cambridge_neal@lankford.senate.gov

Sen. Steve Daines (R-MT): Rachel Green, Health Policy Advisor, rachel_green@daines.senate.gov

Sen. Todd Young (R-IN): Beth Nelson, Health Policy Director, beth_nelson@young.senate.gov

Sen. Ben Sasse (R-NE): Shannon Hossinger, Policy Advisor, shannon_hossinger@sasse.senate.gov

Sending the following message to the LAs is a good way to make contact with the senators. You can send your message even if you are not a constituent.

The suggested message is as follows (feel free to use your own language):

“I am [a constituent and] a member of the Clinical Social Work Association. Please consider becoming a cosponsor for S.870 which will provide greater access to mental health and substance use treatment, desperately needed in these difficult times. S. 870 will increase the number of LCSWs who become Medicare providers. Thank you for your consideration.”

As always, please let me know when you have sent your messages.

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

I hope everyone is feeling well informed about the Good Faith Estimate rule, part of the No Surprises Act, which went into effect on January 1.  There have been several webinars on this topic and one can be found at the CSWA website in the Members Only Section.

CSWA is working on two fronts to get LCSWs exempted from the GFE. One is a letter we co-wrote with the Psychotherapy Action Network (attached). The other is a campaign to let members of Congress know about the fact that LCSWs in private practice do not need to be part of the GFE; we already do everything that it requires and there are vanishingly low numbers of LCSWs who have had actionable complaints filed against them for surprise billing.

Please send your members of Congress at www.Congress.gov the following message: “I am a constituent and a member of the Clinical Social Work Association. The No Surprises Act requires me as a Licensed Clinical Social Worker to give my patients a Good Faith Estimate.  I am in private practice and have patients pay me directly.  The GFE interferes with the mental health treatment process (detailed in the attached letter). Please exempt LCSWs from the Good Faith Estimate requirements.”

NSA Letter to CMS (fin.) - 1-25-22.pdf

As always let me know when you have sent your messages.

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

There have been several requests for language to send members of Congress regarding the Medicare requirement that all patients be seen in-person at least once every 12 months.   This would put patients and LCSWs at risk and CSWA is strongly opposed to this requirement.

There is a possibility that this requirement would only go into effect after the public health emergency ends.  CSWA still opposes any in-person requirement, as it could have a disorienting effect on the treatment.  There is no medical necessity for seeing a patient in person occasionally unless the treatment would be better served by in-person clinical work; seeing a patient once a year in-person would hardly be beneficial to the patient.

With these concerns in mind, CSWA offers the following suggested language for members to send their members of Congress (at www.congress.gov)  to explain the problems with this requirement:

“I am a constituent and a member of the Clinical Social Work Association. The over 270,000 licensed clinical social workers (LCSWs) are the largest group of mental health providers in the country and provide mental health services to Medicare beneficiaries. 

I am writing because Section 123 of the 2022 Physician Fee Schedule has a requirement that LCSWs must see patients at least once a year in-person.  The only way I can safely see my patients currently is virtually, as I have been since the pandemic began in March 2020.  This has worked well for most of my patients.  It would be a hardship for me to maintain an office for a once-a-year meeting, and an intrusion into the virtual treatment for my patients. 

This requirement should be eliminated so that I can continue to provide services to the over 50% of our citizens suffering from emotional distress.  Please oppose this requirement so that I can continue to help all those suffering from PTSD, anxiety, depression, and other difficulties in these perilous times.”

Feel free to use your own words.  As always, let me know when you have sent your messages.

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

As we continue our pandemic journey, changes to the use of telemental health continue to develop.  Two significant ones from CMS have come out this month, one on Place of Service (POS) codes and one on in-person visits required for telemental health treatment.

Place of Service Codes

POS codes are being divided by 1. telemental health provided outside the patient’s home and 2. telemental health provided in the patient’s home.  POS 02, which previously covered both categories, should only be used as of January 1, 2022, for telemental health psychotherapy provided outside the patient’s home.  POS 10, a new code, should be used as of January 1, 2022, for telemental health psychotherapy provided in the patient’s home.  The complete descriptions are as follows:

1. POS 02: Telehealth Provided Other than in Patient’s Home Descriptor: The location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related services through telecommunication technology. 

2. POS 10: Telehealth Provided in Patient’s Home Descriptor: The location where health services and health-related services are provided or received through telecommunication technology. The patient is located in their home when receiving health services or health-related services through telecommunication technology. 

Links for more information can be found at https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set .  These changes may be adopted bycommercial insurance; check with each carrier directly.

Required In-Person Visits with Medicare Patients

I have been tracking this difficult rule for the past year for the Clinical Social Work Association. It is unclear to me how it is going to be enforced. The most recent iteration came out earlier this month. 

The rule was amended in the recent 2022 Physician Fee Schedule as follows: 

“Section 123 of the CAA removed the geographic restrictions and added the home of the beneficiary as a permissible originating site for telehealth services furnished for the purposes of diagnosis, evaluation, or treatment of a mental health disorder. Section 123 requires for these services that there must be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service and requires the Secretary to establish a frequency for subsequent in-person visits. We are implementing these statutory amendments, and finalizing that an in-person, non-telehealth visit must be furnished at least every 12 months for these services, that exceptions to the in-person visit requirement may be made based on beneficiary circumstances (with the reason documented in the patient’s medical record), and that more frequent visits are also allowed under our policy, as driven by clinical needs on a case-by-case basis.” 

The whole rule can be found at https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2022-medicare-physician-fee-schedule-final-rule

The "beneficiary circumstances" seem to offer a way to avoid seeing patients in person but this will need to be clarified by HHS. In any case, the time period has been extended from 6 months to 12 months for in-person meetings. 

As for how to fight this rule, CSWA is working on a two-pronged approach. We encourage all mental health associations to oppose it through letters to HHS and CMS. All individual clinicians can oppose it by writing to our senators and representative about the chilling effect this rule will have on telemental health treatment, especially in this pandemic when emotional distress is high and meeting in person may be dangerous. 

This will be a long-term fight in my view and there is no alternative to holding the government's feet to the fire.  

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

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 
lwgroshong@clinicalsocialworkassociation.org

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 https://www.federalregister.gov/public-inspection/2021-23972/medicare-program-cy-2022-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part

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
lwgroshong@clinicalsocialworkassociation.org