We have no doubt that the incoming administration will make changes in policies,laws, and regulations affecting clinical social workers and our clients. It is possible that some changes will make for long needed improvements.  Others, however, may make it difficult for individuals needing mental health or substance use treatment to obtaincare.  Some may conflict with the ethical principles set out in our Code of Ethics.  Still others could affect the cost of insurance, our reimbursement rates and the viability of our agencies and small businesses.

Even though the changes we anticipate now will be shifting and evolving as the new administration takes shape, CSWA is trying to begin formulating our strategy for advocacy.

The major areas below - based only what we have heard so far during the campaign and transition - are designed to provide context for considering how changes might affect our practices and our patients in the Trump administration. CSWA wants to hear from our members about which issues are of most concern in these areas.     

You can access the Survey at https://www.surveymonkey.com/r/PPY8CQN . Please identify the two issues that cause you the most concern in each area, and add other concerns at the survey using this link by December 28.  The results will be made available after January 1, 2017.

• MENTAL HEALTH PARITY AND REFORM LEGISLATION
• THE AFFORDABLE CARE ACT (“Obamacare”)
• MEDICARE AND MEDICAID
• DIVERSITY AND CIVIL RIGHTS ISSUES
• MENTAL HEALTH TREATMENT

Thanks for your help in developing CSWA’s Legislative Agenda in 2017.

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

Dear CSWA Affiliated Society Members,

Thank you so much for the many messages that have already been sent to the Trump Transition Team.  Margot Aronson and Laura Groshong greatly appreciate your letting them know when you have sent your message.  If you have not yet done so, send your message as soon as possible; let Margot and Laura know when you have.

Many Society members who are not CSWA members have asked how they can help besides sending this message.  One way to help is to join CSWA.  As an independent organization, CSWA relies on individual members to continue our work. 

If you are a member of the Societies that underwrite CSWA dues, you can take advantage of the way that these Societies have defrayed the cost of joining CSWA for their members.  Instead of $100 dues, the cost is $35.

If you would like to have your Society offer this discounted rate, please have your leadership contact Karen Hansen, CSWA Society Liaison, at karenhansenmsw@gmail.com .

We must make our voices as clinical social workers heard.  Join us in standing up for social justice and access to mental health treatment!

Regards,

Melissa, Johnson, LCSW, President
Clinical Social Work Association
mjohnson@clinicalsocialworkassociation.org

CSWA - "The National Voice for Clinical Social Work"
Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY

Certain statements made by President-elect Trump during the campaign for the presidency have been at odds with the Code of Ethics (2016) of the Clinical Social Work Association.  Cultural competence and social justice are fundamental principles underlying the work clinical social workers do to improve the mental health and daily lives of everyone. Here are key concepts from the CSWA Code of Ethics:

II.5.a)      The social work profession has a strong commitment to social justice. As such, clinical social workers shall strive to maintain awareness, knowledge, and skills with regard to cultural competence and its influence on human behavior and society. 

II.5.c)     Clinical social workers shall seek to become culturally competent and understand the effects of trauma caused by institutional and individual oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical disability. 

VI. a)       Clinical social workers do not, in any of their capacities, practice, condone, facilitate, or collaborate with any form of discrimination on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, socioeconomic status, or physical or emotional disability.

We believe that without adherence to these principles, our country will remain divided and polarized.  Economic prosperity alone cannot overcome beliefs that condemn or reject some citizens based on ethnicity, religion, sexual orientation or other differences.

CSWA will continue to take an active role in support of legislation that would benefit the mental health community through our participation in the Mental Health Liaison Group and our advocacy on the Hill.  We will continue to work with members of Congress on legislation that affects our patients and clinical social work practice.

CSWA urges all clinical social workers to participate in a broad grass roots effort to make the President-elect aware of our views. We need to let Mr. Trump know that we expect him to respect and protect the freedoms and rights of all Americans.  Here is some suggested language, but we encourage everyone to express what is most important to them:

“I am a licensed clinical social worker in [your state]. I am concerned about troubling comments made by Mr. Trump during the campaign based on ethnicity, race, and religion. Our professional Code of Ethics does not condone any discrimination on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, socioeconomic status, or physical or emotional disability. I ask that your transition team develop policies that include respect for all our citizens as guaranteed by our Constitution. [Name, Title, Address, Email Address]” 

 Visit his transition team website and tell him your concerns.  The stronger the grassroots presence we establish now, the better we will be better able to confront problems as they arise. 

CSWA would like to hear from all clinical social workers who send a message to the transition team.  Please contact Laura Groshong, CSWA Director of Policy and Practice, lwgroshong@clinicalsocialworkassociation.org or Margot Aronson, CSWA Deputy Director of Policy and Practice, at maronson@clinicalsocialworkassociation.org when you have sent your message.

Dear CSWA Members,

As you know, CSWA has been involved in the Mental Health and Substance Use Disorder Parity Task Force (MHSUDPTF ) created in March, 2016, by President Obama. The goal of this Task Force is to look at the overall failure to enforce the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).  The Rules for MHPAEA, which become the basis for enforcement, were not implemented until 2014.

Today the MHSUDPTF issued its report.  In addition to the 34-page report that was released, there was a 20- page report for consumers about their rights to mental health and substance use treatment. Both are worth reading. The authors of the Report, in addition to the President, included Departments of Treasury, Defense, Justice, Labor, Health and Human Services, Veterans Affairs, Office of Personnel Management, and Office of National Drug Control Policy. The comments submitted to the Task Force by CSWA can be found at the CSWA website (www.clinicalsocialworkassociation.org) .

To find the Report go to http://www.hhs.gov/sites/default/files/mental-health-substance-use-disorder-parity-task-force-final-report.PDF

To find the Consumer Guide go to http://store.samhsa.gov/shin/content//SMA16-4992/SMA16-4992.pdf

While this is not a complete answer to the problems that many CSWA members and our patients have faced with coverage, it is a help.  Remember that the Federal Government has oversight for ERISA – self-insured – plans. Private insurance plans, like Blue Cross, United, Aetna, etc., are overseen by the Insurance Commissioners in each state. This report only applies to ERISA plans, though it is likely to have an impact on private plans.

Members may have a special interest in #4 of the Consumer Guide which addresses how usual and customary out of network reimbursement rates are determined and how they can be questioned.

As always, please let  me know if you have any questions about these documents.

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

Dear CSWA Members,

Mental Health First Aid Act (H.R. 1877) passed the House yesterday by voice vote.  This Act will be extended through 2021 through block grants to train first responders, law enforcement and teachers to assist anyone in a mental health crisis, and reduce stigma toward them.

The bill will expand grant eligibility for the SAMHSA program to include programs to train veterans and law enforcement on how to recognize and respond to persons with mental illness. The program previously only focused on teachers and emergency responders.

The Senate passed a similar bill (S. 1893) in January, 2016. The Senate version, introduced by Sen. Lamar Alexander (R-Tenn.), focused on youth mental health services.

The House and Senate hope to soon create a unified bill in conference they can send to the President Obama soon.

LCSWs may have opportunities to help provide this training.  CSWA will provide more information as it is available.

This is the first of several bills that CSWA hopes will increase access to mental health treatment and support services in the next few weeks.

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 Aware Advocate - 2016

Changes to Medicare for LCSWs in 2017

Laura Groshong, LICSW, Director of Policy and Practice

     As all CSWA members know, since 2012 LCSWs have been subject to the Physician Quality Reporting System (PQRS) which has affected reimbursement rates in a cumbersome and difficult way for the past 5 years.  While the penalties that have been given for failure to comply with PQRS measures were relatively small (1-2% a year), the challenges of keeping track of the yearly changes to measures that LCSWs were supposed to report on have been a source off anxiety and frustration. 

    The good news is that for 2017 and 2018, LCSWs will not have to continue reporting PQRS measures.  The PQRS measures are being rolled in to a new plan called Merit-Based Incentive Payment System (MIPS) which is part of the new Medicare formula for reimbursement, Medicare Access and CHIP Reauthorization ACT (MACRA) that replaced the very problematic Sustainable Growth Rate (SGR).

    Though all LCSWs are free of the new reporting systems for now, it may be helpful to understand the changes that are coming to physicians and may be applied to LCSWs in 2019.  They will apply to quality of care; cost of care; use of electronic record keeping; and activities that attempt to reduce the cost of care while improving quality in Medicaid.

      The Quality measures for physicians and nurses in 2016 are currently defined as follows:

• Anti-depressant medication management

• Preventive care and screening: screening for clinical depression and follow-up plan

• Elder maltreatment screen and follow-up plan

• Dementia: cognitive assessment

• Dementia: functional status assessment

• Dementia: neuropsychiatric symptom assessment

• Dementia: management of neuropsychiatric symptoms

• Dementia: counseling regarding safety concerns

• Dementia: caregiver education and support

• Adult major depressive disorder (MDD): coordination of care of patients with specific comorbid conditions

• Adherence to antipsychotic medications for individuals with schizophrenia

• Follow-up after hospitalization for mental health conditions

It is notable that Medicare describes the covered groups (physicians, nurses, physician assistants) as the “vast majority of behavioral health providers” in Medicare (http://www.thenationalcouncil.org/wp-content/uploads/2016/08/MACRA-Quality-PP-web-Final.pdf) .  There are 38,000 LCSWs that are currently Medicare providers, probably a much smaller group than the current number of primary care physicians and others providing psychotropic medication.

    Keep in mind that LCSWs are still required to submit PQRS information for 2016 and will receive a Medicare reimbursement deduction in 2018 for failure to comply with PQRS reporting; see CSWA website for 2015 measures which are the same as 2016 measures (http://www.clinicalsocialworkassociation.org/PQRS) .  

     In the meantime, look forward to some time off next year if you are a Medicare provider from the PQRS measures.  CSWA will continue to keep you informed about other changes to these reporting requirements.  

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

Clinical Social Work Association
206-524-3690
lwgroshong@clinicalsocialworkassociation.org
Seattle, WA

CSWA - "The National Voice for Clinical Social Work"

Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY

Dear CSWA Affiliated Society Member,

As you know from the numerous CSWA posts about the Senate mental health bill, S. 2680, the Mental Health Reform Act of 2016, this bill is the best option in terms of passing a real mental health plan that works. The House bill, HR 2646 is considerably weaker. S. 2680 creates the enforcement that the Mental Health Parity and Addiction Equity Act failed to implement. It will make psychotherapy available to the 50% of Americans who currently do not have access to treatment.

Please send the following message to your senators at http://www.senate.gov/senators/contact/ BY TOMORROW, September 3. Apologies for the late notice but the strategy including rolling contacts by mental health associations and today is the day for CSWA to send our support.

Dear Sen. ______:

I am a constituent and a member of the Clinical Social Work Association, writing today to urge your Senate leadership to bring up S. 2680, the Mental Health Reform Act of 2016, for immediate consideration. This bill is the best option for giving the 68 million Americans who live with mental illness the help they need, including the 117 people who die every day by suicide. Mental health parity has failed to provide the equal coverage that it promised. Please vote for S. 2680 when it comes to the floor. Sincerely, [Your name, license, address, contact information]

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

Laura W. Groshong, LICSW, Director, Policy and Practice
Clinical Social Work Association
206-524-3690
lwgroshong@clinicalsocialworkassociation.org
Seattle, WA

CSWA - "The National Voice for Clinical Social Work"
Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY

Dear CSWA Members,

You may have heard that hard on the heels of the passage of the Helping Families in Mental Health Crisis Act of 2016, HR 2646, another bill related to clinical social work practice passed the House of Representatives today, the Comprehensive Addiction and Recovery Act (CARA), S 524/HR 963.  

This bill has great policy objectives including including prevention, treatment, recovery support, criminal justice reform, overdose reversal, and law enforcement which will help those with addictions, often in combination with mental health disorders.  Approximately 129 people die every day because of addictions. 

The huge problem with the bill is that there is no additional funding for the increased benefits.  Those who supported the bill felt it was better to get a bill passed and worry about funding later, a strategic decision.  CSWA hopes that the strategy pays off and the bill will be more than a policy statement.  I wanted you to be aware of the pros and cons as you hear about CARA over the coming days and months

Dear CSWA Members,

Thanks to all the many CSWA members who sent their emails to their Representatives.

Today the House of Representatives passed HR 2646 by an overwhelming majority of 422-2! 

Please send the following message to your Representative, even if you did not ask your Representative to vote in favor of the bill:
“I am a member of the Clinical Social Work Association and a constituent.  Thank you so much for voting in favor of the Helping Families in Mental Health Crisis Act of 2016 which will improve access to mental health services for our citizens. [Name, License, Address, email]” 

You can find your Representative's email at http://www.house.gov/representatives/find/ ; .

Now we will wait to see what happens with the Senate bill and hopefully have a compromise committee to combine the best of both bills.

Dear CSWA Members,

On June 15th, HR 2646, the Helping Families in Mental Health Crisis Act of 2016, a bill that CSWA has been following for the past three years, unanimously passed out of the House Energy and Commerce Committee.

This bill will be voted on by the whole House of Representatives next Tuesday, July 5.  Please email your representative as soon as possible.  It is very important to support this bill which will increase funding for many parts of the mental health system, create an Assistant Secretary of Mental Health in DHHS, and create a Minority Fellowship Program.  While there are other parts of the bill that CSWA would like to modify, getting the bill passed out of the House so that we can continue the discussion is crucial at the moment. The Senate mental health bill has also been passed out of committee and needs to be passed out of the Senate, but is not yet scheduled.  To get the Senate bill scheduled, the House bill must pass.

You can find the email address of your Representative at http://www.house.gov/representatives/find/ . Please send the following message to your Representative: “I am a member of the Clinical Social Work Association and a Constituent.  Please vote for passage of the Helping Families in Mental Health Crisis Act of 2016 on July 5 and improve access to mental health services for our citizens. [Name, License, Address, email]”

As always, please let me know when you have emailed your message.