*Legislative

DHHS Office of Evaluation and Planning

• CSWA provided better understanding of clinical social work practice
  
• DHHS wants to know why LCSWs opting out of Medicare
  
• DHHS suggested that CSWA encourage LCSWs to see Medicaid as well as Medicare patients
  
• Supportive and enlightening exchange
  

Meeting at Senator Stabenow’s Office

• Bill being proposed.  Senator wanted CSWA’s input
  
• Major disagreement over increasing reimbursement rates from 85% instead of 100%.  The Senator and her staff believe that asking for 100% reimbursement will kill the Bill at this point.
  
• Looking for a Republican Sponsor (especially from the Finance Committee)
  
• Wants CSWA support for the Bill which includes 10% reimbursement increase for LCSWs, return to independent practice in Medicare Part A as well as inclusion of E & M codes.
  
• CSWA supporting Bill as “first step” effort
  

White House Domestic Economic Policy Council

• Rescheduled due to Pres. Obama’s requiring all Council Secretaries’ presence at WH meeting
  
• This meeting will take place in the near future
  

*CSWA Board Meeting

• Very productive all day meeting with presentations from each Board  and Staff member as well as Clinical Dialog Editor, Gail Nagle; CSWA Newsletter Editor, Eric Huffman; Board Liaison to CSWE, Liz Alvarado; and CSWA Accountant, Debbie Sabean
  
• Efforts towards a stronger presence in DC are in the making!  More to come.
  

*CSWA State Affiliate Summit

• All Board members and staff hosted representatives from 8 out of the 17 State Affiliates at the Summit. 
  
• Bad weather prohibited travel for some. 
  
• Three new state affiliates were added this past year and 3 more state Societies are still being encouraged to affiliate in the future.  That would complete the 20 State Societies that are still operating.
  
• Nancy Harrington and Steve Szopa from the Greater Washington Society (who hosted a lovely reception the night before for everyone) joined us, again, this year as did Joel Kanter from AAPCSW, Marsha Wineburgh from New York,  Diane Frankel from Pennsylvania, Lynda Tate from South Carolina, and Lynn Houck Hefetz from North Carolina.  
  
• New faces to the Summit included Judy Gallant from Greater Washington, Britni Brown and Stacie Fitzgerald from Georgia, Jodi Hogue from Missouri and Shannon Boyle from New York.  Board members Michael Rose and Susanna Ward represented Arizona and Kentucky this year. 
  
• The “trade show” was fun, but State reports and exchange of information from state to state, state to national, and national to state carried the day.  The meeting was informative, inspiring, and enlightening.  What an awesome group.  CSWA hopes that ALL state Societies can be represented next year!
  

*CSWA/NASW Leadership Collaboration Meeting

• Memorandum Of Understanding (MOU) signed and shared
  
• Monthly legislative team conferences to occur
  
• Increased leadership communication established
  
• Potential CSWA participation in NASW 2016 National Conference discussed
  
• CSWA invited NASW leadership to next Board meeting luncheon in DC
  
• NASW offered support regarding greater CSWA presence in DC
  
• CSWA discussed upcoming Stabenow Medicare Bill.  Joint statement upon release of the Bill being developed.

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July, 2015:  CSWA's President met with NASW’s Executive Director to further develop collaborative efforts between the two social work organizations.  Discussions will continue around issues related to legislative efforts, conference possibilities, as well as developing  open lines of communication.  More to come!

I wanted to inform you of the filing of a Washington State class action lawsuit against Group Health Corporation, a major insurer in Washington State, for failing to use adequate guidelines in covering psychotherapy.  An article about the suit has been published by Courthouse News Service at http://www.courthousenews.com/2015/08/05/class-says-insurer-wont-cover-psychotherapy.htm

One of the lead plaintiffs is Washington State Society for Clinical Social Work Past-President, and CSWA Board Member, Karen Hansen, LICSW.  Group Health's attitude toward covering mental health treatment has been quite restrictive for decades.  This is a brave move by Karen and her fellow plaintiffs to stop these unethical practices and potentially benefit all clinicians and patients.

Please contact Albert Kirby, JD, the attorney who has filed this complaint, at ahkirby@soundjustice.com for more information or if you have a case to add to the complaint inn Washington State.

This suit is likely to have an impact on all psychotherapy coverage in Washington State and provide a model for other states who have similar restrictive insurers.

CSWA President Susanna Ward, CSWA Deputy Director of Policy and Practice Margot Aronson, and I met with Sean Cavanaugh, the Director of Medicare, and 7 Deputy Directors last week (four by webcam from Baltimore) about the disparity between Medicare reimbursement for LCSWs providing psychotherapy services. Medicare currently will reimburse clinical social workers only 75% of the amount psychiatrists and psychologists receive for psychotherapy codes.

President Ward, Margot, and I were pleased to find that Dir. Cavanagh and others at the meeting were well-versed in the clinical work we do and appreciative of the documentation and explanatory materials we presented, i.e., the CSWA 4-point description of clinical social work; the list of numbers of LCSWs by state; and the Medicare Position Paper (all available on the CSWA website).

Dir. Cavanaugh explained that neither he nor anyone on his staff could express a stance without first having a go-ahead from the Office of the President. He then generously offered to put us in touch with the relevant White House Office staff to whom we could make our case urging that resources be found to add needed funding to the President's budget next year to fund the request. Additionally we have introductions to staff from the Departments of Management and Budget and Health and Human Services Planning and Evaluation.  We are currently following up with these contacts. 

CSWA has also been in contact with NASW and hopes to reach agreement with our sister organization about seeking full parity for Medicare reimbursement, i.e., 100% of what psychologists and psychiatrists are paid for the psychotherapy codes that LCSWs use. Currently, NASW is seeking 85% of what the other two groups are paid.

Additionally, our visit to the Hill focused on two omnibus mental health bills, one (House) which was developed last year, and one (Senate) which is about to be dropped. CSWA has concerns about how these bills approach evidence-based practice, the Medicare lifetime limit of 190 days of psychiatric hospital treatment, block grant funding, and integration of primary care and mental health treatment.

The relationships we are developing with the prime sponsors of these bills will help us influence these issues of concern. It is gratifying to see that the mental health omnibus bills now have many references to clinical social workers as psychotherapy providers due to our advocacy work earlier this year; the bill last year had only one reference to social work, as discharge planners.

CSWA will continue to keep you informed about the progress of our advocacy efforts and welcomes your thoughts.

The CSWA has secured a meeting with CMS Director of Medicare, Sean Cavanaugh and his deputy directors in two weeks to discuss our Medicare Position Paper about equal reimbursement for equal codes. Several members of Congress encouraged us to have this meeting and we are grateful to them for their support.

CSWA President Susanna Ward, Deputy Policy and Practice Director Margot Aronson, and I will attend and report back to members about next steps.

As many of you may have heard, the Supreme Court decided to uphold the right to all states should have premium subsidies under the Affordable Care Act, on a 6-3 vote.  This is a major victory for the 6.4 million citizens covered in the 34 states who are receiving subsidies from the Federal government,many of whom are our patients.  For more information go to http://www.washingtonpost.com/politics/courts_law/obamacare-survives-supreme-court-challenge/2015/06/25/af87608e-188a-11e5-93b7-5eddc056ad8a_story.html

On another note, many of you may also have heard about the new version of the Helping Families in Mental Health Crisis Act of 2015, H.R. 2646, (formerly H.R. 3717).  CSWA has been working on this bill for the past two years, meeting with prime sponsor Rep. Tim Murphy's office to express our concerns last year.  As a result, Rep. Murphy agreed to include the phrase "clinical social worker" in the bill every time the groups of providers for psychotherapy are mentioned, approximately 20 times.  Previously the term had been the more general "social worker."

Additionally, H.R. 2646 includes the following recommendations made by CSWA last year:  1) establishment of federally qualified community behavioral health clinics; 2) extension of health information technology assistance for behavioral health facilities and professionals engaging in meaningful use; 3) reauthorization of the Garrett Lee Smith suicide prevention program; 4) reauthorization of the National Child Traumatic Stress Network; 5) improvements in Department of Justice programs focused on children with mental illness and substance use disorders involved with the criminal justice systems; and 6) full implementation of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.  

Our main concern about the new version of this bill is around cuts to those with disabilities.  While CSWA will be talking with main sponsors of this bill later this summer, we see this bill as an improvement in many ways from the original bill.  

Finally, CSWA continues to meet with members of Congress and CMS on our Medicare Position Paper to create reimbursement parity for LCSWs.  A report on these efforts will be out later this summer. 

As you know, the CSWA Government Relations Committee has been working for the past year on our Medicare Position Paper to implement Medicare reimbursement at parity with other mental health psychotherapy providers and to include LCSWs as independent providers in Medicare Part A.  

CSWA has been working on these issues with members of Congress, other mental health organizations, and CMS to find a way to implement these goals.

We were glad to note this month that NASW is joining us in pursuing these goals. The more the social work community is united on legislative goals that benefit all LCSWs and our patients, the more successful we are likely to be.

Below is an update on the Congressional effort to repeal the Sustainable Growth Rate (SGR) reimbursement formula for Medicare through HR 2.The Senate started considering HR 2 yesterday.  The procedural hurdle that must be overcome before it is voted on is the amendments which are being proposed.  Leadership has said that all amendments must be submitted by tomorrow when the Senate hopes to vote on the amendments and the bill itself.

If the bill is not voted on by tomorrow, or if it voted on with amendments, the 21% reimbursement cut will go into effect, at least for now.  The amendments will need to be reconciled with the House version of the bill, which will take some time.

If LCSWs are in need of processing these claims to address cash flow, you may want to start submitting claims after tomorrow, even is the cut is in place.  There would still be a possibility that if the cut is eventually rescinded, LCSWs would receive the lost income separately when that occurs.  

Changing the SGR formula is a cumbersome, difficult process.  Hopefully it can be achieved and replaced with a more reliable payment system.  I will let you know as HR 2 gets considered what the outcome is.

The Senate has just passed HR 2 without amendments, 58-42, which means as soon as the President signs the bill, Medicare will again begin processing Medicare claims without the 21% cut that had been looming.

This is exactly the outcome that CSWA had hoped for.  Thanks to all of you for your messages to your Senators in support of HR 2.    

 As soon as the President signs HR 2, which he has indicated he will do, Medicare will begin processing claims at the current rate of reimbursement.  Those of you who have held back claims the past two weeks should now submit them.

Medicare expects processing to take up to two weeks longer than usual because of the backlog. CSWA will send you more information as it becomes available.  

I know many of you have been hearing about changes to Medicare payments and the SGR, and you may be wondering what it all means for LCSWs. Given the fact that the 158-page bill, HR 1470, now HR 2, Medicare Access and CHIP Reauthorization Act (MACRA), was created last week and released yesterday, this preliminary analysis of the bill should not be considered complete. More information will be coming but this will give you a summary of what HR 2, will and will not do, if passed.

First an important note: Without some action by Congress in the next week, all Medicare providers, including LCSWs, will receive a 21% cut in reimbursement as of April 1. That's when the SGR regulations - the ones that have been "kicked down the road" 17 times - will go into effect. Something needs to happen: the SGR cuts finally happen, an 18th postponement, or perhaps HR 1470, which looks like a real possibility.  

There are five major parts to HR 2 that are important to LCSWs as follows: 1) a new Medicare reimbursement formula; 2) a continued implementation of Medicare services based on quality measures (including PQRS); 3) an increase in premiums for higher income Medicare beneficiaries; 4) a two-year continuation of the CHIP program to provide Medicaid services for children; and 5) a more restrictive abortion policy.

Obviously the last two are not directly connected to Medicare policy, but as often happens in Congress, issues which would have difficulty passing on their own are often attached to bills that are likely to pass.

Here is what is meant by each of the five points above:

1. Medicare Reimbursement Formula - the Sustainable Growth Rate would be eliminated. The 21% cut that is looming would be handled by "splitting" the cut between providers and beneficiaries, meaning approximately a 10% cut to LCSWs and other providers and a 10% raise in premiums to higher income beneficiaries. All providers would also receive a .5% reimbursement increase for the next five years.  
   
2. Quality Measures (Merit-based Incentive Payment System) - the move from "quantity" to "quality", from fee-for-service to pay for performance, from small provider groups to large groups, from paper records to EHRs, has been in effect for the last 9 years. HR 2 integrates all these goals into Merit-based Incentive Payment System, or MIPS. This direction can be expected to continue, though CSWA will do everything possible to preserve the ability of LCSWs to be reimbursed as sole practitioners. HR 2 includes four ways to measure the ways that providers comply with the above including quality incentives (including PQRS); adequate use of resources for each condition and episode; meaningful use (does not apply to LCSWs); and use of alternate payment methods like Accountable Care Organizations (ACOs) and health homes. The last item would result in a bonus of 5%.
   
3. Higher Premiums for Higher Income Beneficiaries- this is one area where there is little debate, though the income level at which beneficiaries would need to pay higher premiums is still to be determined.
   
4. Continuation of CHIP- this inclusion of the Children's Health Insurance Program, which provides health care coverage for all children, has been a point of disagreement. The two-year inclusion is only half of what many progressive members of Congress sought, a four-year extension. This is already being challenged by the Senate.
   
5. Continuation of Abortion Limitations in Medicaid- this is an unexpected part of HR 1470 which continues the "Hyde amendment" which was due to expire this year. Many pro-choice members of Congress are opposing this provision.
   

Getting this bill passed will require enormous effort. CSWA believes that the current ambiguity of the bill makes it difficult to actively support it. As the form of the bill becomes clearer, we may be able to support or oppose the bill, or weigh in on parts of it, based on how it affects LCSWs.

CSWA hopes this summary is helpful in understanding what is a complicated, potentially helpful, bill.

As you may have heard, there is another deadline, March 31, for the Sustainable Growth Rate (SGR), the Medicare formula for creating a balanced budget, that would impose a 21% cut on reimbursement for LCSWs and all other Medicare providers. This is the 18th time that a deadline has arisen. The first 17 times the implementation of the SGR has been 'delayed', leading to short term 'fixes' to balancing the Medicare budget.  

It now appears that a new formula has been in development which would eliminate the proposed cut by reducing Medicare benefits by roughly 10% and reducing provider reimbursement by roughly 10%. This is far from what LCSWs would like to see, particularly with the already diminished reimbursement rate LCSWs receive for psychotherapy services through Medicare (see Medicare Position Paper at the CSWA website.)

An additional cause of concern is the possible loss of funding for the Children's Health Insurance Program (CHIP) which is being tied in to replacing the SGR. The President has said he would veto any effort to end CHIP.

Details are still in development in Congress. I will send you an update as I receive more information and a message to send to members of Congress.