You may have been hearing about part of a new law called Section 123 contained in the 1,000-page Consolidated Appropriations Act of 2021 (CAA) at the very end of 2020.  This Section requires all mental health clinicians who are working virtually to see their patients at least once every six months in-person, once the Public Health Emergency (PHE) ends.

Meeting in-person would of course be dangerous in the time of COVID which is why we are working through videoconferencing and audio only in the first place.  There has been a lot of concern about the implementation of Section 123.  An article from the law firm of Foley and Lardner about Section123 is being circulated which is somewhat inaccurate, as it does not highlight the start of Section 123 only when the PHE ends. Here is what CSWA believes Section 123 means at this point:

• The in-person requirement does not go into effect until AFTER HHS declares the Public Health Emergency has ended, which at this point is April 20, 2021, unless extended. 
• Applying this rule solely to mental health treatment and no other medical services violates the mental health parity law.   
• Inserting this rule into an appropriations law that has nothing to do with mental health treatment is duplicitous and misguided.

Please know that CSWA is working in collaboration with the American Psychological Association to eliminate this section.  A bill is being drafted and we are confident that Section 123 can be changed.

CSWA will also work to find out why HHS inserted this section into the CAA and will let you know what we find.

Let me know if you have any other questions.

Laura Groshong, Director, Policy and Practice

The 6.9% Medicare cuts are still planned for 2021 in spite of the major efforts of CSWA and many other mental health groups.  Fortunately, there are two bills which would put off this cut for two years.  Time is short to get S. 5007 and H.R. 8702, “Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020”, passed.  Send messages to your members of Congress.

Both bills would institute additional payments, separate from the physician fee schedule, to essentially establish 2020 Medicare reimbursement rates as the floor for payments in both 2021 and 2022.

Go to https://www.congress.gov/contact-us immediately to ask your Senators to cosponsor S.5007 and your Representative to cosponsor H.R.8702 to protect Medicare payment rates for services provided by LCSWs and other healthcare providers. 

Below is a template for your use:

“I am a member of the Clinical Social Work Association and a constituent.  Please pass H.R. 7802/S. 5007 to allow LCSWs to continue working as Medicare providers.  The proposed cut of 6.9% will make it very hard for me to afford to continue as a Medicare provider.  In these perilous times, the need for mental health services has grown exponentially.  Please allow the 250,000 LCSWs in the country to be able to provide the help that is so sorely needed.”

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

Laura Groshong, LICSW, CSWA Director, Policy and Practice
lwgroshong@clinicalsocialworkassociation.org

There are now 25 new ICD-10 codes for substance use disorders (SUD) which all LCSWs who work with patients diagnosed with these disorders should know.

They are:

• F10.13 Alcohol abuse, with withdrawal
• F10.130  Alcohol abuse with withdrawal, uncomplicated
• F10.131 Alcohol abuse with withdrawal delirium
• F10.132 Alcohol abuse with withdrawal with perceptual disturbance
• F10.139 Alcohol abuse with withdrawal, unspecified
• F10.93 Alcohol use, unspecified with withdrawal
• F10.930 Alcohol use, unspecified with withdrawal, uncomplicated
• F10.931 Alcohol use, unspecified with withdrawal delirium
• F10.932 Alcohol use, unspecified with withdrawal with perceptual disturbance
• F10.939 Alcohol use, unspecified with withdrawal, unspecified
• F11.13 Opioid abuse with withdrawal
• F12.13 Cannabis abuse with withdrawal
• F13.13 Sedative, hypnotic or anxiolytic abuse with withdrawal
• F13.130 Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated
• F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium
• F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance
• F13.139 Sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified
• F14.13 Cocaine abuse, unspecified with withdrawal
• F14.93 Cocaine use, unspecified with withdrawal
• F15.13 Other stimulant abuse with withdrawal
• F19.13 Other psychoactive substance abuse with withdrawal
• F19.130 Other psychoactive substance abuse with withdrawal, uncomplicated
• F19.131 Other psychoactive substance abuse with withdrawal delirium
• F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance
• F19.139 Other psychoactive substance abuse with withdrawal, unspecified

Be sure to use these codes in addition to the mental health disorder codes that we commonly use for anxiety, depression and other conditions.

HEADS UP for the Physician Fee Schedule!  We have been waiting for this rule since last summer.  It should be coming out any day now.  I plan to answer any questions you have about it at the online Town Hall next Thursday, December 10, 2020, at 5 pm EST.  Register at the CSWA website (www.clinicalsocialworkassociation.org) , Hope to see you then.

LWG

I am delighted to inform you that the Federal Court which made the ruling in Wit v. United Behavioral Health in March of 2019 has issued further remedies for the implementation of this ruling today. This ruling was consolidated with Alexander et al. v. United Behavioral Health, another case which found UBH in violation of mental health parity laws nationally and in California. The court explained in the 99-page document the need for the following steps:

1. a 10-year injunction requiring UBH to exclusively apply medical necessity criteria developed by non-profit clinical specialty associations;
2. appointment of a special master;
3. training of UBH in the proper use of court-ordered medical necessity criteria; and
4. reprocessing of nearly 67,000 mental health and substance use disorder benefit claims denied during the class period.

The remedies only apply to self-insured plans that fall under the Employee Retirement Income Security Act of 1974 (ERISA). It does not apply to government employees or commercial insurance plans.

Nonetheless, this implementation of the Wit ruling is as a major success for fully implementing mental health parity for the 50,000 ERISA enrollees in California and serves as a guide for laws in other states which have not fully implemented mental health parity laws.

CSWA is happy to report that the Texas State Board of Social Work Examiners has voted today to overturn the rule change that was enacted last week to allow LCSWs to refuse to see clients on the basis of disability, sexual orientation or gender identity.  For a more complete report go to the Texas Tribune article at https://www.texastribune.org/2020/10/27/texas-social-workers-lgbtq-disabilities-discrimination/ .

Many thanks go to CSWA Board member Kathy Rider, LCSW, a longtime advocate for clinical social work in Texas who was a major contributor to the effort to overturn the unethical rule.

You may have been hearing about a new rule that is called “Open Notes” which begins on November 2, 2020. It allows patients to have extended access to their Medical Record.

While it is technically true that patients have increased access to their electronic clinical records as of November 2, it should not be much of a change for the way we as LCSWs practice with one exception (see below).  Open Notes was part of the Interoperability section of the CURES Act last spring which says:

Blease C, Walker J, DesRoches CM, et al. Annals of Internal Medicine. October 13, 2020. doi: 10.7326/M20-5370

On 2 November 2020, new federal rules will implement the bipartisan 21st Century Cures Act that, in part, “. . . promotes patient access to their electronic health information, supports provider needs, advances innovation, and addresses industry-wide information blocking practices.” The rules forbid health care organizations, information technology vendors, and others from restricting patients’ access to their electronic health care data, or “information blocking.” Although the Health Insurance Portability and Accountability Act gave patients the legal right to review their medical records, the new ruling goes further by giving them the right to access their electronic health records rapidly and conveniently via secure online portals. Providers must share not only test results, medication lists, and referral information but also the notes written by clinicians. Over the past decade, this practice innovation—known as “open notes”— has spread widely, and today more than 50 million patients in the United States are offered access to their clinical notes."  https://www.opennotes.org/research/new-u-s-law-mandates-access-to-clinical-notes-implications-for-patients-and-clinicians/

I believe that Open Notes is primarily for other kinds of medical services, not psychotherapy.  The only exception may be if we are not making notes in the interoperable medical record. There may come a time when other providers or patients complain about it and we will need to make “open notes” in an interoperable record, but that is not the case now unless you are paneled in a plan that requires you make notes in an interoperable record. 

Remember that Psychotherapy Notes can be a separate file from the Medical Record which is for our use only, most commonly what we call process recordings, and are not shared with anyone else.  There is certain information which cannot be kept out of the Medical Record by being put in Psychotherapy Notes; see the CSWA website for more information.

We know that it is a clinical issue if the patient wants to see what we have written about them and it happens fairly rarely.  We also know that it is a best practice whether we are keeping notes for our own Medical Record or an interoperable one, to keep notes brief and connected to the treatment goals established for a given patient. If we stick to these practices, Open Notes should not pose a problem for clinical social workers.

Please let me know if you have any questions.

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

CSWA is concerned about a change in the Texas State Board of Social Work Examiners’ rules which allows LCSWs to refuse to provide services to clients on the basis of disability, sexual orientation or gender identity.  This change was made to make non-discrimination rules consistent with existing Texas statutes.  Governor Greg Abbott proposed the change to LCSW rules.  See the article on this issue in the Texas Tribune at https://www.texastribune.org/2020/10/14/texas-social-workers-rule-discrimination-lgbt-disabilities/#:~:text=New%20Texas%20rule%20lets%20social,conform%20with%20existing%20state%20law .

This change is completely at odds with the ethics and values of clinical social work. This kind of attack on our profession should be fought as strongly as possible whenever it occurs.  The fact that the Texas State Board of Social Work Examiners and the Texas Behavioral Health Executive Council, which oversees behavioral health boards, accepted the proposed rule without objection (on advice of counsel) is even more concerning than the fact that it was proposed in the first place. 

CSWA will be filing a complaint with the Texas Social Work Board and the Governor’s office as well as signing on to a Declaration from the Hogg Foundation for Mental Health, an organization that opposes discrimination in all forms.  To see the Declaration go to https://hogg.utexas.edu/who-we-are/racism-declaration?utm_content=82b8b13291ac3a2233b0e8193b1bb908&utm_campaign=Healthy%20Mind%20Project%20RFP&utm_source=Robly.com&utm_medium=email .

If this can happen in Texas, it can happen anywhere so we wanted to make all members aware of this situation. CSWA encourages all members to oppose any laws and rules that threaten our values and the rights of all clients to our services. 

A new extension of the State of Emergency has been signed by Alex Azar. This extends coverage of telemental health services and audio only services until January 20, 2021.

Click here for the Memo

Let me know if you have questions at lwgroshong@clinicalsocialworkassociation.org

Laura Groshong, LICSW, Director, Policy and Practice

A new source of funds for behavioral health/mental health providers who have worked with anyone affected by the COVID-19 pandemic is now open. Phase 3 of the CARES Act Relief Fund will be available starting today, October 5, 2020, to any LCSWs who have met the criteria listed below until November 6, 2020. Any LCSW who meets one of the yellow outline requirements in the first section may apply.  All criteria in the second section must be submitted.  The link to apply is also listed below.

To be eligible to apply, the applicant must meet at least one of the following criteria:

• Billed Medicaid / CHIP programs or Medicaid managed care plans for health-related services between Jan.1, 2018-Mar.31, 2020; or
• Billed a health insurance company for oral healthcare-related services as a dental service provider as of Mar. 31, 2020; or
• Be a licensed dental service provider as of Mar. 31, 2020 who does not accept insurance and has billed patients for oral healthcare-related services; or
• Billed Medicare fee-for-service during the period of Jan.1, 2019-Mar. 31, 2020; or
• Be a Medicare Part A provider that experienced a CMS approved change in ownership prior to Aug. 10, 2020;
• Be a state-licensed / certified assisted living facility as of Mar. 31, 2020
• Be a behavioral health provider as of Mar. 31, 2020 who has billed a health insurance company or who does not accept insurance and has billed patients for healthcare-related services as of Mar. 31, 2020

Additionally, to be eligible to apply, the applicant must meet all of the following requirements:

• Filed a federal income tax return for fiscal years 2017, 2018, 2019 if in operation before Jan. 1, 2020; or be exempt from filing a return; and
• Provided patient care after Jan. 31, 2020 (Note: patient care includes health care, services, and support, as provided in a medical setting, at home, or in the community); and
• Did not permanently cease providing patient care directly or indirectly; and
• For individuals providing care before Jan. 1, 2020, have gross receipts or sales from patient care reported on Form 1040 (or other tax form)

Note: Receipt of funds from SBA and FEMA for coronavirus recovery or of Medicaid HCBS retainer payments does not preclude a healthcare provider from being eligible.

To apply go to https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html#how-to-apply

Let me know if you have any questions.

Laura Groshong, LICSW, Director, Policy and Practice

Dear CSWA Members,

Today, October 5, is the last day that comments about the possible Medicare cuts by CMS to LCSWs will be accepted. If you have not yet sent your comments to CMS, or messages to your members of Congress, please do so by TODAY at 5 pm ET or they will not be included.

As always, please let me know when you have sent these messages at lwgroshong@clinicalsocialworkassociation.org.

LWG

Dear CSWA Member,

On September 16, you should have received a Legislative Alert to members of Congress regarding the proposed cut to Medicare reimbursement for LCSWs scheduled for January 1, 2021 ( copied below).  Many thanks to the hundreds of members who have sent these messages.  If you have not done so, it is not too late.  While the issue of Medicare cuts is being opposed in the House through Rep. Rush’s letter, it is fine to send your message to Senators as well.  All messages must be sent by October 5, 2020.

Now I am asking you to send another message directly to CMS (Centers for Medicare and Medicaid Services), the organization that oversees reimbursement rates for all Medicare providers, including LCSWs.  Both messages are necessary to make our position on this issue clear by October 5, 2020.  Send the following message (use your own words if you like) to the following link:

https://www.federalregister.gov/documents/2020/08/17/2020-17127/medicare-program-cy-2021-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part

“I am a Medicare provider [if you are] and wish to express my concern about the proposed rate reduction for Clinical Social Workers set to begin on January 1, 2021. Clinical Social Workers are already paid 25% less than other mental health providers for the same CPT Codes as other mental health providers. Though some psychotherapy CPT codes have increased, the 10.6% cut will result in a net reduction of about 7%.  My fixed costs have not changed and I cannot afford this reduction in my fees for my mental health services.

The onslaught of COVID-19 has increased the need for mental health services.  Please make it possible for me to continue to provide them by eliminating the proposed Medicare reimbursement cut.”

As always, let me know when you have sent both messages at lwgroshong@clinicalsocialworkassociation.org.  Thanks for your help.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair 

Clinical Social Work Association
he National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

============================================================

September 16, 2020

There is a proposed cut to Medicare reimbursement for many health care providers, including LCSWs, scheduled for January 1, 2021.  This 7% cut is connected to Evaluation and Management services, for diagnostic and treatment services that LCSWs provide.  It is imperative that all LCSWs contact their members of Congress as soon as possible to let them know how damaging this would be for LCSWs.

We are fortunate to have the support of Rep. Bobby Rush (D-IL) and 93 members of Congress in stopping this cut.  Please check the letter they wrote to Congressional leadership at -

https://rush.house.gov/sites/rush.house.gov/files/documents/Letter%20t%20Leadership%20on%20EM%20Code%20Cuts%20General.pdf  and thank your legislator if he or she signed on.

Even if you are not a Medicare clinician, please send the following message to your members of Congress at https://www.contactingcongress.org:

“I am a member of the Clinical Social Work Association, a Medicare provider [if you are], and a constituent.  Maintaining budget neutrality on the backs of clinical social workers and other mental health providers is a burden that I will not be able to bear.  I am already paid 25% less than other mental health providers for the same diagnostic and treatment services as other mental health providers.  My fixed costs have not changed.

The onslaught of COVID-19 has increased the need for mental health services.  Please make it possible for me to continue to provide them by eliminating the proposed Medicare reimbursement cut.”

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

at lwgroshong@clinicalsocialworkassociation.org