clinical social work association

Regardless of how we feel about providing psychotherapy through telemental health, LCSWs are currently in the position of having to continue to use telemental health or audio only mental health treatment for many months to come.   Since mid-March, the vast majority of LCSWs who used to have an office where they met in person with patients, have been working from home.  We have mostly made peace with the frustrations and, occasionally, surprising advantages, of working from home online or on the phone.

Returning to the Office – The conditions that would allow us to return to our offices without major changes to the air flow and air cleaning, use of masks, plastic shields, are not easy to create and there will be a high level of risk in some areas that is potentially harmful to many of us.  That is why it is so important that Secretary Azar extended the public emergency declaration to October 23, 2020, this week to allow the use of telemental health to continue to be covered by Medicare.  Be aware that this does not guarantee that private insurers will continue to cover telemental health.

Legislative Goals – Other immediate goals are to make telemental health a permanent option through Congressional laws; to make reimbursement for telemental health at the same level as for in office visits; and to compare the use of in office and telemental health treatment delivery methods.  There are about 10 bills that would impact some or all of these issues.  CSWA will keep you aware of the progress of these bills as they affect LCSWs.

Inter-state Telemental Health Practice – There continue to be variation in state rules that allow LCSWs in one state to see patients in another state through telemental health.  This is especially difficult for ongoing patients who were seeing a patient in office from a state in which the LCSW was not licensed.  I hope this chaos will resolve soon, but for now check on current laws and rules for practicing telemental health in states where you are not licensed with the state Board.

Self-Care – Please know that telemental health is more tiring for many LCSWs than office work and build in ways to give yourself more down time, whether it is through seeing fewer clients in a day; having longer breaks between clients; and having some time for relaxation, exercise, and other self-care. 

Many of us have been paying for an office the past five months that we only use for billing or our own research.  More and more requests to sublease offices are showing up.  This painful decision is affecting all of us.  The webinar given last month “To Be or Not To Be: LCSWs Returning to the Office” offers a template for helping make this decision and can be found at the CSWA website in  the Members Only Section.

Be safe, stay well, and let CSWA know if there is any way we can help.

CSWA is pleased to see that the Office for Civil Rights has issued guidance on compliance with civil rights laws during the COVID-19 pandemic.  The health disparities between Black, Indigenous, and People of Color (BIPOC) citizens and white citizens has been a major concern of CSWA.  We hope this guidance will improve the underlying problems that are barriers to mental health care for BIPOC citizens.  The lack of attention to LGBTQ citizens in this guidance is a glaring omission which we hope will be corrected in future guidance.

To read the whole OCR Bulletin, please visit: Title VI Bulletin - PDF

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OCR Issues Guidance on Civil Rights Protections Prohibiting Race, Color, and National Origin Discrimination During COVID-19

Yesterday, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) issued guidance to ensure that recipients of federal financial assistance understand that they must comply with applicable federal civil rights laws and regulations that prohibit discrimination on the basis of race, color, and national origin in HHS-funded programs during COVID-19. This Bulletin focuses on recipients' compliance with Title VI of the Civil Rights Act of 1964 (Title VI).

To help ensure Title VI compliance during the COVID-19 public health emergency, recipients of federal financial assistance, including state and local agencies, hospitals, and other health care providers, should:

• Adopt policies to prevent and address harassment or other unlawful discrimination on the basis of race, color, or national origin.
• Ensure – when site selection is determined by a recipient of federal financial assistance from HHS – that Community-Based Testing Sites and Alternate Care Sites are accessible to racial and ethnic minority populations.
• Confirm that existing policies and procedures with respect to COVID-19 related services (including testing) do not exclude or otherwise deny persons on the basis of race, color, or national origin.
• Ensure that individuals from racial and ethnic minority groups are not subjected to excessive wait times, rejected for hospital admissions, or denied access to intensive care units compared to similarly situated non-minority individuals.
• Provide – if part of the program or services offered by the recipient – ambulance service, non-emergency medical transportation, and home health services to all neighborhoods within the recipient's service area, without regard to race, color, or national origin.
• Appoint or select individuals to participate as members of a planning or advisory body which is an integral part of the recipient's program, without exclusions on the basis of race, color, or national origin.
• Assign staff, including physicians, nurses, and volunteer caregivers, without regard to race, color, or national origin. Recipients should not honor a patient's request for a same-race physician, nurse, or volunteer caregiver.
• Assign beds and rooms, without regard to race, color, or national origin.
• Make available to patients, beneficiaries, and customers information on how the recipient does not discriminate on the basis of race, color, or national origin in accordance with applicable laws and regulations.

OCR is responsible for enforcing Title VI's prohibitions against race, color, and national origin discrimination. As part of the federal response to this public health emergency, OCR will continue to work in close coordination with our HHS partners and recipients to remove discriminatory barriers which impede equal access to quality health care, recognizing the high priority of COVID-19 testing and treatment.

Roger Severino, OCR Director, stated, "HHS is committed to helping populations hardest hit by COVID-19, including African-American, Native American, and Hispanic communities." Severino concluded, "This guidance reminds providers that unlawful racial discrimination in healthcare will not be tolerated, especially during a pandemic."

"Minorities have long experienced disparities related to the medical and social determinants of health – all of the things that contribute to your health and wellbeing. The COVID-19 pandemic has magnified those disparities, but it has also given us the opportunity to acknowledge their existence and impact, and deepen our resolve to address them," said Vice Admiral Jerome M. Adams, Surgeon General, MD, MPH. "This timely guidance reinforces that goal and I look forward to working across HHS and with our states and communities to ensure it is implemented."

A hearing for about 20 mental health bills in the House of Representatives Energy and Commerce Committee was scheduled yesterday on June 30.  Unfortunately, the bill that CSWA has been sponsoring for about 7 years in various forms, H.R. 1533, has not been included in the bills to be heard.  This is the bill that would increase Medicare reimbursement to LCSWs and allow us to again work independently in skilled nursing facilities.

We need an all-out effort to get the bill included.  Please send the following message to your representative, ESPECIALLY if they are on the E&C Committee.  To check whether you representative is on the Committee, go to https://energycommerce.house.gov/about-ec/membership . Feel free to send messages to other members of the Committee as well.

Dear Rep. ___________,

I am a constituent and a member of the Clinical Social Work Association.

Please consider adding HR 1533 to the agenda for the Energy and Commerce Hearing on June 30.  This bill, Improving Access to Mental Health Act, would greatly improve the access of Medicare beneficiaries to mental health services provided by clinical social workers.  As the largest group of mental health providers in the country, clinical social workers are currently a key part of the treatment of behavioral disorders in Medicare and across the country.

I notice that HR 945, which addresses mental health counselors and marriage and family therapists, is included in this hearing, a sister bill to HR 1533.  The goals of these bills are similar, to allow Master’s level mental health clinicians to provide independent services in skilled nursing facilities and give beneficiaries much needed access to mental health services. Currently, HR 945 does not include clinical social workers.  It would make sense to include all Master’s level mental health providers at this hearing.

Thank you for your attention to HR 1533.

Sincerely,
[your name, license, email]

CSWA appreciates your help and continued partnership. As always please let me know when you have sent your messages.

Laura Groshong, LICSW, Director, Policy and Practice
www.clinicalsocialworkassociation.org

On June 16, President Trump issued an Executive Order, “Safe Policing for Safe Communities”, to begin to law enforcement reform.  While it is not as strong as CSWA would wish, it is a start. In the spirit of collaboration on this crucial topic, CSWA has written a response to the Order. 

To ensure clinical social work ideas get included in the discussion we hope the Order will generate, please send the attached document to all your members of Congress, and state legislators with the following message:

“I am a member of the Clinical Social Work Association (CSWA) and a constituent. The President’s recent Executive Order, “Safe Policing for Safe Communities”, is of great interest to us, as clinical social workers.  We offer some suggestions about how to implement the goals of the Order, which we have been working on for decades.  Please let me know if there is any way we can help further this discussion.” 

Click here to find emails for members of Congress.

As always, let me know when you have contacted your legislators.

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

The Aware Advocate

Laura Groshong, LICSW, Director of Policy and Practice

June 15, 2020

The Supreme Court issued a wonderful decision today, BOSTOCK v. CLAYTON COUNTY, GEORGIA, today that guarantees LGBTQ citizens to have the right to work regardless of their sexual orientation or gender.  This decision holds that an employer who fires an individual merely for being gay or transgender violates Title VII. CSWA is in complete support of equal rights for LGBTQ people and we are delighted at this decision.  It is notable that the majority decision was issued by Justice Neil Gorsuch, who was widely seen as having conservative views that might have made him unlikely to lead this decision.  To read the complete decision go to https://www.supremecourt.gov/opinions/19pdf/17-1618_hfci.pdf .

In an incredible and terrible coincidence, HHS issued a rule last Friday that undoes an Obama-administration policy that had redefined “sex” to include “gender identity” and “termination of pregnancy” for purposes of nondiscrimination under the Affordable Care Act.

Section 1557 of Obamacare prohibited discrimination on the basis of race, color, national origin, sex, age, or disability in health-related programs or activities. Near the end of President Obama’s second term, his HHS Department released a regulation redefining “sex” for the purposes of Section 1557 to include “gender identity” and “termination of pregnancy.” As a result of the rule that HHS released, that regulation has been reversed and “sex” once again refers only to biological sex.  This entire new rule may be found at https://www.hhs.gov/about/news/2020/06/12/hhs-finalizes-rule-section-1557-protecting-civil-rights-healthcare.html  This rule will almost certainly be challenged, especially in light of the Supreme Court decision today.

Finally to end on a more positive note, please read the CSWA statement on “Stopping Aggression in our Communities” by CSWA President Britni Brown at https://www.clinicalsocialworkassociation.org/Announcements/9010566 CSWA will be doing many webinars and statements to address the ways that black lives are demeaned, attacked, and harmed.

Another article that calls attention to these issues by Linda Michaels, PhD, Co-Chair of the Psychotherapy Advocacy Network (PsiAN) is ”@Whatsinahashtag@We’reallinthistogether?” which can be found at https://medium.com/@psian/whats-in-a-hashtag-we-reallinthistogether-7928adf5d756?sk=9276106ac0a81675e27e67f54751a8f8  It succinctly and heartbreakingly illustrates the ways that black Chicagoans have had decades of inferior public services, culminating in a much higher incidence of death among black citizens. 

Stay safe and well in these perilous times.

 

Laura Groshong, LICSW, Director, Policy and Practice

www.clinicalsocialworkassociation.org

Clinical Social Work Association
The National Voice of Clinical Social Work

It was a pleasure to ‘meet’ with many of you virtually this weekend about the changes to our practices in the time of COVID-19 which has restricted our in-office practices.  I hope the discussions about how to move to telemental health, the confusion regarding coverage by insurers and how to code for our services, and many other issues were helpful to you.

One of the topics we talked about was advocacy to get Medicare – as well as private insurers – to cover telephonic sessions.  To accomplish this goal we will need an all-out effort, not just to CMS and HHS, but to members of Congress, state legislators, and state Insurance Commissioners. Use your own words to convey the following message:

“I am a constituent and a member of the Clinical Social Work Association. I have patients who are unable to meet with me in person for psychotherapy because of the COVID-19 crisis and do not have access to a smart phone or computer. The Centers for Medicare and Medicaid Services have not expanded coverage of psychotherapy to telephonic sessions, only videoconferencing; however, the only way I can provide services to these beneficiaries is by telephone. 

Some enlightened insurers like Cigna and Aetna have already allowed temporary coverage of telephonic psychotherapy sessions.  Some states such as Maryland, Texas, and Ohio have also required temporary coverage of telephonic psychotherapy sessions by private insurers.

Please tell CMS [and/or private insurers for state legislators and Insurance Commissioners] to approve coverage of telephonic psychotherapy sessions, sorely needed in these fraught times, for Medicare beneficiaries [and other enrollees privately insured] who may be isolated, emotionally fragile, and in need of mental health services."

You can find contact information for members of Congress at https://www.house.gov/representatives and https://www.senate.gov/general/contact_information/senators_cfm.cfm .  You can find email addresses for your state legislators and Insurance Commissioners by going to your state websites.

Finally, send a letter to CMS Administrator Seema Verma and HHS Secretary Alex Azar at the addresses below:

The Honorable Seema Verma

Secretary Administrator

U.S. Department of Health & Human Services Centers for Medicare & Medicaid Services

200 Independence Avenue, S.W. 200 Independence Avenue, S.W.

Washington, D.C. 20201 Washington, D.C. 20201

 

The Honorable Alex Azar  

Secretary

U.S. Department of Health & Human Services  

200 Independence Avenue, S.W. 200 Independence Avenue, S.W.

Washington, D.C. 20201

 

This is a lot of work, but we need to help the millions of patients who have lost their ability to get psychotherapy because they cannot get coverage for telephone sessions.

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

Stay healthy and let me know if you have any other questions.

Laura Groshong, LICSW, Director, Policy and Practice

www.clinicalsocialworkassociation.org

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

A bill for Phase 3 Emergency Relief of COVID-19 is due to be passed TODAY.

Unfortunately, it does not include the needed coverage of telephonic sessions through Medicare. 

Please send the following message to your members of Congress: "I am a member of the Clinical Social Work Association and a constituent.  I have patients who are unable to meet with me for psychotherapy because of the COVID-19 crisis and do not have access to a smart phone or computer. The only way I can provide services to them is by telephone.  Please approve coverage of telephonic psychotherapy sessions, sorely needed in these fraught times."

You can find contact information at https://www.house.gov/representatives and  https://www.senate.gov/general/contact_information/senators_cfm.cfm .

Thanks for your help and as always, let me know when you have sent messages.

Laura Groshong, LICSW, Director, Policy and Practice
www.clinicalsocialworkassociation.org

As you know, CSWA has been calling attention to the unethical and damaging practice of ICE and ORR asking therapists to violate the privacy of minor immigrants.

Thanks to the many letters sent to members of Congress by CSWA members and others and the letter sent by the Mental Health Liaison Group, which CSWA signed, Congress is taking action to stop these egregious actions.  Today the Washington Post published an article describing the ways in which Congress intends to stop this practice which can be found at https://www.washingtonpost.com/national/bill-would-end-practice-of-using-confidential-therapy-notes-against-detained-migrant-children/2020/03/04/0ab73d52-5e46-11ea-9055-5fa12981bbbf_story.html

The MHLG letter which was sent to Congress can be found at https://www.apa.org/news/press/releases/2020/02/confidentiality-immigration-letter.pdf .

CSWA will keep you apprised of the progress of bills which will prevent confidentiality violations as it evolves.

This is very good news!

Dear CSWA Members,

In addition to the letters to your members of Congress about the confidentiality violations of immigrant minors, there is now a petition that CSWA members can sign to let the Office of Refugee Resettlement (ORR) and  Immigration and Customs Enforcement (ICE) know that we oppose these unethical practices.

The petition is sponsored by the Psychotherapy Action Network (PsiAN) which CSWA has been working with for several years. To sign the petition go to https://www.thepetitionsite.com/379/862/396/tell-orr-and-ice-stop-using-psychotherapy-notes-to-betray-and-endanger-children/

Thanks to all of you who have already notified your members of Congress. 

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

Clinical Social Work Association
The National Voice of Clinical Social Work

The Washington Post article (see below) sent to you yesterday on the confidentiality violation of migrant children in detention has generated many responses and a call for what we can do to stand up for LCSW ethical standards.

CSWA recommends sending the following message to your members of Congress.  You can find their email addresses or contact information at https://www.congress.gov/members?searchResultViewType=expanded&KWICView=false

A suggested message is as follows:

“I am a constituent and a member of the Clinical Social Work Association.  Please take action to end the way that immigrant minors being held in detention have no right to confidentiality when seeing a clinical social worker for psychotherapy.  This fundamental ethical principle of psychotherapy is currently being violated by the Office of Refugee Resettlement according to the Washington Post (see article at https://www.washingtonpost.com/graphics/2020/national/immigration-therapy-reports-ice/?utm_campaign=wp_evening_edition&utm_medium=email&utm_source=newsletter&wpisrc=nl_evening ) .  The process of psychotherapy becomes potentially traumatic without the right to confidentially. I would be happy to discuss this with you further.

Please feel free to use your own language in this message.  Contact me if you have questions or need more information.  As always, let me know when you have sent your messages. Thank you for your attention to this important matter.

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

Dear CSWA Members,

The abuse of immigrant minors continues.  This article from the Washington Post details how a 17-year-old who was seen by a therapist while in detention and then had his confidentiality violated with serious emotional consequences. 

The article is called "Trust and Consequences", written by Hannah Drier, and was published on February 15, 2020.  You can find it at https://www.washingtonpost.com/graphics/2020/national/immigration-therapy-reports-ice/?utm_campaign=wp_evening_edition&utm_medium=email&utm_source=newsletter&wpisrc=nl_evening  

CSWA's commitment to confidentiality includes anyone who is seen by an LCSW.  We condemn this act and will continue to work for the right to privacy of all clients