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

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

Dear CSWA Members,

I have been hearing from members who have had trouble communicating with Noridian, the Medicare Administrator for much of western United States. This post is to gather information about how widespread this problem is.

Please let me know the following if you have had any of the following difficulties in the past three months:

1. Mistakes on EOBs which cannot be corrected

2. Inability to get a person to talk to about EOBs or other problems

3. Wait times of more than 20 minutes

4. Being disconnected while on hold

Please respond by February 2. Thanks for your help. Once I have more data I will contact CMS about the problem.

Dear CSWA Members,

This post is to let you know that clinical social workers will not be required to report on the Merit-Based Incentive Payment System (MIPS) in 2020. CSWA has checked with the Centers for Medicare and Medicaid Services (CMS) to verify this. There will be no penalties and no bonuses for LCSWs through MIPS in 2020.

MIPS is the successor to the PQRS program that ended in 2016, which was cumbersome and did not always provide correct results in the penalties assessed to the LCSWs that complied with it.

Here is the rule about clinical social workers in 2020:

Are clinical social workers eligible for MIPS? Why is there a clinical social worker specialty measure set?

No. Clinical social workers continue to be excluded from MIPS in the 2020 performance period. However,we have finalized a clinical social worker measure set to help these clinicians prepare in the event that they are added to the definition of a MIPS eligible clinician through future rule making.

To review the whole final rule, click here.

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

Below is updated information on the CMS Proposed Rules changes.

At this point, the 800 pages of Proposed Rules for LCSWs are mainly about our being included in the Merit-based Incentive Payment System (MIPS), the successor to PQRS.  CMS has asked CSWA for recommendations on the measures which we can logically keep records on.  The CSWA-recommended 16 measures are included in the attached document.

We also encourage you as individual members – whether or not you are Medicare providers - to send comments to CMS about these proposed rules.  A strong showing from the LCSW community can make a difference.  Remember, these proposed rules are not about reimbursement rates, just the inclusion of LCSWs as Medicare providers in the MIPS system.  If you believe LCSWs should not be included in MIPS or that inclusion would affect your willingness to be a Medicare provider, feel free to say so. 

Suggested language:

Re:  Proposed rules CMS-1715-P

I am a licensed clinical social worker and a member of the Clinical Social Work Association.  I am hoping that the reporting requirements will be simpler and clearer than the ones that were required for PQRS, and more carefully monitored. [Or, I oppose the inclusion of LCSWs in the MIPS system.]   Many LCSWs [I was, if you were] had their reporting rejected although it was in compliance with the PQRS measures.  Many LCSWs [I decided, if you did] decided not to remain part of the Medicare provider network because of these onerous reporting requirements.  Such requirements seem particularly unfair given the reimbursement rate for LCSWs at 25% less than for others providing the exact same services.

How to submit comments:

Your comments should be submitted to https://www.regulations.gov/document?D=CMS-2019-0111-0092. Click on the “Comment Now” box on the right side to submit your comment.  All comments must be submitted by Friday, September 27, 2019, 5 pm EDT.

Comments sent by CSWA:

If you would like to read the more extensive comments sent by CSWA, you can find them at CSWA - CMS Comments on Medicare Proposed Rules (Final) - 9-24-19.pdf. CSWA will keep members apprised of the final decision on these proposed rules.

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September 20, 2019

I have received several messages from you about the new CMS proposed rule to lower the Medicare reimbursement for psychologist services.

It appears from the proposal (found in the Federal Register at https://www.govinfo.gov/content/pkg/FR-2019-08-14/pdf/2019-16041.pdf ) that the reduction for psychologists is a higher reduction than for clinical social workers , i.e., 7% vs. 6%.

The proposed rule also asks for recommendations for measures that could be used to include LCSWs in MIPS, the new PQRS, in 2022. 

We are in contact with NASW and hoping to submit joint comments on this proposed rule.

CSWA will be responding to all of these proposals shortly and asking members to do so as well.  You can start reviewing the extensive rule now. Comments must be in by September 27, 2019.

CSWA will have our comments by early next week for your consideration.

Let me know if you have any questions.

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

Dear CSWA Members,

I have received several messages from you about the new CMS proposed rule to lower the Medicare reimbursement for psychologist services.

It appears from the proposal (found in the Federal Register at https://www.govinfo.gov/content/pkg/FR-2019-08-14/pdf/2019-16041.pdf ) that the deduction for psychologists is a higher deduction than for clinical social workers , i.e., 7% vs. 6%. In one area, E/M services, we are now included, and have a small increase of 1%compared to psychologists who have a small decrease of 1%. This is one of the first times that there have been separate recommendations for psychologists and LCSWs, small though they may be.

The proposed rule also asks for recommendations for measures that could be used to include LCSWs in MIPS, the new PQRS, in 2022. 

We are in contact with NASW and hoping to submit joint comments on this proposed rule.

CSWA will be responding to all of these proposals shortly and asking members to do so as well.  You can start reviewing the extensive rule now. Comments must be in by September 27, 2019.

CSWA will have our comments by early next week for your consideration.

Let me know if you have any questions.

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

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

HHS Proposed Changes to Affordable Care Act | Section 1557 on Non-Discrimination | August, 2019

The Clinical Social Work Association strongly opposes the DHHS proposed Section 1557 rule change.  This revision would open the door to discrimination by healthcare providers and by insurers offering Marketplace plans. Discrimination and denying access to health care in our public health care system is unethical and harmful.

Ethical Treatment vs Prejudice

CSWA represents many of the 250,000 Licensed Clinical Social Workers (LCSWs) who provide mental health diagnosis, treatment, and other health related services through in the public and private sectors.  We adhere to a code of ethics that prohibits discrimination; indeed, a social worker would never turn away someone seeking health or mental health care. It is self-evident that all health professions practice within codes of ethics that prohibit discrimination and do no harm.

The DHHS proposed changes are in stark contrast to ethical practice.   Currently, Section 1557 regulations standardize the protections and processes that prohibit discrimination in health care for all vulnerable populations.  Further, current regulations recognize that intersectional discrimination can affect people who belong to multiple protected classes; for example, discrimination against an African-American woman could be based on race, sex, or both.  While DHHS maintains that it “is committed to ensuring the civil rights of all individuals who access or seek to access health programs or activities of covered entities,” the proposed changes, if finalized, would substantially scale back current protections against discriminatory practices, and create a climate friendly toward providers inclined to deny care based on stereotyping and generalized prejudice. 

Proposed Changes for Insurance Carriers

With regard to changes for insurance carriers, CSWA notes with dismay that the DHHS proposal would provide leeway for insurers to shape benefit designs with potential to disadvantaged vulnerable groups often targeted for discrimination by race, color, national origin, sex, age, and/or disability. While these rules would only apply to Marketplace plans, the change would have significant impact on the lives of the 20 million people covered by these plans and could be adopted by private plans. 

It is also of significant concern to CSWA that DHHS also wants to eliminate basic consumer protections by ending grievance procedure requirements and restricting the right to challenge violations of the right to access care in court.

Disability Discrimination

As to the question of relaxing protections currently provided to individuals with disabilities, we cannot see how the proposed exemptions are justified.  Surely an increase in the “undue hardship” exemptions for federally covered entities would seriously curtail access to healthcare for individuals who in their daily lives already face undue hardships due to their disabling conditions.

Recommendation 

CSWA urges that DHHS keep Section 1557 in place and protect the rights of vulnerable and/or disabled enrollees to health care through the Marketplace plans. To open the door for healthcare providers to refuse to provide healthcare services to certain groups and for insurers to develop policies that disadvantage such groups is unethical and would destroy civil and disability rights protections to specific patient populations.  

Thank you for this opportunity to provide input on the DHHS proposal to change non-discrimination regulations under ACA Section 1557.  We are available to respond to any questions.  Please contact us.

Dear CSWA Members,

There was a recent article in the Los Angeles Times about the serious problem at the University of Southern California School of Social Work (USC) which started their online MSW program in 2009.  In 2013 CSWA wrote a position paper about the ways we thought this online program could undermine the interpersonal understanding and ability to connect to others that are necessary components of becoming a competent clinical social worker. You can find this paper on the website at https://clinicalsocialwork.wildapricot.org/Resources/Documents/CSWA%20-%20Position%20Paper%20-%20Online%20MSW%20Programs%20-%209-13-1.pdf .

Our focus was on the clinical skills that would be lost if there is not the direct contact with professors, supervisors, and patients that many online MSW programs minimize or eliminate. As these programs have proliferated, there are two other issues which we touched on in our paper – the cost of these programs, around $90,000 at USC, and the way that the marketing of this program was done by a for-profit marketing firm, 2U, which had to meet certain quotas according to their contract with USC.

Over the past 6 years, the problems with the way that the USC School of Social Work has evolved, and especially the way that 2U allowed students to enter the program who were not qualified to do so, has created a maelstrom of problems.  In the past week, two articles have been written about these problems in the Los Angeles Times, https://www.latimes.com/local/lanow/la-me-usc-social-work-20190606-story.html,and the New York Times,https://www.nytimes.com/2019/06/03/upshot/student-debt-big-culprit-graduate-school.html.

CSWA encourages its members to educate themselves about the way that clinical social work is being endangered by the general lack of adequate training in online programs, as well as the stifling debt that many students accumulate. While some students think that they have gotten the training they need (see comments in these articles), U.S.News and World Report gave USC School of Social Work a rating of the 25^thbest school in 2018, down from its usual place in the top ten schools. 

The Council of Social Work Education, which accredits all MSW programs, has endorsed the use of online MSW programs without reservation,if they conform to the coursework standards of brick and mortar programs. This was a mistake in the opinion of CSWA for the reasons stated above and in our Paper.We encourage members to let their schools know, as alumnae, that the possible diminished training of MSWs using online courses, and the staggering debt accrued, are bad for our profession and bad for the well-being of future clinical social workers. 

The majority of schools of social work now have online MSW programs as an option.  It is time to take a stand on the harm this may do to the clinical social work profession.

Laura Groshong, LICSW, Director, Policy and Practice
Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY