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Legislative Alerts

CSWA Director of Legislation and Policy, Laura Groshong regularly provides Legislative/Regulatory Alerts to the membership to keep them informed about important legislation or regulations that have been introduced at the national level.  In addition to keeping members informed, the CSWA also monitors all current national legislation that affects clinical social workers and the need for action to members of Congress. The list of Legislative Alerts listed below allows members to review the history of CSWA action on national bills in Congress that affect clinical social workers and the outcomes of our actions.

  • 01 Mar 2016 1:34 PM | Anonymous member (Administrator)

    March 1, 2016

    Good morning and welcome.  My name is Margot Aronson, and I am a Licensed Clinical Social Worker.  LCSWs are the backbone of our country’s mental health treatment system.  We are responsible for close to half of clinical services provided in the USA:  assessment and diagnosis, psychotherapy, case management, and more, in clinics, hospitals, group and private practice.  

    I am speaking today for the Clinical Social Work Association, which represents the interests of the 240,000 LCSWs in the US.  Our Association has a strong advocacy program with a focus on mental health issues at the national level and on professional practice issues.  The bill we’re discussing today – H.R. 3712 /S. 2173, the Improving Access to Mental Health Treatment Act – cuts across both those areas of interest.

    This bill addresses problems Medicare beneficiaries have in obtaining mental health care.  As you know, Medicare - our federal insurance program – provides health insurance to Americans over 65, and also to younger people with disabilities or ALS or end-stage renal disease, through Social Security Disability Insurance (SSDI).   Overall, Medicare serves about 50 million Americans.

    According to the CDC (Center for Disease Control), nearly 1 in 3 seniors do not receive treatment for an ongoing mental health condition.  Seniors may be in distress or in crisis with issues of aging such as:  loss of vision, hearing, mobility; with a diagnosis of major illness or Alzheimer’s; with the cognitive impairment – or death - of a life partner; with painful end-of-life decisions. Addiction to prescription medication and/or alcohol is at epidemic levels for the elderly.  And in fact, substance misuse is often a factor with the younger beneficiaries, who may be dealing with debilitating depression, with an anxiety disorder, with serious mental illness, with PTSD.     

    Licensed clinical social workers, along with psychologists and psychiatrists, are the only providers of mental health services for Medicare beneficiaries.  Surveys generally find that our LCSW treatment success and satisfaction rates - for the services provided by all three groups - are at least equal to those of our psychology and psychiatry colleagues (Consumer Reports, 2004, 2010). 

      CSWA spoke with leadership at CMS (the Centers for Medicare & Medicaid Services) last summer. CMS is the oversight agency for Medicare.  They told us that they need LCSWs to help the vast and rapidly expanding numbers of Medicare beneficiaries (10,000 a day for the past two years). 

    Increasingly, however, LCSWs are saying that they cannot continue to work in the Medicare system because the current rates are so low that they cannot sustain their practices (25% less than other mental health providers for the same services). It is this disparity that The Improving Access bill seeks to begin to correct.

    Part I of the Improving Access to Mental Health Act would increase Medicare reimbursement for LCSW services from 75% to 85% of the physician fee schedule rate.

    While the bill will not totally resolve this problem, it is a start.  The increase will bring clinical social workers up to parity with other non-physician Medicare providers – turns out we’re now the only profession at 75%.  We believe that this modest financial boost, combined with the gesture of support from Congress, will go far in encouraging LCSWs to become Medicare providers.  

    Let me just make a quick comment about the discrepancy in pay for the same services with the same success rate:  as you might expect, it is the cause of considerable resentment; and the legislative staffers we’ve met with have themselves identified and expressed concern about the fairness issue; in addition there is the fairness issue to women, as social work is primarily a female profession.

    Part 2 of the bill increases access to LCSW services in skilled nursing facilities.

    Since 1997, LCSWs have not been permitted as independent practitioners to provide treatment to patients in skilled nursing facilities, commonly called SNFs. What this restriction means in practice is that treatment gets derailed for the client who temporarily moves into a SNF because of an illness, or the need for rehab, or to recover from surgery. Sometimes the move is the beginning of what will be a major life change: such a patient may be feeling despair, but an independent LCSW cannot be made available to him to do a timely depression assessment or to provide therapy. This is especially painful for beneficiaries who have had an ongoing relationship with an LCSW that is interrupted while the client in a SNF. This would restore the ability of LCSWs to work within SNFs independently.      

    Finally, Part 3 of this bill eliminates Medicare restrictions on the right of LCSWs to do Health and Behavior Assessment and Intervention services (HBAI), helping clients cope with the social and emotional issues stemming from  medical conditions (cancer, heart disease, diabetes, or Alzheimer’s, for example).  HBAI services are well within the LCSW scope of practice, and our holistic, person-in-environment framework, bringing to bear biological, psychological, social and family elements, is especially relevant in the skilled nursing setting and wherever substance abuse may be an issue. 

    To summarize, the Improving Access to Mental Health Treatment Act is a clear, simple, practical bill. Here are its three straight-forward parts:  

    HR 3712/S 2173 WILL IMPROVE ACCESS TO MENTAL HEALTH THROUGH MEDICARE BY:

    • Make it possible for LCSWs to do what they believe is work that they SHOULD be doing – in the service of the public – while earning a fair wage
    • Allow LCSWs to support longtime clients and others who have moved into skilled nursing care, rather than abandon them when they are most helpless and needy
    • Letting LCSWs help Medicare beneficiaries cope with emotional, behavioral, and psychosocial concerns associated with substance use and medical conditions

    We know that the elderly have a significant percentage of undiagnosed and untreated mental health conditions, and that limited access to mental health providers presents a major barrier to their overall health, leaving them at risk. This bill takes very practical steps to improving their access to mental health treatment; it is a significant bill.  Thank you.


  • 11 Feb 2016 10:42 AM | Anonymous member (Administrator)

    New Legislation is Next Step to Funding Quality Mental Health Care Nationwide

    Tuesday, February 09, 2016


    Source: http://www.stabenow.senate.gov/news/senators-stabenow-blunt-introduce-bill-to-expand-funding-for-community-mental-health-services

    U.S. Senators Debbie Stabenow (D-MI) and Roy Blunt (R-MO) introduced a bill to significantly increase funding for the program they championed to expand community mental health and substance abuse services the country. The Expand Excellence in Mental Health Act will ensure that all 24 states awarded mental health planning grants through an initiative based on Sens. Stabenow and Blunt’s Excellence in Mental Health Act can be funded. While the original law limited funding to eight states, President Obama today announced additional funding in his budget to expand the program to 14 states. 

    24 states, including Michigan and Missouri, were selected in October to work with interested community mental health centers, Federally-Qualified Health Centers, VA clinics, and other mental health organizations to design a state program that meets the new quality standards for Certified Community Behavioral Health Centers. Under current law, eight of these 24 states will be selected to receive full funding for comprehensive community behavioral health services. The Expand Excellence in Mental Health Act will fund community mental health services for all 24 states, which is an important next step toward fully funding quality mental and behavioral health services nationwide. 

    “Fully funding the Excellence in Mental Health Act is critical to making sure communities across the country have the resources they need to improve the lives of everyone living with mental illness and addictions” said Senator Stabenow.  “I appreciate the President’s call for an expansion of community mental health and substance abuse services in the budget, and our bill is an opportunity to take that another step further. Each and every state that came forward with a plan to increase access to community behavioral health services should be allowed to move forward immediately.”

    “One in four adult Americans have a behavioral health issue that is both diagnosable and treatable.  Unfortunately, those coping with a mental health issue and their families are too often confronted with a health care system that is unable to provide the access and quality of care they need,” said Senator Blunt. “The Excellence in Mental Health Act was a critical step toward improving and expanding access to behavioral health services. The legislation we are introducing today will build upon that law, and take us even further toward our goal of bringing behavioral health care in line with the way other illnesses are treated.”

    “This legislation is a critical step forward in making mental health and addiction care available to every American in need,” said Linda Rosenberg, President & CEO of the National Council for Behavioral Health. “The Expand Excellence in Mental Health Act will expand Americans' access to lifesaving mental health and addiction care, while supporting providers with the resources to not only immediately help each individual who walks into a clinic, but to also coordinate their behavioral and physical health needs. Every state that is working to transform its care delivery system deserves to be able to do so. The National Council pledges to continue working with Senators Debbie Stabenow and Roy Blunt to ensure that all 24 states have the opportunity to implement Excellence Act resources.”

    “Since the tragedy at Sandy Hook Elementary School that took the life of my sweet little son, Daniel, we at Sandy Hook Promise have advocated for the expansion of critical mental health services so that more people can have access to high quality, integrated mental health care, and those who are in crisis can get help before anyone gets hurt,” said Mark Barden, Advocacy Director at Sandy Hook Promise.  “TheExpand Excellence in Mental Health Act is an important step toward providing effective, quality mental health care nationwide. These grants will undoubtedly save lives and we are grateful to Senators Stabenow and Blunt for their leadership and tireless advocacy.”

    “The Expand Excellence in Mental Health Act will transform behavioral health care in this country, driving a fragmented and underfunded system to one with expanded access to evidence-based treatments, integrated healthcare, and accountability,” said Brent McGinty, President & CEO, Missouri Coalition for Community Behavioral Healthcare. “Missouri's behavioral health community applauds Senators Blunt and Stabenow for being true mental health champions.”

    “Our sheriff’s office is currently the gateway for the County’s mental health system, and caring for individuals with mental illness without the proper resources continues to be a growing challenge,” said Gene Wriggelsworth, Ingham County, Michigan Sheriff. “I have worked with Senator Stabenow to strengthen community mental health services in Ingham County for decades and appreciate her leadership to help law enforcement address this challenge and ensure patients across the nation get the care they need.”

    Senators Stabenow and Blunt first introduced the Excellence in Mental Health Act in February 2013 to put community mental health centers on an equal footing with other health centers by improving quality standards and fully-funding community services and offering patients increased services like 24-hour crisis psychiatric care, counseling and integrated services for mental illness. The bill was signed into law by President Obama in 2014 and is one of the most significant steps forward in community mental health funding in decades.

    The Expand Excellence in Mental Health Act is supported by over 50 mental health organizations including: American Foundation for Suicide Prevention, Association for Behavioral Health and Wellness, American Psychological Association, Clinical Social Work Association, Depression and Bipolar Support Alliance, Eating Disorders Coalition, Mental Health America, National Alliance on Mental Illness, National Council for Behavioral Health, Sandy Hook Promise, among many others.

  • 05 Jan 2016 2:31 AM | Anonymous member (Administrator)

    [This document clarifies the ways that LCSWs work with Medicare beneficiaries. ]

    Opt-in and Opt-out

    Medicare opt-in and opt-out status for LCSWs has been a source of confusion.  Previously, CSWA had been informed that all LCSWs needed to opt-in or opt-out of Medicare.  This was an error.  There is no requirement to opt-in as a Medicare provider if an LCSW chooses not to work with Medicare beneficiaries.  LCSWS must opt-in if they wish to be paid through Medicare.

    LCSWs must, however, opt-out if they want to work with Medicare beneficiaries who pay the LCSW privately.  This requires a signed contract with each beneficiary the LCSW treats that confirms neither the LCSW or the beneficiary will submit any claims to Medicare for the psychotherapy services that provided.  CSWA has a template which can be used for this purpose and an opt-out letter as well which should both be sent to your regional Medicare Administrative Center (MAC) if you choose to opt-out.  A beneficiary may have a private contract with an LCSW while maintaining Medicare coverage with other providers if they so choose.

    A good Medicare summary document can be found at  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1311.pdf

    CSWA has templates for private contracts with Medicare enrollees and to opt-out of Medicare in the Members Only section of the CSWA website (www.clinicalsocialworkassociation.org) .

    Assignment

    If an LCSW decides to opt-in, the LCSW accepts “assignment” of all Medicare cases who seek treatment.  If an LCSW chooses to refer a beneficiary who seeks treatment, a referral and reason for the referral should be documented. The Medicare terminology for this category is participating (“par”).  There is another category for other providers, non-participating (“non-par”) which does not apply to LCSWs. 

    Another form of assignment is “incident to” the services of physicians, psychologists, nurse-practitioners, or physician assistants.

    Medicare Mental Health Care (outpatient)

    Here is a summary of what Medicare currently covers taken from https://www.medicare.gov/coverage/outpatient-mental-health-care.html

    Medicare Part B (Medical Insurance)covers mental health services and visits with these types of health professionals: 

    • Psychiatrist or other doctor
    • Clinical psychologist
    • Clinical social worker
    • Clinical nurse specialist
    • Nurse practitioner
    • Physician assistant

    Medicare only covers these visits, often called counseling or therapy, when they’re provided by a health care provider who accepts ">assignment[all LCSWs.]

    Part B covers outpatient mental health services, including services that are usually provided outside a hospital (like in a clinic, doctor’s office, or therapist’s office) and services provided in a hospital’s outpatient department. Part B also covers outpatient mental health services for treatment of inappropriate alcohol and drug use. Part B helps pay for these covered outpatient services:

    • One depression screening per year. The screening must be done in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals.
    • Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where beneficiary gets the services [includes all LCSWs.]
    • Family counseling, if the main purpose is to help with individual beneficiary treatment.
    • Psychiatric evaluation.
    • Medication management.
    • Diagnostic tests.
    • A yearly “Wellness” visit. This is a good time to talk to a doctor or other mental health care provider about changes in the beneficiary’s mental health so they can evaluate changes from year to year.

    All people with Part B are covered.

    Costs in Original Medicare

    • You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment [includes all LCSWs.]
    • 20% of the Medicare-approved amount for visits to a doctor or other ">health care provider to diagnose or treat your condition. The Part B ">deductible applies.
    • If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or ">coinsurance amount to the hospital. This amount will vary depending on the service provided, but will be between 20-40% of the Medicare-approved amount.

    Telehealth Services

    • Medicare pays for a limited number of Part B services furnished by a physician or practitioner to an eligible beneficiary via telehealth.  This includes certain mental health services (e.g., individual psychotherapy and pharmacologic management, behavior assessment and intervention, psychiatric diagnostic interview exam, annual depression screening, psychoanalysis, family psychotherapy) as well as a number of specific behavioral health and substance abuse disorder services (e.g., smoking cessation services, alcohol and/or substance abuse structured assessment and intervention services, annual alcohol misuse screening, brief face-to-face behavioral counseling for alcohol misuse)
    • To be eligible for telehealth services, the originating site (location of the beneficiary) must be in a rural health professional shortage area (HPSA) located either outside a metropolitan statistical area (MSA) or in a rural census tract; or a county outside of a MSA.

    LCSWs have concerns about non-mental health clinicians being allowed to provide psychotherapy or make mental health diagnostic assessments, which CMS allows. CSWA continues to work with CMS on the problems with untrained mental health clinicians providing these services.

    Summary

    LCSWs do not need to opt-in or opt-out of Medicare.  If an LCSW wishes to be paid through Medicare, the LCSW must opt-in as a Medicare provider. All LCSWs are expected to accept assignment of any Medicare beneficiary who needs mental health treatment unless there is a reason that the beneficiary needs to be referred.  If an LCSW wishes to be paid privately, the LCSW needs to opt-out of Medicare and have each beneficiary sign a contract agreeing to refrain from submitting any claims to Medicare for the LCSW’s services.    Telemental health services continue to be limited to rural areas with a shortage of mental health clinicians.

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

     


  • 16 Dec 2015 12:00 PM | Anonymous member (Administrator)

    Dear CSWA Affiliated Society Members,

    Here is some information on the letters you may be getting from insurers asking for patient records. These requests are not the usual treatment review requests if they have the term “risk adjustment” as the reason for the request.  Most insurers are hiring an auditing firm to collect this information. Regence BlueShield is using AventMed, for example.  Here is why.

    When the Affordable Care Act was created, Federal regulators set up a Risk Adjustment Program to keep insurance plans with unhealthy patient populations competitive with plans with healthier populations for whom care is less expensive. The Risk Adjustment letters are the assessment of this goal. The first time insurers were required to ask for this information was in November, 2015.

    Some insurers are asking for the “full chart”, a statement that has created confusion. What is being requested is the Medical Record. As you know, if you do not limit the information you include in the Medical Record, you need to submit the whole record, even though it is likely to be far more information than the insurer wants.

    Though it is more work, it will provide much more confidentiality to patient information to have dual records, i.e., to have a Medical Record with basic information, treatment goals, and treatment progress and Psychotherapy Notes as the record of any detailed process notes.


    Below is a summary of what must be included in the Medical Record and cannot be shielded by Psychotherapy Notes.

    Medical Record Template – 12-11
    Laura Groshong, LICSW, CSWA Director, Government Relations

     From HIPAA Seven Years Later: The Impact on Mental Health Practice, Groshong, Myers, and Schoolcraft (2011, p. 17): According to HIPAA Rules, the Medical Record should include, as applicable:

    • Intake information;
    • Billing information;
    • Formal evaluations;
    • Notes of collateral contacts;
    • Records obtained from other providers;
    • Counseling sessions start and stop times;
    • The modalities and frequencies of treatment furnished;
    • Medication prescribed, if known;
    • Any summary of diagnosis, functional status, treatment plan, symptoms, prognosis, and
    • Progress to date.

    Outcome tools may be required in the future to document progress in mental health treatment.

    Psychotherapy Notes: If dual records are kept of the Medical Record and Psychotherapy Notes, i.e., process notes, the process notes are not part of the Medical Record. If there is one record, process note are included in the Medical Record.

    I hope this helps in your responses to these risk adjustment requests.

  • 14 Dec 2015 9:30 AM | Anonymous member (Administrator)

    December 14, 2015

    Dear CSWA Affiliated Society Members,

    A major political and social work figure, Sen. Barbara Mikulski (D-MD), received the Medal of Freedom this month.  This well-deserved award puts a wonderful capstone on her career, as she will be retiring next year.

     All members who live in Maryland can send an email to Sen. Mikulski at www.mikulski.senate.gov/contact/ (below). All others who would like to send a hard copy letter to her office, please send a message of congratulation to Sen. Barbara Mikulski, 503 Hart Senate Office Building, Washington, DC 20510, as follows:

    Dear Sen. Mikulski,

    I am writing as a constituent and member of the Clinical Social Work Association to congratulate you on your latest success: being awarded the Medal of Freedom by President Obama. Your accomplishments are a beacon of social justice to all social workers and the country as a whole.  We at CSWA hope to build on your magnificent legacy.

    Sincerely, _____________, LCSW, [your address]

    Please let me know if you send this message.

    Laura Groshong, LICSW, CSWA Director, Policy and Practice

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

     

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

    Mikulski Gets Medal of Freedom

    WGDB, World's Greatest Deliberate Body, 12/2/15

    President Barack Obama on Tuesday awarded 17 Americans their country’s most prestigious honor. In true American form, there were Presidential Medals of Freedom for baseball legends, Hollywood legends and musical legends.

    And then there was a social worker from Maryland who became a true Washington legend, Democratic Sen. Barbara A. Mikulski.

    Obama recounted the fight that summoned Mikulski into her career of public service, a battle over a proposed highway that was to cut through her Baltimore neighborhood.

    He noted the project appeared all but a done deal “until it ran into a young social worker — and let’s just say you don’t want to be on the wrong side of Barbara Mikulski.

    “She stopped that highway,” Obama said, a nodding Mikulski seated just to his left.

    She would go on to become “a lioness on Capitol Hill” who advocated for issues such as women’s rights and a slew of domestic programs, he said.

    Mikulski, 79, is the longest serving woman in Congress and became the dean of women in the Senate. When she retires next year at the end of her term, she’ll have served 30 years in the Senate and another 10 before that in the House.

    She chaired the powerful Senate Appropriations Committee from 2012 until 2015, the first woman and Marylander to do so. During that span and throughout her congressional career she has been a vocal advocate for social programs like those run by the Maryland-based National Institutes of Health.

    Mikulski earned a reputation among her colleagues, aides and reporters for always speaking candidly.

    Spotted in attendance in the White House’s East Room were members of the Maryland congressional delegation, including House Democratic Whip Steny H. Hoyer and Ben Cardin, the top Democrat on the Senate Foreign Relations Committee.

    Mikulski did not speak during the ceremony, but took to the Senate floor last week to speak about the coming award, saying “the honor has always been to be here.”

    True to form, she had a memorable line about her start in public service, which began when she organized the “Hell No, We Won’t Go” committee to protest that proposed Baltimore highway:

    “You know what’s so great about this country? In others, they put you in jail and beat you. In this country, they sent me to city council and I beat the political bosses.”

    Other recipients included performers and artists James Taylor, Barbra Streisand, Steven Spielberg, Stephen Sondheim, as well as Emilio and Gloria Estefan; baseball legends Yogi Berra and Willie Mays; and Bonnie Carroll, who founded an organization that helps those affected by the death of a loved one killed while serving in the U.S. military.


  • 10 Dec 2015 3:54 PM | Anonymous member (Administrator)

    December 8, 2015

    Dear CSWA Affiliated Society Members,

    Here is some good news for LCSWs in dealing with PQRS in 2016.  There are no changes from the reporting necessary to be PQRS compliant from 2015!

    There are still seven PQRS measures that apply to LCSWs and have QDCs that we report on the CMS-1500.  That means LCSWs still do not meet the Medicare requirement of nine measures and three domains.  Simply apply as many of the measures as you can to 50% of all Medicare patients and you will be compliant with PQRS through the MAV process.

    Please review carefully the instructions on how to document PQRS measures which can be found at http://www.clinicalsocialworkassociation.org/Resources/Documents/CSWA%20-%202015%20PQRS%20Requirements%20for%20LCSWs%20%20%28FINAL2%29%20-%202-15.pdf to refresh your memory about how to submit QDCs.  The date will be changed from 2015vto 2016 shortly.

    A 2015 summary chart (soon to be changed to 2016) is also available at http://www.clinicalsocialworkassociation.org/Resources/Documents/CSWA%20-%20PQRS%202015-A%20glossary%20and%20chart--4.12.15%20%281%29.pdf which has the seven measures and domains listed out.

    Failure to comply with all the instructions listed the above documents may result in PQRS non-compliance in 2016 and a 3% reimbursement cut for Medicare payments in 2018. It appears that the vast majority of CSWA members who chose to become PQRS compliant were successful in doing so.  Most of the few members who were found to be non-compliant in 2015 understand what needs to be changed to avoid non-compliance in 2016.

    Remember that you still can request an informal review if you have been told that you were non-compliant until December 16, 2015. Here are the links and phone numbers to use: Information about how to request an informal review is available 1) on the 2014 QRUR website; 2) through the QRUR Help Desk at pvhelpdesk@cms.hhs.gov ; or 3) at 888-734-6433 (select option 3).

    If you chose not to be compliant until now in 2015, it is too late to become compliant, but you can start doing so in 2016.

    I wish you all happy holidays. 

    Laura Groshong, LICSW, CSWA Director, Policy and Practice

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


  • 15 Oct 2015 3:07 AM | Anonymous member (Administrator)

    Dear CSWA Affiliated Society Members,

    It is time to start supporting the Improving Access to Mental Health Act of 2015, the bills that have recently been created by Sen. Debbie Stabenow and Rep. Barbara Lee.  These bills are being sponsored by CSWA, though the Medicare reimbursement increase requested – 10% – is less than the 25% that CSWA had hoped for.  This is a first step toward the goal of 100% parity with other mental health providers that CSWA still supports.  An improvement in the 75% of other providers is what the Association sees as feasible at this time.

    Please send this message to your members of Congress by October 31, 2015.  You can find their email addresses at http://www.contactingthecongress.org/ :

    Dear (Sen./Rep.) ________________:

     I am a member of the __________ Society [if you are] and the Clinical Social Work Association [if you are] and a constituent. [If you are in Michigan - Sen. Stabenow's state - or California's 13th District - Rep. Lee's district - please thank them for supporting the bill here.]

     I am [calling/writing] to ask for your support of S. 2173/H.R. 3712, the Improving Access to Mental Health Act of 2015 that will improve access to mental health treatment by increasing the number of licensed clinical social workers who choose to be participating Medicare providers.  The changes that the bills propose are:

    • Increase Medicare reimbursement for LCSW services from 75% to 85% of the physician fee schedule rate.
    • Eliminate restrictions on the delivery of LCSW services for Medicare beneficiaries in skilled nursing facilities and hospitals.
    • Expand the statutory definition of LCSW services to include all psychotherapy services (including Health and Behavior Assessment and Intervention services)

    Anticipated cost offsets from lower medical costs should make this fiscal change revenue neutral.  A cost assessment is currently in process. I hope you will consider sponsoring this bill.

    Sincerely,

    [Name, degree, license]

    The CSWA Government Relations Committee is working hard to get sponsors as well but we need your help!  As always, please let me know when you have sent your messages to your members of Congress.

    Laura Groshong, LICSW, CSWA Director of Policy and Practice


  • 08 Oct 2015 4:11 PM | Anonymous member (Administrator)

    Clinical Social Work Association Members and State Affiliate Members:

    It is with great pleasure that we write you to inform you of the recent introduction of S. 2173 & H.R. 3712, the Improving Access to Mental Health Act of 2015 on October 8, 2015 by Senators Debbie Stabenow (D-MI) and Barbara Mikulski (D-MD) in the Senate and Rep. Barbara Lee (D-CA) in the House.  NASW and Clinical Social Work Association (CSWA) have been working on achieving this together on your behalf.

    We are actively working with Senator Stabenow, Senator Mikulski and Representative Lee to build bipartisan support for the bill in both the U.S. Senate and the House of Representatives. Given Senator Stabenow’s background as a social worker and her position on the influential Senate Finance Committee, she will be a strong champion for advancing our mutual Medicare agenda. Sen. Mikulski, also a social worker, Dean of the Women in the Senate as well as the longest serving woman in the history of the United States Congress is working collaboratively with Sen. Stabenow on this legislation and they are each committed to advancing the bill through the legislative process. Rep. Lee is also a social worker, serves on the House Appropriations Committee and leads the Congressional Social Work Caucus.

    The two main goals of the Improving Access to Mental Health Act of 2015 are to increase beneficiary access to services provided by licensed clinical social workers (LCSW) and to advance a credible and achievable Medicare agenda for LCSWs.  The Improving Access to Mental Health Act of 2015 achieves these goals in several ways. 

    • First, S. 2173 & H.R. 3712 increases Medicare reimbursement for LCSW services from 75% to 85% of the physician fee schedule rate. (This is the first step to 100%!)
    • Second, this bill eliminates restrictions on the delivery of LCSW services for  Medicare beneficiaries in skilled nursing facilities.
    • Finally,  These Senate and House Bills expand the statutory definition of LCSW services to include all services (including Health and Behavior Assessment and Intervention services) that LCSWs are authorized to perform under their respective state licensure states and regulations.

    The Improving Access to Mental Health Act of 2015 recognizes the critical shortage in resources for clinical social work services and the limitations it places on beneficiary access.  This bill would help alleviate those shortages by increasing CSWs reimbursement rate from 75% to 85%. By raising this rate, payment parity would be established between CSWs and other non-physician professionals, including physician assistants, nurse practitioners, and clinical nurse specialists. Although passing any legislation through Congress is difficult, especially proposals that require increased spending in uncertain economic times, we believe increasing the Medicare reimbursement rate to 85% of the physician fee schedule is a credible and politically viable proposal.

    NASW and CSWA are very grateful to Sens. Stabenow and Mikulski and Rep. Lee for their leadership on this bill and encourage all their constituents who are members to let them know.  Under separate cover, an alert will go out to the NASW Advocacy Listserv and CSWA listserv that will let you know how to contact your elected officials about this legislation. To join the Advocacy Listserv, click here.

    Sincerely,

    Susanna Ward, PhD, LCSW
    President & CEO, CSWA

    Angelo McClain, PhD, LICSW                                            
    Chief Executive Officer, NASW                                          


  • 07 Oct 2015 9:36 PM | Anonymous member (Administrator)

    *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.

    Membership in CSWA is an investment in your professional growth and development. CSWA is the only national organization that advocates for your interests! CSWA IS WORKING FOR YOU!  LOGIN TO RENEW YOUR MEMBERSHIP TODAY!


  • 13 Aug 2015 9:38 PM | Anonymous member (Administrator)

    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!


PO Box 10, Garrisonville, Virginia  22463 | administrator@clinicalsocialworkassociation.org

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