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The National Voice of Clinical Social Work 

Strengthening IDENTITY  | Preserving INTEGRITYAdvocating PARITY

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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.

  • 16 Dec 2015 12:00 PM | CSWA Administrator (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 | CSWA Administrator (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 (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 | CSWA Administrator (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 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 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 ; 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 | CSWA Administrator (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 :

    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.


    [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 | CSWA Administrator (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.


    Susanna Ward, PhD, LCSW
    President & CEO, CSWA

    Angelo McClain, PhD, LICSW                                            
    Chief Executive Officer, NASW                                          

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


    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 | CSWA Administrator (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!

  • 06 Aug 2015 5:09 PM | CSWA Administrator (Administrator)

    I wanted to inform you of the filing of a Washington State class action lawsuit against Group Health Corporation, a major insurer in Washington State, for failing to use adequate guidelines in covering psychotherapy.  An article about the suit has been published by Courthouse News Service at

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

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

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

  • 28 Jul 2015 1:03 AM | CSWA Administrator (Administrator)

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

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

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

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

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

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

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

  • 12 Jul 2015 11:49 PM | CSWA Administrator (Administrator)

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

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

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