October 25, 2020

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

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

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

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

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

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

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

Please let me know if you have any questions.

- Laura W. Groshong, LICSW, CSWA Director of Policy and Practice

October 23, 2020

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

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

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

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

October 8, 2020

I’ve received several questions about the HHS extension of the State of Emergency which I will answer below:

1. Does the HHS State of Emergency affect reimbursement for telemental health or audio only treatment? No, this only applies to the coverage in some form of telemental health and audio only therapy by Medicare and Medicaid, which is determined by CMS. Reimbursement rates are the same as for in-person sessions.

2. Does the HHS State of Emergency extension affect coverage and reimbursement by commercial insurers? The commercial insurers, e.g., Optum, Aetna, BlueCross/BlueShield, Cigna, etc., will develop their own policies about telemental health/audio only coverage. Many have followed the direction that CMS takes so far. Reimbursement is more varied. Some states have required insurers that cover telemental health and audio only treatment to reimburse at the same level as in-person treatment. Check with your Insurance Commissioner or Social Work Board.

3. Does the HHS State of Emergency extension affect the ability to provide treatment across state lines without being licensed in the state of the client? The extension does not address the ability to treat clients in states where the LCSW is not licensed. Some states have allowed LCSWs to get a temporary license, some allow temporary reciprocity if an LCSW is licensed in another state. There are a couple bills in Congress that would make this national policy if they are passed. For now, it is the responsibility of the individual LCSW to find out what the policy about treating clients in states where they are not licensed in that state, as well as in the state where they ARE licensed.

4. What will happen when the State of Emergency ends to coverage of telemental health and audio only treatment? That is currently unknown but unless there is a permanent requirement that telemental health and audio only treatment be covered as in-person treatment is, it is likely that insurers will only cover in-person treatment.

In short, coverage of telemental health and audio only treatment will now continue until January 21, 2021, for Medicare and Medicaid. The reimbursement rates will remain the same for Medicare and Medicaid during this time. Commercial insurers may follow this policy but are not required to. The responsibility to find out what coverage is for commercial insurers is our responsibility as LCSWs to check.

Let me know if you have any other questions about the State of Emergency extension at lwgroshong@clinicalsocialworkassociation.org.

- Laura W. Groshong, LICSW, CSWA Director of Policy and Practice

October 6, 2020

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

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

- Laura Groshong, LICSW, CSWA Director of Policy and Practice

October 28, 2020

Please visit the CSWA Position Papers page to view a Position Paper on Mental Health. 

October 5, 2020

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

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

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

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

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

Let me know if you have any questions.

- Laura Groshong, LICSW, CSWA Director of Policy and Practice

October 5, 2020

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

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

September 24, 2020

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

Now I am asking you to send another message directly to CMS (Centers for Medicare and Medicaid Services), the organization that oversees reimbursement rates for all Medicare providers, including LCSWs. Both messages are necessary to make our position on this issue clear by October 5, 2020. Send the following message (use your own words if you like) to the following link: https://www.federalregister.gov/documents/2020/08/17/2020-17127/medicare-program-cy-2021-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part.

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

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

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

- Laura Groshong, LICSW, CSWA  Director of Policy and Practice, Government Relations Chair

September 19, 2020

2020 has been a challenging year for everyone. The pandemic has increased anxiety, fear, isolation and grief, leading to declining mental health and increased substance use in our communities that will only continue to get worse.

In July, the Federal Communications Commission (FCC) made the historic announcement that it had unanimously voted to designate 9-8-8 as the universal three-digit dialing code for the National Suicide Prevention Lifeline.

Unfortunately, the bipartisan, non-controversial National Suicide Hotline Designation Act is stalled in Congress, putting at risk the promise that this easy-to-access, three-digit dialing code for the life-saving services 9-8-8 could provide.

To date, the House and Senate have each approved similar, but not identical, bills establishing 9-8-8 as the dialing code and supporting the new hotline by establishing a funding mechanism through states and wireless phone carriers. But that legislation is not yet over the finish line. Without this bill becoming law, our communities will not be able to respond to the increasing demand for needed suicide prevention services.

CSWA urges you to call all your Members of Congress by tomorrow to help pass the National Suicide Hotline Designation Act. Go to https://www.contactingcongress.org/ to get their emails or phone numbers and leave the following message: “I am a member of the Clinical Social Work Association and a constituent. Please pass the National Suicide Hotline Prevention Act and save lives. The pandemic and other natural disasters have increased the number of citizens who have hopeless helpless feelings leading to suicidal thoughts. They need ways to access mental health treatment which the over 250,000 clinical social workers can provide.”

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

- Laura Groshong, LICSW, CSWA Director of Policy and Practice, Government Relations Chair

September 16, 2020

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

We are fortunate to have the support of Rep. Bobby Rush (D-IL) and 93 members of Congress in stopping this cut. Please check the letter they wrote to Congressional leadership at https://rush.house.gov/sites/rush.house.gov/files/documents/Letter%20to%20Leadership%20on%20EM%20Code%20Cuts%20General.pdf and thank your legislator if he or she signed on.

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

“I am a member of the Clinical Social Work Association, a Medicare provider [if you are], and a constituent. Maintaining budget neutrality on the backs of clinical social workers and other mental health providers is a burden that I will not be able to bear. I am already paid 25% less than other mental health providers for the same diagnostic and treatment services as other mental health providers. My fixed costs have not changed. The onslaught of COVID-19 has increased the need for mental health services. Please make it possible for me to continue to provide them by eliminating the proposed Medicare reimbursement cut.”

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

- Laura Groshong, LICSW, CSWA Director of Policy and Practice, Government Relations Chair