March 30, 2020

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

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

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

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

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

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

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

The Honorable Seema Verma, Secretary Administrator, U.S. Department of Health & Human Services Centers for Medicare & Medicaid Services, 200 Independence Avenue, S.W. 200 Independence Avenue, S.W., Washington, D.C. 20201 Washington, D.C. 20201

The Honorable Alex Azar, Secretary, U.S. Department of Health & Human Services, 200 Independence Avenue, S.W. 200 Independence Avenue, S.W., Washington, D.C. 20201

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

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

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

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

March 27, 2020

The complete change to our personal and professional lives in the past two weeks as the result of the COVID-19 pandemic has been overwhelming. It has led to feelings of helplessness about how to do our jobs as clinical social workers that many of us have not had to face for decades.

CSWA has tried to outline the changes that most private practitioners are facing and ways to adjust our practices. Once we get past the shock of feeling disoriented, the shift to telemental health that we need to make for at least the next 2-3 months are manageable. Below is a brief summary of the areas that should be considered. The complete hour-long webinar can be found under the Members-only area of the CSWA website.

Practice Considerations:

CSWA is offering more guidance on the changes created by this pandemic. There will be two Open Webinars to discuss the questions LCSWs have and provide mutual support on March 28 and 29 (see Upcoming Events at CSWA website). There will be a two-hour conference on more detailed discussion of how to provide telemental health. We want to be your partner in this time of flux and transition.

March 22, 2020

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

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

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

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

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

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

March 17, 2020

I spoke this morning with Karyn Anderson, CMS Technical Director as she was about to develop this guidance from CMS on telemental health services. She was quite receptive to our concerns.

I am happy to report that CMS has approved an expansion of Medicare telemental health to cover anyone we see, new patients or ongoing ones. Unfortunately, it does not include telephonic sessions. CSWA will keep working to get them included as well. To see the FAQ on all the changes included see 3.17.20 COVID 19 Telehealth Waiver FAQ Final.pdf.

Please read this carefully and let me know if you have any questions.

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

March 16, 2024

There have been many questions about how to establish a telemental health practice as we address COVID-19. Here are some ideas about what to consider.

• Take a course to understand the basic skills that are needed to provide telemental health videoconferencing. The TBHI Courses offered by Marlene Maheu are excellent and can be found here. There are many others, but Dr. Maheu has based hers in part on the ethical standards for clinical social workers.
• Read the Technology in Social Work Standards, that CSWA helped develop, which can be found here.
• Find a platform to use for your videoconferencing work. There are several available but the ones that seem to be the best are VSee, Zoom, doxy.me (which has some service problems from recent reports), Simple Practice and Theranest. Most have a monthly charge. Some are more reliable than others. To see comparisons of the platforms, go to Rob Reinhardt’s website www.tameyourpractice.com.
• Find a payment method for videoconferencing. The ones that seem to be the best are Zelle and Paypal. Zelle is bank related and have privacy protections; you will need to get the patient’s bank account number. I believe Paypal will sign a BAA.
• Develop an Informed Consent form for videoconferencing. CSWA has developed a template which can be found at CSWA - Telemental Health Informed Consent - 3-20.docx.
• Check with all third party payers as to whether your patients will be covered for videoconferencing or telephonic sessions. Medicare patients await guidance from CMS and HHS which should be forthcoming in the next two weeks. If patients are not covered, see if arrangements for private pay can be made.

If you have any other questions, please let me know.

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

March 15, 2020

There have been many questions about the status of the telemental health expansion of Medicare and private insurers as the COVID-19 crisis itself has rapidly expanded. Here is what CSWA knows so far.

The emergency bill signed on March 6 allows for an expansion of Medicare telehealth services of all kinds, once guidance from CMS and HHS is made available. There is no definite date when this will happen, but we hope to have it within two weeks.

CSWA, NASW, and the American Psychological Association will be sending a letter to CMS and HHS tomorrow encouraging them to allow a temporary expansion for patients that we have been seeing within the past three years. The option that is currently being discussed per the March 6 bill is videoconferencing only, not telephonic sessions. Of course CSWA hopes that telephone sessions will be allowed as well, but it is unlikely that it will be as soon as videoconferencing is covered. It is a possibility that when videoconferencing is expanded by CMS, it will be retroactive to February, 2020.

As for private insurers, there is confusion about what they are willing to cover through videoconferencing and telephonically at this time. Most companies that offer coverage are doing it for in-network providers only, who must use a specific telemental health platform and accept the fee offered. This is generally less than LCSWs are used to being paid by these insurers for in-person sessions. Out-of-network providers may or may not have the option of being covered for videoconferencing or telephonic sessions. It is VERY important to check with any private insurers you have been reimbursed by, if you want to know the facts about their policies at this time. Having patients call to find out what their policies are and request videoconferencing and/or telephonic coverage if necessary, is a good idea as well.

Another question is coverage for patients who live in a jurisdiction in which you are not licensed, for example, a patient has previously come to your office in Washington, DC, but lives in Maryland. You are licensed in Washington, DC, not Maryland, so would be practicing without a ;license if you treat the patient through videoconferencing while they are in Maryland. I recommend calling the Social Work Board in any state in which a patient resides in which you are not licensed, to ask what their policy is on videoconferencing with patients (or telephonic sessions) who reside there. Again, there may not be good solutions here if the state insists that you be licensed in the state in which the patient resides. Have patients call the Social Work Board in their state and ask for an exemption.

Finally, there is the question of what to do if you have already moved to videoconferencing or telephonic sessions to protect you and your patients from becoming infected by COVID-19; it is problematic if you want to continue getting reimbursed by third party payers who currently do not cover videoconferencing. You can continue to provide sessions through videoconferencing with the hope that they will be covered eventually; take a break while this is sorted out; or make arrangements with patients to pay privately. None are ideal.

I hope we will have some clarity on telemental health expansion soon and will keep you posted. This is a unique and troubling time for LCSWs, all mental health professionals, and our patients. CSWA will do everything possible to give us the ability to continue providing our needed services.

March 10, 2020

On Friday, the President signed into law a $8 billion emergency funding bill that included $500 million towards Medicare telehealth, including telemental health services, because this is a declared emergency. There are a few caveats (see below).

The good news: this bill allows the HHS Secretary to waive current Medicare telehealth restrictions (originating/geographic sites) on telemental health during the COVID-19 public health emergency, so that care can be provided regardless of where a patient is located, including at home.

The other news: a qualifying provider, like licensed clinical social workers, needs to have provided a service to an eligible beneficiary in the last three years—so this can only be applied to existing, or recent, patients. Additionally, the telemental health services can only be provided through videoconferencing, not telephone only.

Place of service should be 02 for telehealth. The GT modifier is no longer necessary, but 95 is still needed. CPT codes should be as for an office visit.

This is overall good news and CSWA will work to make it a permanent option.

March 9, 2020

I just received guidance from CMS on whether we can be reimbursed for telemental health beyond the accepted treatment in rural areas. Their response is attached.

Basically the answer is no at this time. I recommend calling CMS at1-866-288-8912, x3 to ask for more guidance.

CSWA is developing a Legislative Alert to send to members of Congress to request an expansion of coverage for telemental health during this health crisis.

CSWA - Medicare on Distance Sessions - 3-9-20.docx

March 8, 2020

Below is an update on the COVID-19 epidemic.

It appears that the number of cases is spreading, close to 500 with the Seattle area being the heaviest hit (128 cases, 19 deaths as of this writing). We really don't know when the situation will improve as various cities are just starting to see cases and the tests for confirmation of COVID-19 are still hard to get.

I wanted to pass on some things that members are doing to protect themselves and their patients in addition to the list I sent out last Monday. Some are cover fabric chairs and couches, even leather ones, with plastic/vinyl material which is easier to clean with antiseptic spray.

It is important to make sure that any DIY hand antiseptic is at least 70% alcohol, the rest aloe vera gel, with some drops of aromatic oils like tea tree or lavender; unfortunately, many areas are completely out of alcohol and aloe vera. Amazon can send in a week.

Those most at risk of being harmed by COVID-19 are people with underlying health conditions and those over 65. Traveling is not recommended for this group in particular.

Many members have asked about whether Medicare will cover telemental health sessions. The bill signed on Friday provides $8.3 billion for a variety of ways to address the virus but there is no clear guidance on whether CMS will expand their coverage of telemental health yet. I will let you know when this becomes available. Sen. Ron Wyden did get a provision in to support telemental health but no specific enforcement. As for private insurers there is no clarity there either. I suggest having patients request that telemental health be covered if they have private insurance; that is the most likely way to get coverage.

This is a time of anxiety in our personal and professional lives. We should try to remember that we are all in this together and hopefully can help each other get through it.

March 4, 2020

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!