October 27, 2016

As you know, CSWA has been involved in the Mental Health and Substance Use Disorder Parity Task Force (MHSUDPTF ) created in March, 2016, by President Obama. The goal of this Task Force is to look at the overall failure to enforce the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The Rules for MHPAEA, which become the basis for enforcement, were not implemented until 2014.

Today the MHSUDPTF issued its report. In addition to the 34-page report that was released, there was a 20- page report for consumers about their rights to mental health and substance use treatment. Both are worth reading. The authors of the Report, in addition to the President, included Departments of Treasury, Defense, Justice, Labor, Health and Human Services, Veterans Affairs, Office of Personnel Management, and Office of National Drug Control Policy. The comments submitted to the Task Force by CSWA can be found at the CSWA website (www.clinicalsocialworkassociation.org).

To find the Report go to http://www.hhs.gov/sites/default/files/mental-health-substance-use-disorder-parity-task-force-final-report.PDF.

To find the Consumer Guide go to http://store.samhsa.gov/shin/content//SMA16-4992/SMA16-4992.pdf.

While this is not a complete answer to the problems that many CSWA members and our patients have faced with coverage, it is a help. Remember that the Federal Government has oversight for ERISA – self-insured – plans. Private insurance plans, like Blue Cross, United, Aetna, etc., are overseen by the Insurance Commissioners in each state. This report only applies to ERISA plans, though it is likely to have an impact on private plans.

Members may have a special interest in #4 of the Consumer Guide which addresses how usual and customary out of network reimbursement rates are determined and how they can be questioned.

As always, please let me know if you have any questions about these documents.

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

September 27, 2016

Mental Health First Aid Act (H.R. 1877) passed the House yesterday by voice vote. This Act will be extended through 2021 through block grants to train first responders, law enforcement and teachers to assist anyone in a mental health crisis, and reduce stigma toward them.

The bill will expand grant eligibility for the SAMHSA program to include programs to train veterans and law enforcement on how to recognize and respond to persons with mental illness. The program previously only focused on teachers and emergency responders.

The Senate passed a similar bill (S. 1893) in January, 2016. The Senate version, introduced by Sen. Lamar Alexander (R-Tenn.), focused on youth mental health services.

The House and Senate hope to soon create a unified bill in conference they can send to the President Obama soon.

LCSWs may have opportunities to help provide this training. CSWA will provide more information as it is available.

This is the first of several bills that CSWA hopes will increase access to mental health treatment and support services in the next few weeks.

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

September 7, 2016

Changes to Medicare for LCSWs in 2017

As all CSWA members know, since 2012 LCSWs have been subject to the Physician Quality Reporting System (PQRS) which has affected reimbursement rates in a cumbersome and difficult way for the past 5 years. While the penalties that have been given for failure to comply with PQRS measures were relatively small (1-2% a year), the challenges of keeping track of the yearly changes to measures that LCSWs were supposed to report on have been a source off anxiety and frustration.

The good news is that for 2017 and 2018, LCSWs will not have to continue reporting PQRS measures. The PQRS measures are being rolled in to a new plan called Merit-Based Incentive Payment System (MIPS) which is part of the new Medicare formula for reimbursement, Medicare Access and CHIP Reauthorization ACT (MACRA) that replaced the very problematic Sustainable Growth Rate (SGR).

Though all LCSWs are free of the new reporting systems for now, it may be helpful to understand the changes that are coming to physicians and may be applied to LCSWs in 2019. They will apply to quality of care; cost of care; use of electronic record keeping; and activities that attempt to reduce the cost of care while improving quality in Medicaid.

The Quality measures for physicians and nurses in 2016 are currently defined as follows:

It is notable that Medicare describes the covered groups (physicians, nurses, physician assistants) as the “vast majority of behavioral health providers” in Medicare (http://www.thenationalcouncil.org/wp-content/uploads/2016/08/MACRA-Quality-PP-web-Final.pdf). There are 38,000 LCSWs that are currently Medicare providers, probably a much smaller group than the current number of primary care physicians and others providing psychotropic medication.

Keep in mind that LCSWs are still required to submit PQRS information for 2016 and will receive a Medicare reimbursement deduction in 2018 for failure to comply with PQRS reporting; see the CSWA website for 2015 measures which are the same as 2016 measures.

In the meantime, look forward to some time off next year if you are a Medicare provider from the PQRS measures. CSWA will continue to keep you informed about other changes to these reporting requirements.

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

September 2, 2016

As you know from the numerous CSWA posts about the Senate mental health bill, S. 2680, the Mental Health Reform Act of 2016, this bill is the best option in terms of passing a real mental health plan that works. The House bill, HR 2646 is considerably weaker. S. 2680 creates the enforcement that the Mental Health Parity and Addiction Equity Act failed to implement. It will make psychotherapy available to the 50% of Americans who currently do not have access to treatment.

Please send the following message to your senators at http://www.senate.gov/senators/contact/ BY TOMORROW, September 3. Apologies for the late notice but the strategy including rolling contacts by mental health associations and today is the day for CSWA to send our support.

Dear Sen. ______:

I am a constituent and a member of the Clinical Social Work Association, writing today to urge your Senate leadership to bring up S. 2680, the Mental Health Reform Act of 2016, for immediate consideration. This bill is the best option for giving the 68 million Americans who live with mental illness the help they need, including the 117 people who die every day by suicide. Mental health parity has failed to provide the equal coverage that it promised. Please vote for S. 2680 when it comes to the floor. Sincerely, [Your name, license, address, contact information]

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

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

July 8, 2016

You may have heard that hard on the heels of the passage of the Helping Families in Mental Health Crisis Act of 2016, HR 2646, another bill related to clinical social work practice passed the House of Representatives today, the Comprehensive Addiction and Recovery Act (CARA), S 524/HR 963.

This bill has great policy objectives including prevention, treatment, recovery support, criminal justice reform, overdose reversal, and law enforcement which will help those with addictions, often in combination with mental health disorders. Approximately 129 people die every day because of addictions.

The huge problem with the bill is that there is no additional funding for the increased benefits. Those who supported the bill felt it was better to get a bill passed and worry about funding later, a strategic decision. CSWA hopes that the strategy pays off and the bill will be more than a policy statement. I wanted you to be aware of the pros and cons as you hear about CARA over the coming days and months.

July 6, 2016

Thanks to all the many CSWA members who sent their emails to their Representatives.

Today the House of Representatives passed HR 2646 by an overwhelming majority of 422-2!

Please send the following message to your Representative, even if you did not ask your Representative to vote in favor of the bill:

“I am a member of the Clinical Social Work Association and a constituent. Thank you so much for voting in favor of the Helping Families in Mental Health Crisis Act of 2016 which will improve access to mental health services for our citizens. [Name, License, Address, email]”

You can find your Representative's email at http://www.house.gov/representatives/find/.

Now we will wait to see what happens with the Senate bill and hopefully have a compromise committee to combine the best of both bills.

July 1, 2016

On June 15th, HR 2646, the Helping Families in Mental Health Crisis Act of 2016, a bill that CSWA has been following for the past three years, unanimously passed out of the House Energy and Commerce Committee.

This bill will be voted on by the whole House of Representatives next Tuesday, July 5. Please email your representative as soon as possible. It is very important to support this bill which will increase funding for many parts of the mental health system, create an Assistant Secretary of Mental Health in DHHS, and create a Minority Fellowship Program. While there are other parts of the bill that CSWA would like to modify, getting the bill passed out of the House so that we can continue the discussion is crucial at the moment. The Senate mental health bill has also been passed out of committee and needs to be passed out of the Senate, but is not yet scheduled. To get the Senate bill scheduled, the House bill must pass.

You can find the email address of your Representative at http://www.house.gov/representatives/find/. Please send the following message to your Representative: “I am a member of the Clinical Social Work Association and a Constituent. Please vote for passage of the Helping Families in Mental Health Crisis Act of 2016 on July 5 and improve access to mental health services for our citizens. [Name, License, Address, email]”

As always, please let me know when you have emailed your message.

June 21, 2016

Four major national social work organizations - NASW, CSWA, CSWE, and ASWB - have been developing draft Social Work Technology Standards for the past two and a half years. These standards will cover every area in clinical social work practice that may be affected by the use of technology including clinical practice, record-keeping, education, and macro social work. Many thanks to Laura Groshong, CSWA Director of Policy and Practice, who served as CSWA's representative on the Task Force that put in hundreds of hours on this project.

These standards have been posted for public comment until July 20, 2016. They are available at the following link with instructions on how to submit comments: http://www.socialworkers.org/practice/naswstandards/TechnologyStandardsInSocialWorkPractice/CommentSubmission.aspx Another way to obtain the draft standards is to go to www.socialworkers.org. To the right, look for the “What’s New” box. Scroll down and click on “Draft Technology Standards in Social Work Practice.”

Comments must be submitted by July 20, 2016 to be considered. After consideration of the changes by the Task Force, the draft technology standards will be submitted for review and approval to the NASW Board of Directors in September, 2016 and the other organization Boards (CSWA will meet in October).

The goal is to have these standards published by the end of 2016.

CSWA is proud to have been a participant in this important project and encourages all members to review the draft standards and send comments.

June 15, 2016

Dear CSWA Members,

It is hard to accept the massacre of LGBTQ people in Orlando and the hate it represents.

There have been some good summaries of how to think about it, including one by Glenda Russell (attached). A PDF version is available online at http://drglendarussell.com/wp-content/uploads/2016/06/Responding-to-Orlando.pdf. Please feel free to share with others.

"Give an Hour" is making the thousands of therapists who give an hour of treatment to veterans available to the Orlando LGBT community - to join go to http://www.giveanhour.org/ForProviders.aspx. To read their press release, go to http://bit.ly/1YnkaTl.

We can never stop insisting on the right of everyone to live their lives regardless of color, sexual orientation, gender or any identity that has been demonized. Please re-read the CSWA Statement on Discrimination (attached). The hate being legalized against trans people in the states mentioned is a contributing factor to the terrible loss in Orlando. Speak out against all forms of hate."

- Susanna Ward, PhD, LCSW, CSWA President & CEO

- Melissa Johnson, LCSW, CSWA President-Elect

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

June 1, 2016

We clinical social workers all recognize the possibility that an unexpected life event could interfere with our clinical social work practice. We help our patients deal with unanticipated events every day. Yet many clinical social workers have no plan for notifying patients in such a case, and no arrangement with a colleague who, should it become necessary, would enact this plan.

Of equal concern is the end of a practice: best practice dictates a mindful approach to closing a practice, with a plan developed long before retirement draws near. Yet a comprehensive study (Hovey, 2014) of how social workers address the end of a practice found that only 18% of those surveyed had completed a professional will. The sample (n=83) consisted primarily of White/Caucasians (94 %), female social workers (82 %), ranging in age from 24 to 80 years, most of whom were in private practice (78 %). While 35 % said they had made some informal arrangements with colleagues, 47 % had made no arrangements at all. These results highlight the likelihood that clinical social workers have not given practice interruptions and endings the attention that they should have.

What Makes Planning So Difficult?

As Ragesua, Shatsky, and others have noted, it is often difficult for clinicians, including clinical social workers, to anticipate interruptions in a practice, planned closing of a practice, or instructions for the unplanned closing of a practice. Shatsky states: “As clinicians, we champion our patients’ examination of the difficult, important transitions of their lives. Yet, when it comes to this issue, more often than not we fail to conduct a competency examination on ourselves….Why is it unusual to hear cognitively fit colleagues openly discuss looking forward to retirement? Unlike other health professional arenas, why is planning for and discussing this significant transition (amongst psychotherapists) rarely embarked upon with enthusiasm?” (2016). Ragusea gets to the heart of the matter in his adaptation on ending a practice “On rare occasions, reality breaks through our merciful denial and we all consider our own demise. Yes, the last great adventure beckons to us; even psychologists [and clinical social workers] die. Most of us like to think that we will pass away quietly in old age, peacefully sleeping in our own beds and, perhaps, surrounded by loved ones. But, what if the path goes off in a different, surprising direction? What if we die suddenly, unexpectedly?” (Ragusea, 2002).

The internal process of accepting the fact that there are likely to be interruptions and there will definitely be endings to clinical practice may involve working through feelings of loss, ambivalence, guilt, relief, and much more. Clinical social workers should begin to consider their feelings about the inevitable ending of clinical practice from the beginning of their careers, rather than wait until nearing the likely end of their working lives. Having no plan in place for an unexpected interruption or ending could put patients at risk for a wrenching disruption in treatment and may burden an unprepared spouse, partner, or colleague with the complex task of closing a practice. The responsible clinical social worker will have a plan in place; this is best practice, ethical practice, and even required in some states by the boards of social work.

What The Clinical Social Work Association Can Do To Help

There are four major ways that clinical social work practices may be interrupted or ended:

1. Unplanned Termination of Practice;

2. Temporary Inability to Continue Practice;

3. Extended Inability to Practice; and

4. Planned Termination of Practice.

Over the next few weeks, we will consider each of these four possibilities. We will offer you guidelines for developing a plan in each case, and a template agreement or professional will for carrying out needed responses in the CSWA Members Only section (you must join CSWA separately from your society). Watch for notices that these templates are available.

References

Hovey, J. K. (2014). “Mortality practices: How clinical social workers interact with their mortality within their clinical and professional practice” (Unpublished master’s thesis). Smith College School for Social Work, Northampton, MA. Available from https://dspace.smith .

Ragusea, S. "A Professional Will for Psychologists", adapted from VandeCreek, L. & Jackson, T., Eds. (2002) Innovations in Clinical Practice: A Source Book, Vol. 20, pp. 301-305. Sarasota, FL: Professional Resource Press.

Shatsky, P. (2016) “Everything Ends: Identity and the Therapist’s Retirement”. Clinical Social Work Journal, Vol. 44, No. 2, pp. 43-149.