November 21, 2024

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

I have received several questions about Medicare coverage of virtual telemental health which is currently scheduled to end on December 31, 2024. This would be a significant problem for the many LCSWs that have continued to see patients through videoconferencing since the pandemic first led to coverage of this option. Audio-only coverage is also being challenged.

It may be hard to remember that four and a half years ago, these delivery systems were not covered by Medicare; all patients were seen in person unless they lived in rural areas or had a disability that made it impossible for them to be seen in person. Commercial insurers, as they often do, generally followed the lead of CMS in their willingness to cover therapy through videoconferencing and audio-only means.

There are some bills in Congress now that would extend and/or make permanent the ability to have videoconferencing and audio-only treatment covered by Medicare. There is a good chance that one of them may pass or be attached to another bill. CMS has already recommended that videoconferencing and audio-only psychotherapy services be covered permanently, but Congress must pass a bill that will make that law.

Therefore, please send the following message to your members of Congress by visiting https://www.congress.gov/members/find-your-member and to the Senate at https://www.senate.gov/senators/senators-contact.htm?Class=1: "I am a licensed clinical social worker, a member of the Clinical Social Work Association, and a constituent. Please pass a bill that will allow me to continue treating Medicare patients with mental health and substance use problems virtually. This has become the only way many patients can receive treatment. If not changed, these patients will be unable to continue to work on these serious problems after December 31, 2024." As always, please let me know when you have sent your messages.

As for the issue of seeing patients in person every six or twelve months, that rule has been delayed for two years, and will be reviewed during that time.

It is frustrating to be faced with these changes that may significantly affect our practices. With any luck, we will be able to continue to do our work in ways that are best for our patients and for us as LCSWs.

November 18, 2024

It has been almost two weeks since we received the results of our 2024 elections. While clinical social workers are by no means a political monolith, we are hearing from our members as well as our clients that many people are feeling discouraged, unsafe, and uncertain about the future.

CSWA's role will be as important as ever in these next four years. It is uncertain how a new administration will impact Medicaid, Medicare, Social Security, the Affordable Care Act, regulations protecting mental health care, disability rights, and reimbursement rates. We will continue to monitor upcoming legislative and policy changes and inform you, as well as advocate tirelessly for you as clinical social workers. This allows us to focus on our core values of clinical social work, namely service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence.

If you are so inclined, here are some ways that clinical social workers can be involved in these coming years:

1. Get to know your local and national elected representatives. Your calls, letters, and emails matter!

2. Consider joining advocacy groups that fit with your values.

3. Get to know your neighbors. Our micro-communities are important, and we need to care for each other.

4. Consider watching for advocacy opportunities for those groups who may be disenfranchised in our society, such as trans people, queer people, or undocumented immigrants.

5. Continue to read the information that CSWA sends about protecting mental health treatment. We will be your eyes and ears for our profession nationally!

CSWA is here for you. The Town Hall last week was called a “safe space” where members could talk to each other about the many feelings they had about the elections. Our next Town Hall will be on December 10th.

We're grateful for your support, today and in the future!

- Stephanie Payne, LCSW, CSWA President

November 6, 2024

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

There is some important information about changes - and potential changes - to LCSW reimbursement that we wanted to let you know about.

Physician Fee Schedule

The Physician Fee Schedule (PFS) came out on Friday, November 1, and outlines changes to reimbursement rates for the over 300 categories of Medicare providers, including LCSWs. The PFS is not finalized, but the recommendation is that there be a 4% raise in LCSW rates for all CPT codes that we are eligible to use. This is one of the largest increases suggested for any group. Of course, our rates are still much lower than other mental health clinicians, so this is only a start toward the reimbursement we should be receiving. But it is a start.

Telemental Health

Another important issue that many members are concerned about is the continuation of coverage for telemental health and audio-only psychotherapy. These delivery systems are currently scheduled to end on December 31, 2024. There are several bills in Congress that would extend coverage in some way. The most likely bill to pass is one which would continue it for two years until December 31, 2026, when it would be reviewed again. The likelihood is that nothing will happen until after elections are counted, so probably next week at the earliest. We will keep you posted on developments as they occur.

Optum Audits

Finally, Optum, without explaining why they engaged in audits of LCSWs, is reporting that the audits of LCSWs (and others) who received overpayments are over. If you are still having problems with reimbursement as a result of the Optum error, please let us know.

October 11, 2024

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

On November 12, 2024, at 5:30 pm ET, CSWA will hold its 50th Town Hall. These zoom meetings, which began in August of 2020, have become a great way to connect with other CSWA members and find out what is happening in the profession. Hope to see you then!

It has been a while since the last The Aware Advocate was published, primarily because so much of my work for CSWA has been focused on the creation of the Social Work Compact. Here is a summary of the past few months about issues that affect LCSWs, including the current status of the ASWB exams; the current status of the Compact; recent MHLG sign-ons to Congressional bills and letters; information on the Compact Commission development; a KQED report on lower reimbursement for LCSWs doing outpatient work compared to those working in hospitals; and LCSW problems with insurance.

ASWB Update

ASWB held a Work Force Coalition meeting last month, attended by CSWA President Stephanie Payne and CSWA Deputy Director of Policy and Practice Judy Gallant, that reviewed the results of the Social Work Census and explained the work that is being done to address disparities in pass rates for the clinical, master’s, and bachelor’s examinations. As a follow-up to the August 2022 ASWB Report, which first identified these disparities, another report was released which goes into more detail about the disparities by schools which social workers have attended. To view this report please visit https://www.aswb.org/exam/contributing-to-the-conversation/exam-performance-reports-for-social-work-schools-and-programs/.

In addition to the disparities in pass rates for the clinical exam between Black and white social workers, those with English as a second language and a primary language, and older social workers compared to younger social workers, there are also disparities between other minority groups of social workers and white social workers, male and female social workers, and other breakdowns of the pass rates. A detailed analysis of this new data is being developed which will be sent to CSWA members as soon as it is available.

The changes that ASWB is making to improve the test-taking process so that those who fail can have additional help and adjustments to exam structure were also discussed. The harm being done to certain groups who do not have the training and education to pass the test needs to be corrected.

Compact Commission Update

The first meeting of the Interim Social Work Compact Commission was held on September 17. There were representatives in attendance from all 22 states that have passed the Compact bill into law at the 5-hour meeting. In addition, there were about 75 members of the public. I was asked to chair this meeting and will also chair the next meeting which will be held in January 2025. At that meeting, the Executive Committee – Chair, Vice-Chair, Secretary, and Treasurer – will be elected by the delegates; I am not eligible for these positions because I represent a national organization, not a state. CSWA will have a representative as an ex officio member or as a public member at future meetings.

It is likely that the Commission will be running by fall of 2025 or winter of 2026, at which time all individual LCSWs in states that have joined the Compact, can join the Compact individually and work with clients in all 22 states. Other states are still eligible to join the Compact if they pass the bill.

Mental Health Liaison Group (MHLG)

Here are recent letters that CSWA has signed on to through MHLG or by request from sponsors:

Sign-On in Support of the Stabilization to Prevent (STOP) Suicide Act

Sandy Hook Promise is circulating a FY 25 letter of support for increased STOP School Violence Act

Sign-on Letter on Mental Health Parity and Addiction Equity Act

Endorsement Opportunity: Improving Seniors’ Timely Access to Care Act

Workforce Working Group Leading Letter on Bipartisan Workforce Policies

The CSWA Government Relations Committee has reviewed about 20 letters and bills in the past eight months for sign-ons.

Request from KQED on Clinical Social Work Reimbursement

A reporter from NPR station KQED contacted CSWA for information about the disparity in California reimbursement rates for in-hospital work and out-patient work. While the article was not focused on private practitioners, it was related to the pay disparities for LCSWs which we are very familiar with. To view the article please visit https://www.kqed.org/news/12007779/sf-frontline-workers-who-help-people-on-streets-in-shelters-call-for-fair-pay.

Insurance Issues

Problems with insurance reimbursement are numerous but the most challenging ones are the way that some insurers are engaging in “clawbacks” which are a demand that payments made be returned to the insurer, sometimes many months after they have been made. The most recent example is the way that a company called Change Healthcare made payments that were at the wrong (higher) rate for LCSWs. Another issue is the refusal of insurers to pay for more than one session a week, questioning the use of 90837 regularly, or seeing a patient for more than a year, all of which can lead to audits. Finally, there is an increase in “prior authorizations” for some kinds of treatment by some insurers, a practice that had not been active for several years.

These issues have been around for about 10 years but have had an uptick in the past year. This increase could be due to the likelihood that mental health parity rules are being made more stringent and that insurers will have to comply with more coverage of mental health conditions that they have avoided until now. CSWA will be offering a webinar on these issues in January of 2025.

Please let me know if you have questions or comments about any of these issues.

September 11, 2024

A notice about new Mental Health Parity rules to implement the long-standing Mental Health Parity and Equity Act (2008), which has been languishing since it was first enacted, was put out this week. The recent articles from ProPublica may have influenced the release of these rules at this time.

A review of the history of the MHPAEA can be found at https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity. The basic premise is that mental health treatment and substance use treatment be covered as fully as medical/surgical treatment. The primary areas where this applies include inpatient in-network; inpatient out-of-network; outpatient in-network; outpatient out-of-network; emergency; and prescription drugs. The problems in applying these reasonable standards is that there is no formula for what they should actually be, and reimbursement is not included in the areas that must be at parity for mental health treatment.

While any attempt to get insurers to cover mental health and substance use is worthwhile, until real enforcement is built into the rules – which is still not the case in the new rules – there will likely be little change to the ways that insurers currently limit coverage of mental health treatment.

Note that these new rules will go into effect in phases, with some being enacted in 2025 and some in 2026.

Please let me know if you have any questions.

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

September 3, 2024

ProPublica has released an additional white paper on mental health. This companion piece to the article sent last week (see previous announcement) reviews the ways that states do or do not have regulations about coverage for mental health treatment. This is based on the same problems identified in the paper titled, “Why I Left the Network.”

To read the entirety of the additional paper, written in collaboration with NPR, please visit https://www.propublica.org/article/mental-health-wiltn-states. To read the NPR summary, go to https://www.npr.org/sections/shots-health-news/2024/08/23/nx-s1-5084256/insurance-mental-health-care-coverage-legal-protection?utm_source=pocket-newtab-en-us.

August 27, 2024

ProPublica is one of the most respected investigative journalism groups in the country. For the past year they have been looking at various ways in which insurers do not provide mental health services and/or payment, either before or after they are needed/provided. I spoke with them for about two hours on the problems LCSWs and others have been struggling with in regard to insurance coverage and payment over the past six months. They have published an excellent white paper on this topic, documenting much of what LCSWs and other clinicians in private practice have known for decades.

The continued lack of payment, harassment by reviewers, clawbacks, inadequate networks, refusal to explain denials of care, rejection of payment because claims are deemed faulty without specific requests for more information, and refusal to abide by federal and state laws about mental health parity are discussed in detail. The result has been continued decisions by clinicians to leave insurance networks.

No one wants to see patients go without care, end treatment prematurely, or have income slashed so much that we cannot make a living. It is articles like “Why I Left the Network” that may finally bring the scope of the problem to legislators and the public so that something can be done about the abysmal ways that LCSWs are treated unfairly by many insurers.

To read the complete white paper, go to https://projects.propublica.org/why-i-left-the-network/. To see a summary put together by NPR, please visit https://www.npr.org/sections/shots-health-news/2024/08/24/nx-s1-5028551/insurance-therapy-therapist-mental-health-coverage. CSWA will offer some suggestions shortly about how to inform legislators about the scope of these problems.

August 16, 2024

CSWA is pleased to let members know about this 50+ page white paper, “Core Competencies for Licensed Clinical Social Workers”. For the past two years, an ad hoc committee has been working on this summary of the ways that clinical social workers develop their knowledge, skills, and expertise. These competencies are divided into 4 different levels of understanding: Novice, Intermediate, Advanced/Independent, and Expert. This document is intended to be a definitive statement on what clinical social workers should strive towards throughout their practice. Additional information about the purposes and intentions of the white paper are in its introduction.

There are 25 areas of clinical social work practice that are discussed in this paper: Ethics, Laws, and Regulations; Confidentiality; Informed Consent; Self-Determination; Supervision and Consultation; Documentation; Continuing Education; Independently Treats Individuals, Couples, Families, and Groups Using Generally Accepted Methods of Psychotherapy; Therapeutic Alliance in Psychotherapy; Assessment in Psychotherapy Practice; Risk Assessment in Psychotherapy Practice; Delivery of Psychotherapy Services; Diagnostic and Statistical Manual; Goal Setting; Self-Disclosure and Boundaries; Transference and Countertransference; Evidence-Based and Evidence-Informed Modalities; Trauma; Evaluating Treatment Outcomes; Termination of Psychotherapy; Social Justice; Discrimination and Bias; Diversity; Interdisciplinary Relationships Within Mental Health Care; and Therapist Self-Care.

CSWA hopes you find this document helpful in understanding the complexity of the clinical social work profession.

Download the white paper to review it today.

July 22, 2024

Biden-Harris Administration Proposes $2.5 Million in Support of Social Work Compact

The Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), announced the first-ever Licensure Portability Grant Program, which is an investment in the multi-state social worker licensure compact. This grant will provide $2.5 million in support of the Social Work Compact. This welcome support will make the implementation of the Compact easier and may be less of a financial burden for LCSWs who live in states that have passed the Compact and choose to join as individuals. Please visit the U.S. Department of Health and Human Services website for more information.

More details about the Compact will be forthcoming after the September 17 meeting to establish the Commission that will be running the Compact, which I will be running as Interim Chair. CSWA will continue to provide information about the Compact as it develops.

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

July 9, 2024

As of July 9, there are 22 states that have passed the Social Work Compact! This is the fastest level of passage that any of the 14 compacts have achieved. The Council of State Governments (CSG) was very impressed with the speed by which our Compact has gotten passed.

As you know, the next phase of Compact development now goes into effect. The Compact will be run by a Commission, which will be created on September 17, 2024. Each Compact state will appoint a representative to be part of the Commission, and the Commission Chair and other leadership positions will be filled at the September meeting.

We are pleased to inform members that CSWA's Director of Policy and Practice, Laura Groshong, LICSW, has been asked to be the Interim Chair to facilitate electing the Commission’s permanent leadership. CSWA and other major social work organizations (NASW, ASWB, and CSWE) will have ex officio members on the Commission, if the Commission rules allow for this provision.

The Compact will officially go into effect in 12-18 months. The rules will be made available by the Commission as they are developed.

To see the list of states which have passed the Compact to date, go to the CSWA webpage. More reports will be forthcoming as they are available.