CLINICAL SOCIAL WORK ASSOCIATION

The National Voice for Clinical Social Work

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CSWA ALERTS


CSWA is proud to vigilantly monitor issues within the field of clinical social work, and national legislation that affects clinical social workers. Please see below for a history of those announcements and legislative alerts. To receive timely information directly to your inbox, join CSWA today

  • December 30, 2024 4:21 PM | Anonymous member (Administrator)


    February 28, 2024

    The Social Work Workforce Coalition (a group comprised of various social work leaders across North America) will launch a social work census in March 2024.

    To ensure our demographics and broad range of services and specialties are fully captured, everyone is encouraged to participate.

    Please visit https://swcensus.org/ now to sign up for the census. You will then receive an email when the census opens.

  • December 30, 2024 4:20 PM | Anonymous member (Administrator)


    January 30, 2024

    Here is an article in which I was quoted about the Social Work Compact extensively. The article is about the Social Work Compact, not a “single social work license”, but the text is very well done. Please find the article by visiting https://news.bloomberglaw.com/health-law-and-business/states-pursue-single-social-work-license-to-boost-labor-supply.

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

  • December 30, 2024 4:17 PM | Anonymous member (Administrator)


    January 22, 2024

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

    There is a lot going on in the world of clinical social work at the moment that I will try to summarize here, some positive, some problematic. Let’s start with the positive:

    Social Work Compact Bills

    There are now 22 states that have bills pending to pass the Social Work Compact. As you know, when 7 states have passed the bill, a Commission will be created by the Council of State Governments (which has overseen the development of the Compact Bill) to oversee the implementation of the Compact. There will be a Commission member from each state that joins the Compact as well as ex officio members from major social work stakeholder groups, including CSWA. Please find out the numbers of the Compact bills being considered in your state, usually HB___ and/or SB___, and ask your legislators to support them. To view additional information on the CSWA website, visit https://www.clinicalsocialworkassociation.org/compact-information. Please let me know if your state passes the Compact!

    “Inseparable” Report

    A relatively new mental health policy organization, Inseparable, published a report last month called “Improving Mental Health Care: The Access Report” which has some excellent information about the percentage of citizens in each state that have a mental health problem and how many actually receive care. To view the report, please visit https://pdf.live/edit?url=https%3A%2F%2Fwww.inseparable.us%2FAccessReport.pdf&source=f&installDate=060322.

    OPTUM “Clawbacks”

    And now for the not so positive news.

    I’ve heard from several members that they have received letters from OPTUM saying that they were overpaid between 2021 and 2023 and need to repay United Health Care the amount that was overpaid. This can amount to thousands of dollars. While OPTUM acknowledges that this was a “systems error” on their part, they still say that LCSWs who were overpaid should have known that they were overpaid and refused to accept the money. Remember that this is a Medicare Advantage plan which is overseen by commercial insurers, in this case, United Health Care, and not Medicare, which is a public plan. Commercial plans are overseen by either Department of Labor (ERISA or self-insured plans) or state insurance commissioners, if the plan is not an ERISA plan.

    Here are some ways that you may choose to respond to this letter:

    1. Find out if the plan is an ERISA plan or a commercial plan.

    2. Check the insurance rules in your state and see whether there are any rules about how long insurers have to request LCSWs to pay back funds that they were not entitled to. If the request has exceeded the request, file a complaint with the insurance commissioner.

    3. Hire an attorney to file a cease-and-desist letter to OPTUM/United, explaining that this was their error, not yours, and you should not have to repay the funds you were paid.

    Let me know if you receive any responses regarding this situation.

  • December 30, 2024 4:12 PM | Anonymous member (Administrator)


    December 4, 2023

    The final rule for the Medicare Physician Fee Schedule (PFS) in 2024 has been issued and will go into effect on January 1, 2024. The link to the complete summary can be found by visiting https://www.cms.gov/files/document/mm13452-medicare-physician-fee-schedule-final-rule-summary-cy-2024.pdf

    Please find a list of the changes that will affect clinical social workers below.

    Physician Fee Schedule Changes

    New codes:

    • CPT 0591T-0593T will now be available for “health and well-being coaching services” on a temporary basis.
    • HCPCS G0136 will now be available for Social Determinants of Health Risk Assessment (SDOH) permanently.

    Telemental Health Services:

    • Telemental health services will continue to be covered through 2024, regardless of where the patient is located.
    • The requirement that patients be seen in person every six months is delayed throughout 2024.
    • The modifier for telemental health services will continue to be “95”.

    Expansion of Behavioral Health Services:

    • LMFTs and LMHCs will be included as mental health providers under Medicare.

    Expansion of Crisis Codes:

    • CPT codes for crisis services, 90839 and 90840, will be covered by Medicare regardless of the location of the patient.

    New Codes for LCSWs:

    • Health Behavior Assessment and Intervention (HBAI) services will now be covered for LCSWs by Medicare using CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168. These codes are designed to assess the psychological, behavioral, emotional, cognitive, and social factors included in the treatment of physical health problems.

    Change to Relative Value Units (RVUs) for LCSWs:

    • Over the next four years there will be an increase in payment for in-office psychotherapy, to be determined.

    Please let me know if you have any questions.

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

  • December 30, 2024 4:11 PM | Anonymous member (Administrator)


    December 24, 2023

    Licensed Clinical Social Workers (LCSWs) are the largest group of licensed mental health clinicians in the country, working in the public and private sector, providing psychotherapy and counseling on an individual, family and group basis in every state and jurisdiction. The acronyms below are the titles used in each state/ jurisdiction to designate independent clinical social work practice in that state. Here is a list of the number of LCSWs in each state with the exact title used in that state. This data was collected from state social work Boards and administrators in November, 2023. All LCSWs have requirements of two-three years post-graduate supervised experience and have taken a national exam. Most LCSWs are licensed to diagnose all mental health disorders in the Diagnostic and Statistical Manual-5-TR and future editions and to treat these disorders through psychotherapy when appropriate.


  • December 30, 2024 3:56 PM | Anonymous member (Administrator)


    November 15, 2023

    The recent communication about Medicare Advantage led to several questions. Please see answers below:

    Will Medicare Advantage reimburse traditional Medicare paneled LCSWs? Since Medicare Advantage is a separate program from traditional Medicare, it does not reimburse claims for traditional Medicare.

    Why does Medicare Advantage often pay less than traditional Medicare? Because Medicare Advantage plans are run by commercial insurers, some reimburse at less than traditional Medicare and some at a higher rate. Remember that traditional Medicare rates vary from region to region as well.

    Should LCSWs accept Medicare Advantage, even if rates are lower, because it is all that some people can afford? Some people think of Medicare Advantage as a midway point between Medicare and Medicaid and want to accept these plans to offer services to lower income patients.

    How can we make Medicare Advantage have reimbursement parity with traditional Medicare? Medicare Advantage is a completely different system from traditional Medicare with different reimbursement. Medicare Advantage reimbursement has reimbursement governed by commercial insurers; traditional Medicare has reimbursement governed by CMS. While CSWA has advocated for reimbursement parity in traditional Medicare (with medical/surgical reimbursement) and in commercial plans (with medical/surgical), there is no way to create parity between Medicare Advantage and traditional Medicare.

    How can we improve access to mental health treatment in general? There is no one way to accomplish this but the new mental health parity rules and integration of primary care and mental health should help.

    Do LCSWs have to be credentialed with Medicare to be eligible for Medicare Advantage? No. The reverse is true as well, i.e., LCSWs can be credentialed with Medicare without accepting Medicare Advantage patients.

    Do LCSWs have to be credentialed with the commercial insurer sponsoring the Medicare Advantage plan? This varies, but in general it is not necessary to be credentialed with a commercial insurer to be reimbursed for a Medicare Advantage plan. Check with each plan.

    How much will Medicare Advantage plans affect Medicare beneficiaries going forward? Many analysts have said that the Medicare Advantage plans will continue to grow to cover 50-60% of Medicare beneficiaries by 2030.

    Please continue to send questions on Medicare Advantage as they occur.

    - Laura Groshong, LICSW, Director of Policy and Practice

  • December 30, 2024 3:55 PM | Anonymous member (Administrator)


    November 13, 2023

    WHAT IS MEDICARE ADVANTAGE?

    Medicare Advantage (MA) plans have been heavily marketed for the past year or so. LCSWs have had many questions about what the difference is between MA plans and traditional Medicare. This summary of those differences may be helpful in understanding what mental health coverage patients have in these plans and how MA plans may affect coverage overall.

    MA plans, known as Part C plans, are overseen by commercial insurers, i.e., United, Aetna, Cigna, BCBS, etc. The general goal of these plans is to improve profits; this is not different from the other plans that commercial insurers offer. Traditional Medicare, a public plan with Federal oversight, has an interest in keeping costs down balanced with an interest in giving the elderly and disabled reasonable health care.

    Some Medicare Advantage plans inappropriately delay and deny critical care; have low premiums but then charge exorbitant copays that prevent people from getting care; have limited networks and few providers available; and may have networks with poor quality providers. Additionally, MA plans do not have the Medigap component that traditional Medicare offers to cover the “gap” that Medicare does not allow for certain conditions, including mental health treatment.

    There is little doubt that the for-profit MA plans will put the needs of their shareholders first. Most Medicare-eligible beneficiaries are drawn to the low premiums and do not read the fine print about the limitations of MA plans. This may happen when there is a health crisis and the limitations on what care is covered by which paneled clinicians becomes suddenly clear.

    According to the Psychotherapy Action Network, “Medicare Advantage (Part C) plans have been demonstrably disadvantageous to people who are sicker. If you have Part C and wait until you are sick to shift over to a Traditional Medicare plan, you may not be able to get a Medigap policy to cover copays and coinsurance, or that premium may be much higher.”

    How do the MA plans affect mental health treatment coverage? For acute or short-term treatment, the lower premiums may be an advantage. The advantage will disappear in an MA plan if a beneficiary needs long-term psychotherapy. The cost of copays may be so high that the total cost of treatment may be much more expensive. Further, beneficiaries cannot purchase a Medigap policy (which covers co-pays) if MA is their primary insurance.

    There are many articles on what can be done to prevent the “bait-and-switch” approach of MA plans, from lawsuits against commercial insurers to advocating for a single payer health care plan. For now, the best option in the view of CSWA, is to think carefully about the pros and cons of MA plans and traditional Medicare before choosing MA plans. Please contact me if you have any other questions about MA plans.

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

  • December 30, 2024 3:50 PM | Anonymous member (Administrator)


    September 26, 2023

    Please take a moment to submit a comment on the proposed rule to make the Mental Health Parity and Addiction Equity Act more enforceable. You may use the template below or write your own. Comments are due on October 2, 2023.

    To read the document visit https://www.regulations.gov/document/EBSA-2023-0010-0001.

    To submit a comment visit https://www.regulations.gov/commenton/EBSA-2023-0010-0001.

    Template:

    Subject: Re: 0938-AU93 1210-AC11 1545-BQ29 Requirements Related to the Mental Health Parity and Addiction Equity Act

    Dear Secretary Becerra, Assistant Secretary Gomez, and Deputy Commissioner O’Donnell;

    Thank you for the opportunity to comment on the Requirements Related to the Mental Health Parity and Addiction Equity Act (MHPAEA) proposed rule. I write as a licensed clinical social worker who has noticed increased difficulty for patients to find coverage for mental health and substance use (MH/SUD) treatment.

    It is quite unfair that mental health and substance use treatment is still not covered at parity with medical/surgical care after the initial rules for the 2008 MHPAEA were delayed until 2014 and are still not covered at parity almost 10 years later.

    Please finalize the following specific proposals WITHOUT EXCEPTION:

    • Requiring health plans to prove their MH/SUD parity compliance by showing the effect the limits they place on benefits have on a person’s access to treatment;
    • Evaluating the health plan’s provider network, including how long the wait times are; how often consumers must seek out-of-network providers; how much a plan pays providers; how often prior authorization is required for services a practitioner prescribes; and how often prior authorization requests are denied; and
    • Imposing strong consequences when a plan is found to be out of compliance with the parity requirements, including barring them from imposing the plan requirement.

    We urge the Departments to consider penalties when plans ignore these consequences.

    Please make these changes to eliminate barriers to care and ensure that everyone has the same access to mental health and substance use benefits as they do physical health benefits.

    Thank you again for the opportunity to comment.

    As always, let me know when you have submitted your comments.

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

  • December 30, 2024 3:50 PM | Anonymous member (Administrator)


    August 10, 2023

    Please visit https://jswve.org/volume-20/issue-1/item-03/ for an editorial written by our Director of Policy and Practice and Board President. 

  • December 30, 2024 3:48 PM | Anonymous member (Administrator)


    August 2023

    Please visit the CSWA Position Papers page to view the Position Paper on Artificial Intelligence and Psychotherapy.

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