July 29, 2023

For the past year, I have been working on a document with NASW on Clinical Social Work Standards. A draft of this document has been released for public comment. I hope all CSWA members will take a look at it and offer your comments. You can find it at https://www.socialworkers.org/Practice/Clinical-Social-Work/Practice/clinical-social-work-standards-draft-forum2. The comment period is open until September 15, 2023.

This is kind of a condensed version of the Private Practice in Clinical Social Work: A Reference Manual, which I also participated in developing with NASW, released in 2021.

Please send me your thoughts as well.

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

July 12, 2023

Good news! On July 7th, 2023, Governor Mike Parson signed Senate Bill 670 and Senate Bill 157 making Missouri the first state to enact the Social Work Licensure Compact. This is a milestone development in supporting the mobility of licensed social workers.

SB 670 was sponsored by Senator Travis Fitzpatrick and Senator Lauren Arthur, and SB 157 was sponsored by Senator Rusty Black.

The Social Work Licensure Compact seeks to increase public access to social work services, provide licensees with opportunities for multistate practice, support relocating military families, and allow for expanded use of telehealth technologies. Currently, the model compact legislation is available for other states to introduce and enact like Missouri. Thus far there have been nine other states that have introduced: Utah, Kentucky, Vermont, New Hampshire, New Jersey, Georgia, South Carolina, North Carolina, and Ohio.

How is the Social Work Compact progressing in your state?

If you have not reached out to your legislators to let them know about the Compact, please start the process now. You can find the materials to use on the Compact Information page on the CSWA website.

Please let me know when you have 1) a pending or passed bill in your state, 2) a legislator who is willing to sponsor the bill, 3) if you need assistance in finding a legislator to sponsor the Compact bill, and/or 4) have talked to NASW about working together to get the Compact going.

Let me know when you have any information on the above issues.

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

June 29, 2023

By Laura Groshong, LICSW, Director, Policy and Practice

Here are two issues which I hope you will all address with your members of Congress and your state legislature.

For Members of Congress:

For State Legislatures:

Please let me know when you have sent messages to Congress and members of your state legislatures. Thanks for your help.

June 20, 2023

Looking for a way to be more involved? Organizations that Offer Support for Trans People

To follow up on our Position Paper released in April, please find resources below that may be helpful in promoting efforts to block anti-trans bills, notably relative to the provision of gender-affirming care.

https://www.acludc.org/en/cases/hinton-v-district-columbia-challenging-department-corrections-policy-discriminatorily-housing

https://www.aclu.org/legislative-attacks-on-lgbtq-rights

https://www.them.us/story/orgs-fighting-back-anti-trans-legislation

https://www.npr.org/2022/11/28/1138396067/transgender-youth-bills-trans-sports

https://www.wbur.org/hereandnow/2023/06/16/anti-trans-laws-mental-health

https://www.cnn.com/2023/04/06/politics/anti-lgbtq-plus-state-bill-rights-dg/index.html

Barsky, A. E. (2023, June 16). Ethics Alive: Urgent Alert – “Some states have banned gender-affirming care for transgender minors. What are our responsibilities?” The New Social Worker.

https://www.socialworker.com/feature-articles/ethics-articles/urgent-alert-states-banned-gender-affirming-care-social-workers-responsibilities

Please let us know if you have other resources that we can share with CSWA members. CSWA will continue our efforts to oppose anti-trans legislation and other harmful practices.

June 8, 2023

Below are the materials to use to begin lobbying for the creation of the Social Work Compact. They are hopefully self-explanatory but let me know if you need any further information or direction. Please start the process in the next couple weeks.

Many thanks,

Laura Groshong, LICSW, CSWA Director of Policy and Practice

Background on SW Compact 6-23

LCSW Compact - Lobbying 6-23

SW Compact - Bullet Page 2023

June 2, 2023

Here is some clarifying information about Medicare’s requirement that patients that are being seen through telemental health must have an in-person session every six or twelve months.

The language from Medicare is as follows (yellow outline is mine):

Telehealth includes certain medical or health services that you get from your doctor or other health care provider who's located elsewhere (or in the U.S.) using audio and video communications technology (or audio-only telehealth services in some cases), like your phone or a computer. You can get many of the same services that usually occur in-person as telehealth services, like psychotherapy and office visits.

Through December 31, 2024, you can get telehealth services at any location in the U.S., including your home. After this period, you must be at an office or medical facility located in a rural area (in the U.S.) for most telehealth services.

You can get certain Medicare telehealth services without being in a rural health care setting, including:

In short, diagnosis and treatment of mental health disorders will be covered by traditional Medicare until at least 12/31/24 without an in-person session. Audio only treatment will be covered “in some cases” so more guidance is needed on what the cases are that will be covered.

Treatment overseen by Medicare Advantage, or commercial insurers, may or may not require in-person sessions, and may or may not cover telemental health or audio only treatment.

I hope this clarifies the situation for now. Let me know if you need more information.

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

May 25, 2023

Here is a clarifying announcement from CMS about coding and requirements for in-person meetings. Most of this information was sent last month. There is coding information about audio only which should be followed. Though the information is for rural health clinics it also applies to private practice elsewhere.

The information can be found at https://www.cms.gov/files/document/se22001-mental-health-visits-telecommunications-rural-health-clinics-federally-qualified-health.pdf.

May 17, 2023

Please visit the CSWA Position Papers page to view the Position Paper on Trans Youth. 

May 1, 2023

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

As was noted in the CSWA Announcement of March 16, 2023, “Telemental Health Coverage When PHE Ends”, there will be changes to clinical social work practice when the Public Health Emergency (PHE) ends on May 11, 2023. This paper elaborates on these additional changes which affect many more areas of practice.

HIPAA Changes

As we know, the kinds of video platforms that were allowed to conduct mental health treatment during the pandemic were relaxed. Platforms that did not meet the security requirements of HIPAA including Facetime, Skype, and others which did not provide a Business Associate Agreement (BAA), were accepted by the Office of Civil Rights (OCR) and not seen as a violation of HIPAA rules. This relaxation will change with the end of the PHE. The relaxation of providing the Good Faith Estimate (GFE) for telemental health will also be back in effect.

OCR is providing a 90-calendar day transition period for covered health care providers to come back into compliance with the HIPAA Rules with respect to their provision of telehealth. The transition period will be in effect beginning on May 12, 2023 and will expire at 11:59 p.m. on August 9, 2023. OCR will continue to exercise its enforcement discretion and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules that occurs in connection with the good faith provision of telehealth during the 90-calendar day transition period.

In other words, by August 9, 2023, all LCSWs will need to demonstrate that they are using a HIPAA compliant platform, e.g., ZoomPro, Doxy.me, and other platforms offer a BAA. OCR has not been penalizing LCSWs for the failure to give a GFE to patients who are self-pay or pro bono. These penalties will be back in effect as of August 9 if LCSWs are found to be non-compliant.

For more information visit https://www.hhs.gov/about/news/2023/04/11/hhs-office-for-civil-rights-announces-expiration-covid-19-public-health-emergency-hipaa-notifications-enforcement-discretion.html.

Changes to Codes and Modifiers for Medicare

Medicare has added more guidance in regard to codes which will be covered and modifiers needed for coverage. In addition to psychotherapy codes, there are several new codes available to clinical social workers for Behavioral Care Management which would include care integration and other services that have not been covered until now. The code will be G0323 for Care Management Services for Behavioral Health Conditions.

The details are:

● New for CY 2023: Describes general BHI that a clinical psychologist (CP) or clinical social worker (CSW) performs to account for monthly care integration

● A CP or CSW, serving as the focal point of care integration furnishes the mental health services

● At least 20 minutes of CP or CSW time per calendar month

Additionally, the modifier for Medicare claims is “GT” though “95” can be used for other claims.

For more details visit https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/BehavioralHealthIntegration.pdf.

Medicare Advantage Changes

Medicare Advantage (MA) plans may offer continued telehealth benefits. Individuals in a Medicare Advantage plan should check with their plan about coverage for telehealth services. Remember that MA plans are commercial insurance and have their own coverage. Some MA plans may require patients to be seen in person at least once a year. After December 31, 2024, when these flexibilities expire, some MA Accountable Care Organizations (ACOs) may offer telehealth services that allow primary care doctors to care for patients without an in-person visit, no matter where they live. If your health care provider participates in an ACO, check with them to see what telehealth services may be available. In short, the coverage for MA plans may be more variable than coverage for traditional Medicare.

For more information, visit https://www.cms.gov/files/document/what-do-i-need-know-cms-waivers-flexibilities-and-transition-forward-covid-19-public-health.pdf.

Private Health Insurance and Telehealth

As is currently the case during the PHE, coverage for telehealth and other remote care services will vary by private insurance plan after the end of the PHE. When covered, private insurance may impose cost-sharing, prior authorization, or other forms of medical management on telehealth and other remote care services. For additional information on your insurer’s approach to telehealth, contact your insurer’s customer service number located on the back of your insurance card.

Summary

For more detailed information in general, visit https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/BehavioralHealthIntegration.pdf.

The next few months will bring many changes. Let me know if you have any questions.

March 16, 2023

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

The Public Health Emergency (PHE) is ending on May 11, 2023. This has caused some concern for LCSWs who have been working through telemental health since the pandemic began in 2020. The question of whether psychotherapy will be covered when the PHE ends is a complex one. Here is what we know about telemental health coverage at the moment:

Coverage of Telemental Health – The Consolidated Appropriations Act of 2023 extended Medicare coverage of telemental health until December 31, 2024, which is good news. While most commercial insurers tend to follow CMS guidance, this time it appears that this may not be the case. Some insurers have already begun to limit telemental health coverage; this may increase after May 11. It is not too early to have patients check with their insurers about the likelihood that telemental health will be limited/no longer covered going forward.

Meeting In-Person – The CMS requirement that Medicare patients be seen in person at least once a year when the PHE ends has been delayed until December 31, 2024.

Audio-Only Telemental Health – CMS coverage of Medicare patients through audio-only telemental health will continue until December 31, 2024.

If a patient’s insurer is planning to stop telemental health or audio only coverage in some way, it would be helpful to have patients talk to their HR person about keeping telemental health coverage in place. It may also be helpful to file a complaint with state insurance commissioners if insurers are unwilling to continue coverage of telemental health treatment.

There may be other questions that members have about the way that the end of the PHE will affect LCSW practices. Please let me know if you do. For more information on these topics go to https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/policy-changes-after-the-covid-19-public-health-emergency#permanent-medicare-changes. CSWA will be tracking these changes for members.