Laura Groshong, LICSW, Director, Policy and Practice

What Will “Normal” Psychotherapy Become? A Somewhat Cloudy Crystal Ball Updated

The pandemic continues to have a major impact on the psychotherapeutic work that LCSWs do. This article is a somewhat updated version of the one I wrote for the last newsletter on this overriding topic.

Overview

Since the Department of Health and Human Services (DHHS) recently extended the state of emergency through October 23, it appears that the current coverage of videoconferencing and audio therapy will continue during this time as well. There are bills currently in Congress that would make Medicare coverage of videoconferencing and audio-only treatment permanent after the Public Health Emergency (PHE)  ends, if passed.

Right now, however, there is still widespread discrepancy in terms of which private insurers and self-insured or ERISA plans (Employee Retirement Income Security Act) will cover videoconferencing and audio psychotherapy, which insurers and ERISA plans will cover or waive co-pays, and which insurers and ERISA plans will pay for videoconferencing/audio therapy at the same rate as in-person therapy. While LCSWs used to feel frustrated by reimbursement rates, lack of coverage for more than once-a-week treatment, and treatment reviews for psychotherapy that has lasted more than a year, we now have a whole new set of frustrations. Of course, the anxiety we face about becoming infected or infecting others colors everything we do, rendering our insurance concerns less meaningful. So here are the issues that will determine whether the practice changes we have endured the past 4-6 months will become permanent, stay as ongoing new options, or be eliminated when the dangers of physical contact with others have waned.

One of the problems with predicting these issues is that states/jurisdictions are following such different trajectories in terms of the way COVID-19 is impacting the people who live there. “Hot spots” may be part of a state’s difficulty with the virus, while other areas are unscathed. Here is a website that can tell you what the risks are in your personal location: https://covidactnow.org/?s=37528

Our state and local governments are trying to create guidelines that will protect as many people as possible, mainly through physical distancing, hand washing, wiping down all high touch surfaces, and  masks. That is the legal “frame”; we all still have to determine what we think is safe in doing our work in the present and moving forward. I have heard from LCSWs all over the country and the vast majority have been conducting psychotherapy through videoconferencing and telephonic means for the past 4-5 months.

Now I will address the confusion around insurance coverage of these new delivery systems.  

Insurance Issues

What do we do when an insurer states they will cover the co-pays, pay the same amount for distance therapy as in-person therapy, describe which Point of Service (POS) code and modifier to use, and then fails to reimburse according to these stated policies? These problems are some of the most frustrating that we face. Spending hours tracking down provider liaisons about why our claim was denied, or paid at a lower rate, is painful and even scary. One remedy is to engage our patients in the process of finding out what their current co-pay coverage is; this is another area of confusion though.  Some insurance plans have waived co-pays. Some are just returning to mandatory co-pays. The prudent LCSW will keep an updated list of POS and modifiers by insurer,  easier said than done. How frustrating and annoying is this? Very. If (when) you find inconsistencies, let your insurance commissioner and attorney general know. This is the best way to get action on insurers’ failure to pay us what they have agreed to when we have complied with stated policies.

The Future of Telemental Health

As for the future: although Medicare will maintain coverage of the expanded videoconferencing and audio psychotherapy through October 23, the question remains whether or not private insurers will follow their lead. Their policy will impact most private insurers, according to my cloudy crystal ball. Since the current restrictions will be cut back state by state, it is hard to say when the Centers for Medicare & Medicaid Services (CMS) will decide there is enough safety to insist that Medicare beneficiaries be treated in-person. What I don't know is whether there will be an assessment of the videoconferencing and audio psychotherapy to determine whether they are as helpful as in-person treatment and how much more expensive it is to allow these forms of treatment to continue. There has been an explosion of bills in Congress that will make telemental health and audio only treatment  permanent options for providing psychotherapy. CSWA will continue to work with Congress and other Federal agencies to preserve these options.

Self-Care

Expect to feel more fatigued doing telemental health. A couple of articles that outline the impact of doing all our work online  are:

“Therapy During the Coronavirus Pandemic”, Cornwell, P., March 29, 2020, Seattle Times, https://www.seattletimes.com/seattle-news/health/therapy-during-a-pandemic-this-is-new-for-all-of-us/

“Therapists and Patients Find Common Ground: Virus-Fueled Anxiety”, Nir, S., New York Times, May 3, 2020, https://www.nytimes.com/2020/05/03/nyregion/coronavirus-therapy-nyc.html

Most of us have made some major readjustments to the ways we practice, which has been especially difficult for those of us who have been working in our offices for decades. Be kind to yourselves and find ways to give yourselves time to process these major changes to our professional lives, and accept the frustrating uncertainty we face about whether office practice will be safe in the near future. The dangers of feeling isolated as we work online from home, already a risk in office work, have increased. Try to remember you are not alone in dealing with the distress we all face and that this perilous time will eventually end.

Laura Groshong is the Director, Policy and Practice for the Clinical Social Work Association.