Laura Groshong, LICSW, CSWA Director of Policy and Practice

Medicare Physician Fee Schedule Final Rule Summary: CY 2024 The final rule for the Medicare Physician Fee Schedule (PFS) in 2024 has been issued and will go into effect on January 1, 2024. This link is to the complete Summary: 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.  lwgroshong@clinicalsocialworkassociation.org

Telemental Health Coverage When PHE Ends

As was noted in the CSWA Announcement of March 16, 2023, “Telemental Health Coverage When PHE Ends” (https://www.clinicalsocialworkassociation.org/Announcements/13134039), 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 go to: 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
• • POS of 11 should be used through the end of 2023 for telemental health

Additionally, the modifier for Medicare claims is “GT” though “95” can be used for other claims. For more details go to: 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, go to: 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, go tohttps://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.

Here is the long awaited Social Work Compact Bill which will allow:

• LCSWs to join the Compact, after their home state has joined the Compact;
• LCSWs to practice in all Compact states without becoming licensed there separately;
• LCSWs that join the Compact to essentially have a multistate license.

The Compact will not be operational until at least seven states’ legislative bodies have passed the Compact into law in their states. Once this happens, the Social Work Commission will be created to oversee the Compact and individual LCSWs can join.

This is the basic information that explains the Compact: https://swcompact.org/

The actual language of the Social Work Compact Bill is here: https://swcompact.org/wp-content/uploads/sites/30/2023/02/Social-Work-Licensure-Compact-Final.pdf

I will be sending lobbying suggestions shortly.

In states which have a session that is ending soon, the bill will probably have to wait till next year. Some states are ready to drop the bill today. We hope to reach the seven state threshold by next year.

Laura Groshong, LICSW, CSWA Director of Policy and Practice

Judy Gallant, Fran Schopick, Jaylee Cox, and I met with Ben Donovan, Legislative Aide to Rep. Derek Kilmer (D-WA), who had reached out to CSWA, to talk about mental health needs in the military.

Rep. Kilmer has a district which has a heavy military presence. He realized that the last organized effort to look at the way that mental health is handled in the military was in 2005. He would like to revive the Commission created then look at this issue. He would like to include clinical social workers in this group. They would like to have more dedicated clinicians on carriers and on bases at rates that are more commensurate with the numbers of personnel; currently each clinician is expected to serve 1000-8000 military personnel. There is more support from officers for mental health than in the past. Some officers are starting to see access to mental health treatment as the most important need in the military currently.

There were a number of suicides on a carrier in Virginia (USS George Washington) recently when it was being maintained there. Rep. Kilmer would like to avoid this in the future. He and others are trying to create a baseline for how many people mental health clinicians, included in telemental health, need to see. He would also like to stop the mental health stigma that still exists in some parts of the military.

We talked about the problems we have had with Tricare, both with reimbursement rates and inclusion of enough clinicians. We all agreed that funding for mental health is a huge problem and more is needed to make mental health an integrated part of the military. We will look into whether MH parity covers the military and could therefore address this problem.

We will continue this discussion.

Laura Groshong, LICSW, CSWA Director of Policy and Practice

CareDash, BetterHelp, and CSWA

CSWA has been carefully tracking the way that CareDash and BetterHelp were trying to undermine private practice LCSWs by directing prospective patients to their lists of clinicians. For more background, go to https://www.clinicalsocialworkassociation.org/Legislative-Alerts/12868204 .

Due to an overwhelming response from CSWA members and other groups, the most egregious practices have been stopped.  There is still more work to do, but here is where things stand.

On August 4, BetterHelp issued a statement which said that they were ending their connection to CareDash. On August 6, CareDash announced that they were backing off their harmful stance toward clinical social workers in private practice as well. While there are still some problems to be resolved, CareDash has 1) stopped their deliberate confusion about LCSW availability; 2) removed their “book an appointment” option, which directed potential patients away from LCSWs who were not part of the CareDash network; and 3) clarified that their information comes from the NPI list of clinicians and has nothing to do with the quality of those clinicians. To see the whole CareDash statement, click on https://twitter.com/caredash/status/1555658652786348032?s=20&t=0wbvSA8XI46b1egY3gvpjg .  

I am fairly certain that the outstanding response of CSWA members to the demeaning policies of CareDash had a major impact on their decision to back off their original stance. Thanks to all of you for your great contributions to this effort.

CSWA will continue to insist on the rights of all LCSWs in private practice to have access to all patients who want to see them, without interference by any external organizations. Toward that goal, we have created a petition at https://www.ipetitions.com/petition/stop-caredash-and-betterhelps-duplicitous . I encourage everyone to sign and add your comments on the CareDash/BetterHelp process.

Laura Groshong, LICSW, CSWA Director of Policy and Practice

House HELP Committee Hearing, April 5, 2022

There are over 100 bills in Congress that affect clinical social work practice.  Nineteen of them were heard in a HELP hearing on April 5 and will be voted on shortly.  They are a good summary of the way that mental health is being addressed currently. You can hear the testimony at the following link: https://energycommerce.house.gov/committee-activity/hearings/hearing-on-communities-in-need-legislation-to-support-mental-health-and well-being.

Good news:

• The No Health without Mental Health letter on Collaborative Care that CSWA signed onto was discussed and entered into the record;  
• Rep. Matsui made a direct request for the in-person requirements for telemental health be dropped; 
• Multiple Reps. talked about the failure of the Mental Health Parity and Addiction Equity Act to give mental health treatment equal coverage with medical care; 
• Multiple Reps talked about the lack of attention to the mental health of children and adolescents; and
• The importance of ongoing telemental health coverage was discussed.  

Bad news:

• The only clinicians who testified were psychiatrists;
• Addiction was discussed as a medical problem, not a mental health one; and 
• The main treatment discussed was crisis management.

Below are the bills being considered:

Possible Legislation

H.R. 2376, the “Excellence in Recovery Housing Act”

H.R. 2929, the “Virtual Peer Support Act”

H.R. 4251, “Native Behavioral Health Access Improvement Act of 2021”

H.R. 4944, “Helping Kids Cope Act of 2021”

H.R. 5218, the “Collaborate in an Orderly and Cohesive Manner”

H.R. 7073, the “Into the Light for Maternal Mental Health Act”

H.R. 7076, the “Supporting Children’s Mental Health Care Access Act of 2022”

H.R. 7232, the “9–8–8 and Parity Assistance Act of 2022”

H.R. 7233, the “Keeping Incarceration Discharges Streamlined for Children and Accommodating Resources in Education Act” or the “KIDS CARES Act”

H.R. 7234, the “Summer Barrow Prevention, Treatment, and Recovery Act”

H.R. 7235, the “Substance Use Prevention, Treatment, and Recovery Services Block Grant Act of 2022” 

H.R. 7236, the “Strengthen Kids’ Mental Health Now Act of 2022”

H.R. 7237, the “Reauthorizing Evidence-based and Crisis Help Initiatives Needed to Generate Improved Mental Health Outcomes for Patients Act of 2022” or the “REACHING Improved Mental Health Outcomes for Patients Act of 2022”

H.R. 7238, the “Timely Treatment for Opioid Use Disorder Act of 2022” 

H.R. 7241, the “Community Mental Health Services Block Grant Reauthorization Act”

H.R. 7248, the “Continuing Systems of Care for Children Act”

H.R. 7249, the "Anna Westin Legacy Act of 2022"

H.R. 7254, the “Mental Health Justice and Parity Act of 2022” 

H.R. 7255, the “Garrett Lee Smith Memorial Reauthorization Act”

Whether these bills will get passed out of committee is hard to say but there was agreement that there is a mental health crisis, even if the funding to correct it is not yet available.

Witnesses

Panel I

Miriam E. Delphin-Rittmon, Ph.D.
Assistant Secretary for Mental Health and Substance Use
Substance Abuse and Mental Health Services Administration

Testimony

Carole Johnson, M.A.
Administrator
Health Resources and Services Administration

Testimony

Panel II

Rebecca W. Brendel, M.D., J.D.
President-Elect
American Psychiatric Association

Testimony

Sandy L. Chung, M.D., F.A.A.P., F.A.C.H.E.
President-Elect
American Academy of Pediatrics

Testimony

Steven Adelsheim, M.D.
Clinical Professor of Psychiatry and Director
Stanford Center for Youth Mental Health and Wellbeing
Stanford University School of Medicine
Stanford Children's Health

Testimony

Debra Pinals, M.D.
Medical Director, Behavioral Health and Forensic Programs
Michigan Department of Health and Human Services
On behalf of the National Association of State Mental Health Program Directors

Testimony

Cassandra Price, M.B.A.
Director, Office of Addictive Diseases
Georgia Department of Behavioral Health and Developmental Disabilities
On behalf of the National Association of State Alcohol and Drug Abuse Directors

Testimony

LeVail W. Smith, C.P.S.S.
Peer Support Specialist Instructor and Mentor

Testimony

Contact: lwgroshong@clinicalsocialworkassociation.org 

Exempt LCSWs from GFE - 1-26-22

I hope everyone is feeling well-informed about the Good Faith Estimate rule, part of the No Surprises Act, which went into effect on January 1.  There have been several webinars on this topic and one can be found at the CSWA website in the Members Only Section.

CSWA is working on two fronts to get LCSWs exempted from the GFE. One is a letter we co-wrote with the Psychotherapy Action Network (attached). The other is a campaign to let members of Congress know about the fact that LCSWs in private practice do not need to be part of the GFE; we already do everything that it requires and there are vanishingly low numbers of LCSWs who have had actionable complaints filed against them for surprise billing.

Please send your members of Congress at www.Congress.gov the following message: “I am a constituent and a member of the Clinical Social Work Association. The No Surprises Act requires me as a Licensed Clinical Social Worker to give my patients a Good Faith Estimate.  I am in private practice and have patients pay me directly.  The GFE interferes with the mental health treatment process (detailed in the attached letter). Please exempt LCSWs from the Good Faith Estimate requirements.”

Joint Advocacy by CSWA and PSian on our Behalf  | NSA Letter to CMS (fin.) - 1-25-22.pdf

Contact: lwgroshong@clinicalsocialworkassociation.org 

Laura Groshong, LICSW, CSWA Director of Policy and Practice

Good news from CMS!  CMS announced on November 2, 2021, the first group of many rules regarding the Physician Fee Schedule, which CSWA, and many of you, GWSCSW members, commented on in August.  Our voices made a difference.  CMS will extend coverage of telemental health and audio-only psychotherapy until the end of 2023. 

CMS also changed the requirement that patients be seen in person from every six months to every 12 months starting in January of 2022.  CSWA will continue to get this restrictive and unnecessary rule eliminated.

The announcement from CMS on rules for telemental health raised some questions which I will answer below:

1. Does the new rule mean that LCSWs are able to freely use telemental health to see patients in states where we are not licensed? No. That is what CSWA is working on through the Compact.  All state restrictions about licensure still apply.  Check with the state social work Board if you wish to see a patient who resides in a state in which you are not licensed.  A few states still have relaxed reciprocity standards, but others are ending their willingness to extend the ability to practice without licensure.
2. Does the rule mean that private insurers will automatically agree to extended coverage of telemental health and audio-only psychotherapy? No. Private insurers often follow Medicare rules, but there is no guarantee.  There appeared to be some changes in the way that private insurers were going to cover telemental health before the rule was announced; the rule may affect those changes and others going forward.  Check with individual insurers or have patients check.
3. Does the state in which the patient resides still dictate the necessity of an LCSW to be licensed in their state to treat the patient? In general, yes.  Check with the state social work Board where the patient resides as noted in #1.
4. Will this rule cover Medicaid as well as Medicare? All Medicaid decisions will continue to be made by states. This rule may encourage some states to cover telemental health in Medicaid.
5. Will LCSWs still be required to see patients in person every six months as previously required? No, this requirement has now been changed to every 12 months.  CSWA will be working to eliminate this requirement as we did to eliminate the six month rule.

Thanks to everyone who participated in this effort.  Let me know if you have questions.

Contact: lwgroshong@clinicalsocialworkassociation.org 

Laura Groshong, LICSW, CSWA Director of Policy and Practice

COVID Issues

The rise in COVID-19 cases due to the new Delta variant and others is cause for concern.  But in this case, as in much of the pandemic, all concerns are not created equal.  To understand the risk we face on the personal and professional level, it is necessary to get information that is specific to our location.  The CDC has just created a new data base that provides the current level of infection for every county in the country.  The COVID Data Tracker is updated daily and can be found at https://covid.cdc.gov/covid-data-tracker/#county-view  CSWA suggests that whether you live in an area that is a hot spot for infection or one with low levels of infection, it is prudent to continue to wear masks and maintain social distance of 6 feet in public indoor areas. 

The topic of whether to return to seeing patients in person is also on the minds of LCSWs.  Please see the two hour webinar I recorded on July 22 to get detailed information on how to make your own decision about what is best for you. You can find it at https://www.clinicalsocialworkassociation.org/CSWA-Webinars#ToBe in the Members Only section.

Medical Necessity

More and more often, LCSWs are receiving letters questioning the “medical necessity” of our treatment.  To address these often baseless conclusions, CSWA has developed the response below which you may use to explain the validity of your treatment decisions. An electronic Word document of this letter can be found at the CSWA website.

CSWA Survey on Returning to the Office

CSWA would like to get an idea of where members stand on the issue of returning to the office and in-person practice.  Please take this brief survey to help us gather this data.  There is also a section on what topics members would like to see CSWA provide in webinars.  Please go to https://docs.google.com/forms/d/e/1FAIpQLScas3RrgHzg1syi5-0aV-Os4PwTx2CzWinKQashpJbZQ-HNCA/viewform to complete the survey. Thank you for your participation.

Laura Groshong, LICSW, CSWA Director of Policy and Practice

CSWA has been holding virtual Town Halls every 3-4 weeks for the past six months, moderated by Laura Groshong, CSWA Director of Policy and Practice.  Since there are not many representatives from GWSCSW – except for stalwarts Steve Szopa and Margot Aronson (Hi, Steve and Margot!) – I thought you might like to get a taste of what goes on in these 90-minute meetings of 30-40 CSWA members around the country.  The summary below is from our April 20 Town Hall:

We convened about 15 minutes after the verdicts on Chauvin were announced and almost everyone referenced the relief they felt about the decision; some tears were shed by most attendees.  It took about an hour to get through the intros and process the feelings raised by the decision.

We did get to other issues including:

1. How will people be able to decide whether to go back to the office or not (referred them to my webinar to review the many issues involved)
2. What to do about patients who lie about having COVID (a terrible situation)
3. How to decide whether to give up the office or not (a steadily increasing number are giving it up)
4. Will insurance cover audio/telemental health and for how long (audio only till PHE ends, TMH till end of year)
5. Should you take on patients who are suicidal without meeting in person (a risk that should be assessed on a case by case basis)
6. Survive and Thrive, CSWA’s Zoom group for clinical social workers of color, got a shout out from members
7. An attendee offered to revive the AZ Society
8. Much interest in CSWA sponsoring consulting groups  

Several long-term members of the group have formed relationships outside the meetings and everyone was very grateful for the opportunity to continue to meet.

We hope you join us at our next session on June 8, 5:30 pm EDT