Judy Ratliff and Wayne Martin, Co-Chairs, VA Legislation and Advocacy Committee
Looking for a Lobbyist
As you may know, GWSCSW and VSCSW share a lobbyist. Sue Rowland has been our lobbyist over the past several years and she is leaving to go into semi-retirement. She was very helpful in arranging zoom meetings between members of our committee and Senators George Barker and Janet Howell of Fairfax. Dan Campbell joined us in meeting with Senator Howell, who was very appreciative of his input with VOICES in trying to obtain full funding for Crisis Receiving Centers and the STPE VA System. We will sorely miss Sue's lobbying efforts on our behalf and that of our clients.
Responding to Our Members' Insurance Concerns
Last fall, our members voiced numerous concerns about pressures from insurance companies, including justifying certain payment codes and withholding or delaying payments. We heard you. Our lobbyist contacted the Virginia Bureau of Insurance (BOI) and the VSCSW took the lead in setting up a conference with a BOI representative in October, 2021. Many concerns were voiced during that conference. One of the most serious concerns is that the BOI, by law, can only accept complaints from our clients who are the insurance recipients and cannot accept complaints from therapists. Sue Rowland took this concern to Senator Barker, who agreed to submit legislation to change the existing law to allow treatment providers to contact BOI directly. Unfortunately, we were unable to get it on the legislative docket for this year. We understand that there will be strenuous pushback from the insurance companies. We also understand that the psychiatrists have expressed the same concerns and it may be possible to "join forces" with them during the rest of this year, to push for this much needed change in the law during the 2023 Legislative Session.
The Joys of Sharing
I stated above that the GWSCSW and the VSCSW share the cost of a lobbyist who will represent our interests, and those of our clients, in the Virginia Legislature. However, we share even more. We jointly sponsor meetings and allow full members of each society to attend each others' workshops for free or at member rates. This allows members of both societies to benefit from a greater range of low-cost CE programs. Additionally, Wayne Martin and I regularly attend quarterly VSCSW zoom board meetings, which the lobbyist also attends. This facilitates smoother coordination of efforts toward the same goals.
Telehealth
There will be telehealth legislation proposed this year. We will keep you posted.
Contributions from Our Members
Below, please see an article by Roger Rothstein, who documents the power of our members working together to deal with a request from Medicare for case documentation to justify the use of procedure code 90837.
In January 2021, I received a letter from Novitas Solutions, the Medicare administrator for the DC Metro Area, which is summarized below: The Centers for Medicare and Medicaid Services continually strive to reduce the improper payment of Medicare claims . As a Medicare Contractor, Novitas is tasked with preventing inappropriate Medicare payments. One of the ways this is conducted is through medical review of claims. Medical review of claims helps to ensure that Medicare pays for services that are covered, correctly coded and medically reasonable and necessary. Services you billed to Medicare were chosen for a post-payment service specific review for procedure code 90837 (psychotherapy 60 minutes) because data analysis has identified these services are frequently not billed and coded correctly per the Medicare guidelines. As a result of this data, we have selected a post-payment sample of 20 claims reporting code 90837 from 2019 . You are responsible for providing documentation for the services identified by March 8, 2021 (6 weeks). Translation to the above: Here are 20 claims for services rendered in 2019. You need to document your justification for these services provided with procedure code 90837 by sharing your records of each of these 20 encounters. After the review, we are authorized to require you to reimburse us for monies paid to you for those services if we deem them not justified as needing 60 minutes of clinical time. After reading this several times and noting my anxiety level elevating by the second, I started to call a few colleagues about this. One person said she had received the same letter, but others did not. I am sure my news elevated their anxiety as well. I decided to put this out to the GWSCSW listserve soon after I received the letter. By a few days later, it became clear that these letters had arrived at many offices: specifically they seemed to have targeted Northern Virginia clinicians in social work and psychology. What to do? Having a live meeting in January 2021, didn’t seem like a wise idea so a zoom meeting was offered to anyone interested in discussing this situation and planning a response. Within a week or so, we had identified a Saturday morning to meet and about 18 people were on the call. This group came together in ways to strategize and support each other. Various record-keeping templates were exchanged electronically; members were tasked to contact the Clinical Social Work Association and consult with an attorney; research for documentation on rationales for using various ICD codes were shared; “talking points” on what Medicare was looking for in patient records was discussed; how and whether to inform clients of this review was discussed (two of the client’s whose cases they wanted me to document had died since 2019). At the end of this first meeting, we had developed a strategy to work together with the goal of helping each person prepare to provide the information requested. Over the next couple of weeks, much information was gathered and we again met as a group . The reduction in anxiety was evident as members of the group talked about how they had begun to approach this task. There was much appreciation expressed to everyone who had contributed their time, thoughts and clinical knowledge. What a great example of how in this digital age, people can exchange ideas and research both in text and online chat to help manage challenging tasks! The Clinical Society’s listserve networking technology and being able to tap into it’s vast informed membership were invaluable to our meeting this challenge. I was able to submit my documentation late in February and was notified shortly afterward that I “passed” and therefore would not need to reimburse Uncle Sam for my efforts.
In January 2021, I received a letter from Novitas Solutions, the Medicare administrator for the DC Metro Area, which is summarized below:
The Centers for Medicare and Medicaid Services continually strive to reduce the improper payment of Medicare claims . As a Medicare Contractor, Novitas is tasked with preventing inappropriate Medicare payments. One of the ways this is conducted is through medical review of claims. Medical review of claims helps to ensure that Medicare pays for services that are covered, correctly coded and medically reasonable and necessary. Services you billed to Medicare were chosen for a post-payment service specific review for procedure code 90837 (psychotherapy 60 minutes) because data analysis has identified these services are frequently not billed and coded correctly per the Medicare guidelines.
As a result of this data, we have selected a post-payment sample of 20 claims reporting code 90837 from 2019 . You are responsible for providing documentation for the services identified by March 8, 2021 (6 weeks).
Translation to the above: Here are 20 claims for services rendered in 2019. You need to document your justification for these services provided with procedure code 90837 by sharing your records of each of these 20 encounters. After the review, we are authorized to require you to reimburse us for monies paid to you for those services if we deem them not justified as needing 60 minutes of clinical time.
After reading this several times and noting my anxiety level elevating by the second, I started to call a few colleagues about this. One person said she had received the same letter, but others did not. I am sure my news elevated their anxiety as well. I decided to put this out to the GWSCSW listserve soon after I received the letter. By a few days later, it became clear that these letters had arrived at many offices: specifically they seemed to have targeted Northern Virginia clinicians in social work and psychology.
What to do? Having a live meeting in January 2021, didn’t seem like a wise idea so a zoom meeting was offered to anyone interested in discussing this situation and planning a response. Within a week or so, we had identified a Saturday morning to meet and about 18 people were on the call. This group came together in ways to strategize and support each other. Various record-keeping templates were exchanged electronically; members were tasked to contact the Clinical Social Work Association and consult with an attorney; research for documentation on rationales for using various ICD codes were shared; “talking points” on what Medicare was looking for in patient records was discussed; how and whether to inform clients of this review was discussed (two of the client’s whose cases they wanted me to document had died since 2019). At the end of this first meeting, we had developed a strategy to work together with the goal of helping each person prepare to provide the information requested.
Over the next couple of weeks, much information was gathered and we again met as a group . The reduction in anxiety was evident as members of the group talked about how they had begun to approach this task. There was much appreciation expressed to everyone who had contributed their time, thoughts and clinical knowledge. What a great example of how in this digital age, people can exchange ideas and research both in text and online chat to help manage challenging tasks! The Clinical Society’s listserve networking technology and being able to tap into it’s vast informed membership were invaluable to our meeting this challenge.
I was able to submit my documentation late in February and was notified shortly afterward that I “passed” and therefore would not need to reimburse Uncle Sam for my efforts.
We welcome input from members. If any of you are out there advocating for clients or legislation, please let us know and submit an article for us to include here in the GWSCSW quarterly newsletter.
Judy Ratliff, Co-Chair, jratliff.lcsw@gmail.com | Wayne Martin, Co-Chair, wamnoles@aol.com
Sue Rowland has been our lobbyist for several years and has played a very important role in helping GWSCSW and VSCSW successfully achieve legislative goals. Recently, she has been instrumental in setting up meetings between GW and delegates/senators from Northern Virginia, as well as meetings that have also included VSCSW. A major goal was to acquaint them with some of the serious problems our members are having with insurance companies. The end result was that they agreed that we could send them the problems, but also recommend some solutions. So, please send your case examples to me at jratliff.lcsw@gmail.com or to Wayne Martin at wamnoles@aol.com and we will forward all that are appropriate, along with your suggestions to solve the problem. Medicaid-related problems are governed by Virginia Law and will be quite appropriate to send to the legislators. If your problems are with private insurance, we will figure out how to make them relevant to the legislative process. Keep reading and you will see other options for dealing with this.
Our lobbyist will also explore setting up meetings with insurance company representatives and representatives from our organizations. Another possible solution will be found below.
This brings us to the more unhappy news about our lobbyist. Sue Roland will be retiring from most of her lobbying clients, which means she will be leaving both Societies. She has given us the names of two potential new lobbyists, and we will be meeting with them soon. Sue will remain involved with us through the end of December, 2021.
Insurance Issues
Based on the problems with insurance plans that kept showing up in the list-serve. I asked our lobbyist, Sue Rowland, to set up a meeting with the VA Bureau of Insurance (BOI) to clarify what they can and cannot do for us and our clients. The meeting was organized jointly by us and the VSCSW, and they were the primary organizers. The meeting was held on October 15, 2021, with Ms. Billie White.
The BOI enforces and administers the insurance laws of Virginia to protect consumers and safeguard insurer solvency. The BOI also provides free professional information and complaint services to residents of Virginia. Alas, herein lies the rub. Our clients can call and register complaints against the insurance companies, but we, as providers, cannot. It took a while, and a lot of case examples presented by attendees, but Ms. White finally heard us. She agreed to relay our desire to be able to contact the BOI ourselves to an appropriate contact higher up in the BOI administration. This change would not only help us, but would give the BOI the opportunity to collect provider data to send to the Legislature, which is the only body that can change the law to allow providers to contact BOI directly.
There were two other points made by Ms. White. Providers need to check their contracts carefully to determine what is actually required of them by the insurance company. And providers can contact the BOI, who will direct them to the appropriate person to contact with problems with federal, Medicare and Medicaid insurances.
How to Find Your Legislators
Sue Rowland presented at the recent Legislation and Advocacy Luncheon held on October 31.
One of the topics covered was how to find which Virginia senator and delegate represent you. To do this, go to https://www.virginiageneralassembly.gov. Click on Visit the New "Who's my New Legislator Service". Then follow the prompts to find the legislators who represent you, as well as which legislative district you live in.
Crisis Receiving Centers (From a press release)
Governor Ralph Northam signed legislation on September 21, 2021, establishing the "Marcus Alert", a statewide mental health alert system to ensure behavioral health experts are involved in responding to individuals in crisis, including by limiting the role of law enforcement. The law is named to honor Marcus-David Peters, a high school biology teacher who was killed by a police officer in Richmond while experiencing a behavioral health crisis in 2018.
"Individuals in crisis must be treated with dignity and met by behavioral health professionals who are equipped to help them get the care they need," said Governor Northam. "I am grateful to the advocates across Virginia (who) made their voices heard, and I thank the General Assembly for passing this bill, which represents an important step forward in reforming a system that too often criminalizes mental illness. Our work is far from finished, and I remain committed to continuing our efforts." Hopefully, our new governor and the Republican House will continue to see the importance of this program.
It should be noted that one of our members, Dan Campbell, has been very active in advocating for this program and has provided a synopsis of his work, as follows:
The Virginia Department of Behavioral Health and Developmental Services is implementing the Marcus Alert Law in response to the police killing of Marcus-David Peters in 2018. The law requires Virginia to create a mental health crisis response system that will include a new 988 emergency number that will go to a separate call center beginning in the summer of 2022. Crisis responders will be able to bring people in need to Crisis Receiving Centers (CRC’s) rather than to criminal detention centers or emergency departments. These services will reduce mass incarceration and the overpopulation of state psychiatric hospitals. A CRC is opening in Prince William County with 23-hour stabilization beds for 16 adults and 16 children. Additionally, 16 medium-term beds will allow patients to stay for up to 14 days, usually on Temporary Detention Orders (TDO’s). As you might imagine, a lot of money is required for the initial build out and ongoing operation of CRC’s. While Medicaid will pay for patients, the current estimate is that 38% of patients in the Prince William County CRC will be uninsured, requiring $7 million per year to keep it open. Fairfax County has similar services through the Merrifield Center. Other counties also are creating their own mobile crisis teams and CRC’s. However, state money to fully fund these efforts has not been allocated and is not in the current Governor’s budget for the 2022 General Assembly session. GWSCSW has Virginians for Organized Interfaith Community Engagement (VOICE), a grassroots advocacy group with over 50 dues-paying member congregations, to push for the full funding of CRC’s throughout the state. Dan Campbell has been active with both VOICE and our legislative advocacy committee. VOICE also advocates for other social justice issues, such as affordable housing and restoring drivers' licenses to felons. If you want to learn more about this issue, reach out to Dan Campbell at dancampbell@aol.com.
The Virginia Department of Behavioral Health and Developmental Services is implementing the Marcus Alert Law in response to the police killing of Marcus-David Peters in 2018. The law requires Virginia to create a mental health crisis response system that will include a new 988 emergency number that will go to a separate call center beginning in the summer of 2022. Crisis responders will be able to bring people in need to Crisis Receiving Centers (CRC’s) rather than to criminal detention centers or emergency departments. These services will reduce mass incarceration and the overpopulation of state psychiatric hospitals.
A CRC is opening in Prince William County with 23-hour stabilization beds for 16 adults and 16 children. Additionally, 16 medium-term beds will allow patients to stay for up to 14 days, usually on Temporary Detention Orders (TDO’s). As you might imagine, a lot of money is required for the initial build out and ongoing operation of CRC’s. While Medicaid will pay for patients, the current estimate is that 38% of patients in the Prince William County CRC will be uninsured, requiring $7 million per year to keep it open. Fairfax County has similar services through the Merrifield Center. Other counties also are creating their own mobile crisis teams and CRC’s. However, state money to fully fund these efforts has not been allocated and is not in the current Governor’s budget for the 2022 General Assembly session.
GWSCSW has Virginians for Organized Interfaith Community Engagement (VOICE), a grassroots advocacy group with over 50 dues-paying member congregations, to push for the full funding of CRC’s throughout the state. Dan Campbell has been active with both VOICE and our legislative advocacy committee. VOICE also advocates for other social justice issues, such as affordable housing and restoring drivers' licenses to felons. If you want to learn more about this issue, reach out to Dan Campbell at dancampbell@aol.com.
Contributions to This Monthly Article from The Members
We welcome, well, we actually desire, to have--articles like Dan's that reflect what you, as members, are advocating for. We will be sending out a request for information to go into this column, on a quarterly basis, to be posted in the list-serve. Our members are doing a lot in the area of advocacy and we want to recognize that.
REQUEST FOR NEW BLOOD
No, we are not vampires. But we do need new blood on our L & A Committee. We are old and are both retired. We need members who are still practicing. It does not require giving a pint. A quarter of a cup, even an eighth of a cup, will do. A request from us may be to assist us in our contacts with legislators, provide information that will assist in passing relevant legislation, writing an article for this column, or in contacting your legislator to assist in promoting or defeating legislation. We look forward to your responses to our requests.
GOV. NORTHAM ANNOUNCED $485 MILLION FUNDING COMMITMENT TO STRENGTHEN VIRGINIA'S BEHAVIORAL HEALTH SYSTEM
This includes investments in mental health services, substance use treatment and prevention, hospital staffing and critical infrastructure. The plan also includes targeted investments to alleviate pressure on state mental health hospitals and strengthen community-based services.
The proposed funding package will rely on a combination of discretionary funds and block grants from The American Reconciliation Act and The Consolidated Appropriations Act. The funding includes $200 million for staffing at state behavioral health facilities and intellectual training centers and $150 million to increase access to community-based crisis services and child and family support services, and provide dispatcher training for a new statewide mental health alert system designed to ensure behavioral health experts are involved in responding to individuals in crisis. An additional $5 million dollars will be dedicated to providing permanent supportive housing in Northern Virginia to assist with bed services.
CE WORKSHOP WITH A REPRESENTATIVE FROM THE VIRGINIA BUREAU OF INSURANCE CO-SPONSORED BY VSCSW (THE ZOOM HOST) AND GWSCSW
Please let me or Wayne Martin know your concerns about insurance so we can include them in the planning process The workshop will be held in late September or October, and we will keep you up to date on the listserve.
There are some more issues "in the works" and we will report on them in the next newsletter.
Changing Face of Virginia - from Delegate Ken Plum
The results of the 2020 U.S. Census remind us that the world around us changes in more ways than we might consciously detect or understand. That small sliver of the world known as Virginia has undergone many changes before and after receiving its name.
For many, the history of Virginia started with the English landing at Jamestown in 1607. Humans inhabited the land area of what is now known as Virginia for 15,000 to 20,000 years before the English arrived. Its first inhabitants probably crossed the glaciers at the now Bering Straits and made their way along the edges of the glaciers down river valleys and probably entered what is now Virginia in its southwestern area. Archaeological findings support this explanation of the settling of Virginia
At the time English colonists arrived in the spring of 1607, Virginia was inhabited by the Powhatan Indians, who had a total population of about 13,000 to14,000 with a rich history of culture and traditions and a government of 30-some tribal groups. With aggressive English expansion throughout the state, the number of Indians in Virginia was but a fraction of the number at its highest point and with the Racial Integrity Act of 1924 were eliminated from official statistics. Adding to the original settlers were thousands of enslaved Black persons who were brought here without their consent.
The census report released last week paints a different face for Virginia. The country passed two milestones on its way to becoming a majority-minority society in the coming decades: For the first time, the portion of white people dipped below 60%, slipping from 63.7% in 2010 to 57.8% in 2020. And the under-18 population is now a majority of people of color, at 52.7%.
Between the 2010 census and the new census, Virginia’s population grew by 7.9%, slightly higher than the national growth rate of 7.4%. Virginia remains the 12th most populous state.
Fairfax County is now the second most racially diverse county in Virginia and is now a majority-minority population following Prince William County. While white residents remain the largest racial or ethnic group in the county, they are no longer the majority, making up 47.1% of the overall population with 542,001 residents, a drop of nearly 50,000 people from 2010, when the county’s 590,622 white residents constituted 54.6% of its population. Compared to the rest of the United States, Fairfax County ranked 42nd out of 3,143 counties in the country on the racial and ethnic diversity index of the 2020 Census.
This new face of Virginia as identified in census results will be redistricted at the federal, state and local levels. Virginia will retain eleven seats in the House of Representatives, but the boundaries of the districts will be redrawn by the General Assembly to reflect shifts in populations. Likewise, House of Delegates and State Senate seats will be drawn by a commission approved by the voters last year to reflect population shifts. That commission has already been hard at work holding public hearings throughout the state. Local governments will redistrict themselves.
Even before official counts until today we can trace a different face for Virginia.
Information contained in this article has been taken from communications from the Governor’s office, Delegate Ken Plum and our lobbyist, Sue Roland.
BOARD OF SOCIAL WORK
The Board will cease making hard-copy licenses, certifications and registrations. During the next renewal, a final hard copy that contains the expiration date will be issued. The renewal period for the Board of Social Work will begin in early May and the Board will send out email notices at that time. This final copy should be maintained, carried or posted in accordance with relevant applicable laws and regulations. State health regulatory boards, insurance providers and citizens seeking verification of current licensure status in the Commonwealth of Virginia may obtain this information via “License Lookup”.
Judy Ratliff, LCSW, (recently retired from work but not from GWSCSW or from life). She is the Co-Chair, VA Legislation and Advocacy Committee.
YOUR VIRGINIA LEGISLATIVE AND ADVOCACY COMMITTEE AT WORK FOR YOU
The Virginia Legislature has just completed a 30 day session and will begin a special session on February 9. In order to identify bills that will impact us and our clients. Our lobbyist, Sue Rowland, reviews all the bills and sends daily updates to Wayne Martin, my co-chair, me, and Rick Goodling and Joe Lynch from the Virginia Society of Clinical Social Work (VSCSW). The four of us met with Sue twice a week on Zoom since the legislative session began. We will continue to meet to monitor the passage of pertinent bills through the special session.
BILLS HB 1987 AND SB 1338 PERTAIN TO EXTENSION OF REIMBURSEMENT FOR TELEHEALTH
These bills pertain only to Medicaid recipients and not to private insurance. The bills cover NO mental health diagnoses and only a few physical diagnoses. I have written to my delegate, Ken Plum, who is one of the sponsors of the House Bill, inquiring as to why mental health was excluded but I have not yet had a reply.
Both societies and our lobbyist know that extension of telehealth coverage for our clients is very important, as are other insurance concerns. Therefore, our group has decided to continue our meetings on a less frequent basis to deal with insurance-related other concerns.
LEGALIZATION OF MARIJUANA is very complicated and will probably not pass this year. According to Delegate Ken Plum, BILLS PENDING this session include repealing mandatory minimum sentencing, ending felony possession for drugs, reforming the broken probation system, instituting automatic expungement of criminal records, establishing pay parity for public defenders, ending presumption against bail, and eliminating the death penalty.
CONTINUING EDUCATION
Another benefit of the collaboration between the two societies is that both groups benefit from reciprocity for continuing education classes. Members in each Society can enroll in classes for the member cost. Please take advantage of this opportunity to extend your options for free or lower cost CEs.
COVID 19 TESTING, VACCINATIONS AND UPDATES
Wayne and I urge Virginia members to subscribe to the email lists for newsletters from your county supervisors, the head of your county Board of Supervisors and your Virginia delegate and senator. These emails are "chock full" of information as to testing and vaccinations sites, updates and other important information. Just put "constituent" in the subject line and request to receive their newsletters.
Hot off the Press! As of November 4, with 2556 precincts out of 2585 reporting, the Constitutional Amendment described as follows did pass, with 65.85% voting "Yes" and 34.15% voting "No".
The question was: "Should the Constitution of Virginia be amended to establish a redistricting commission, consisting of eight members of the General Assembly (4 Republicans and 4 Democrats) and eight citizens of the Commonwealth, that is responsible for drawing the congressional and state legislative districts that will be subsequently voted on, but not changed by the General Assembly and enacted without the Governor's involvement and to give the responsibility of drawing districts to the Supreme Court of Virginia, if the redistricting commission fails to draw districts or the General Assembly fails to enact districts by certain deadlines."
NEW LAWS PERTAINING TO POLICE AND CRIMINAL JUSTICE REFORM, AS OF NOVEMBER 1, 2020
The laws:
PROHIBIT law enforcement officers from seeking or executing a no-knock search warrant.
REDUCE the militarization of police by prohibiting law enforcement from obtaining or using specified equipment, including grenades, weaponized aircraft and high-caliber firearms However, law enforcement will be able to seek a waiver to use restricted equipment for search and rescue missions.
CREATE statewide minimum training standards for law enforcement officers, including training on awareness of racism, the potential for biased profiling and de-escalation techniques.
MANDATE law enforcement agencies and jails to request the prior employment and disciplinary history of new hires.
EXPAND AND DIVERSIFY the Criminal Justice services Board (CJSB) ensuring that the perspectives of social justice leaders, people of color and mental health providers are represented in the state's criminal justice policymaking.
STRENGTHEN the process by which law enforcement officers can be decertified and allow the CJSB to initiate decertification proceedings.
LIMIT circumstances in which law enforcement officers can use neck restraints.
REQUIRE law enforcement officers to intervene when they witness another officer engaging or attempting to engage in the use of excessive force.
EMPOWER localities to create civilian review boards and to give these boards the authority to issue subpoenas and make binding disciplinary decisions. Five pilot programs have been designated, with one located in Alexandria, VA. (Fairfax County already has an oversight committee.)
MANDATE the creation of minimum crisis intervention training standards and require law enforcement officers to complete crisis intervention training. Please note that crisis intervention systems have already been set up in our jurisdictions and that money has been appropriated. Mental health professionals will be included in response teams.
The 2021 Legislative Session will begin on January 13 and will last for 45 days. Bills are now being introduced.
udy Ratliff
Extension of Coverage for Telemental Health by Insurance Companies
Our GWSCSW Virginia Legislation and Advocacy Committee met with our lobbyist, Sue Roland, via Zoom on July 17. We focused on the issue of extending telemental health (video and audio) insurance coverage and to eventually making it permanent. According to Sue, Scott Johnson, the lobbyist for the Virginia Medical Society, said that he does not think that anything will really change regarding payment and interactions with insurance companies until well into next year. Unfortunately, there is no guarantee that private insurers will continue to cover telemental health services. However, Secretary Azar has extended the public emergency declaration that covers Medicare reimbursement until October 23, 2020.
Our Committee members joined Sue Roland and the Board of the Virginia Society for Clinical Social Work (VSCSW) on July 18, to discuss mutual legislative concerns. We decided to form a committee of members from both societies to focus on this issue in preparation for the 2021 convening of the General Assembly. Eventually, we will be requesting information and feedback from GWSCSW's Virginia members that will help us in this task.
Laura Groshong, Director, Policy and Practice, Clinical Social Work Association (CSWA), has stated that the goals of CSWA are to make telemental health a permanent option through federal laws; to make reimbursement for telemental health at the same level as for in office visits; and to compare the use of in office and telemental health treatment delivery methods. They will also be focusing on the issue of variation in state rules that allow LCSWs in one state to see patients in another state virtually or through audio.
Review of Health Insurance Coverage for Behavioral health and Medical Services
In 2020, the General Assembly passed HB 280, requiring the State's Bureau of Insurance (BOI) to collect and report new information in its annual report, comparing health insurance claims for behavioral health services to those for medical services. The bill also directs the Joint Legislative Review Commission (JLARC) to evaluate whether BOI's annual report includes sufficient information to assess whether health insurance plans are adequately covering behavioral health services (parity).
The legislation requires JLARC to report recommendations for modifying the report to the Senate and House Commerce and Labor Committees and to the Joint Subcommittee to Study Mental Health Services in the Commonwealth in the Twenty-First Century.
This work will be completed by JLARC's Health and Human Resources Unit. JLARC staff will determine whether Virginia is collecting adequate information from insurance plans to assess parity and evaluate whether insurance plans appear to be meeting parity requirements. If the team determines there are not enough behavioral health providers in some networks, JLARC staff will collect provider and insurance plans' perspectives on the reasons for that.
HB 51 directs several agencies to jointly study the feasibility of developing an early childhood mental health consultation program that would be available to all early care and education programs serving children from birth to 5 years of age. A final report is due by the start of the 2021 General Assembly session.
(Thanks to Sue Roland for the information on these pertinent bills.)
From the Governor
Governor Ralph Northam has called a special session on August 18, 2020 to resolve the budget.
On July 15, "Governor Ralph Northam announced the adoption of statewide emergency workplace safety standards in response to the novel coronavirus, or Covid-19. These first-in-the-nation safety rules will protect Virginia workers by mandating appropriate personal protective equipment, sanitation, social distancing, infectious disease preparedness and response plans, record keeping, training and hazard communications in workplaces across the Commonwealth. The actions came in the absence of federal guidelines." (Taken from a press release from the Governor's office.)
HB 795, which would have allowed associations that represent independent contractors to create and provide their own medical insurance plans to their members was passed by both houses and vetoed by the Governor.
HB 1301, which became law on July 1, 2020, "created the Office of Children's Ombudsman, charged with reviewing and investigating the Commonwealth's child-serving agencies to ensure that children and their families are being treated with fairness."
Judy Ratliff, LCSW, (recently retired from work but not from GWSCSW or from life) Co-Chair, VA Legislation and Advocacy Committee.
Judy Ratliff
Board of Social Work Changes to the Regulations Governing the Practice of Social Work
Laws Passed by the Virginia Legislature and Signed into Law in 2020
(Please note that summaries of the bills in items 4-8 are courtesy of Delegate Ken Plum, Reston)
The 2020 Virginia Legislative session has seen the passage of some bills beneficial to social work. These bills passed the House in which they were initiated and went to the other House for reconciliation on February 11, which is known as "Crossover Day." SB 1046, Clinical social workers: patient records; involuntary detention orders. This bill adds clinical social workers to the list of eligible providers that includes treating physicians and clinical psychologists who can disclose or recommend the withholding of patient records, face a malpractice review panel and provide recommendations on involuntary temporary detention orders. SB1562, Music Therapy: definition of music therapist, licensure. Requires the Board of Social Work to adopt regulations establishing a regulatory structure to license music therapists in the Commonwealth and establishes an advisory board to assist the Board in this process. Under the bill, no person shall engage in the practice of music therapy or hold himself out or otherwise represent himself as a music therapist unless he is licensed by the Board.
Another bill that has been proposed is SB53: licensure by endorsement, which requires the Board of Social Work to establish in regulations the requirements for licensure by endorsement as a social worker. The bill allows the Board to issue licenses to persons licensed to practice social work under the laws of another state, the District of Columbia or a US possession or territory, if in the opinion of the Board, the applicant meets the qualifications required of licensed social workers in the Commonwealth.
Other more general but equally important bills include a bill passed in the House that ends discrimination in housing, accommodations, employment and other forms of discrimination and a bill to extend protections of the hate crime bills to all persons, regardless of their sexual orientation or gender identity.
There is also a bill to raise the minimum wage to $15.00, with multi-year step increases. The laws that had been passed in prior years designed to make it more difficult for a woman to have access to an abortion when necessary are being repealed. Additionally, a number of laws that have made it more difficult and cumbersome to vote have been repealed and the law regarding absentee voting will now enable voters to cast an absentee ballot for any reason, with no restrictions.
The last item of focus in this article is the prospect that I may be leaving my position as Virginia Chair of the Legislation and Advocacy Committee as early as July, 2020. Thus far, a few students have expressed an interest, but, as students, have had no time to consider even accompanying me to Richmond or Charlotesville to attebd board meetings of the Virginia Society of Clinical Social Work (VSCSW). If there is no one to fill my position, then we will literally have no voice in how legislation affecting us in Northern Virginia will be shaped.
Yes, it's a lot of work. Yes, it means driving to Richmond three times a year and Charlotesville once a year. Yes, it's easier for me to do this because I am single and have no family obligations. Yes, you write a quarterly article for the Newsletter. And, yes, if there is crucial legislation pending, then there are times when there are weekly legislative committee telephone meetings to strategize and plan actions. Yes, it is a lot of work. Yet, the rewards are great. Because of the work done by Margot, Delores and Alice before me, and continued by me (forcefully at times), we now have true joint decision making and an equal voice in how legislation is shaped to include Northern as well as southern Virginia social work and client interests. It would be very sad if this is lost because no one (or two or three) will step up to take over this important work.
Judy Ratliff, Chair, Virginia Legislation and Advocacy Committee
SOCIAL WORK LICENSING CHANGES
The changes to licensure which have recently gone into effect include establishing separate tests for LMSWs and LBSWs. In the past, both have taken the same test. As a result, LMSWs who took the old test for BSWs will now have to take the new test for LMSWs. Also, the definition of a Masters Social Worker as it is written in the Code of Virginia Chapter 37 is problematic. It states: "Master's social worker" means a person who engages in the practice of social work and provides non-clinical generalist services, including staff supervision and management." According to Joe Lynch, head of the Virginia Society for Clinical Social Work Legislation Committee, is working hard on behalf of all Virginia social workers to fix the problem, "We are stuck with that definition until there is a change in the law."
There is a level of mental health professional called the Qualified Mental Health Professional (QMHP) which is regulated by the Board of Counseling. QMHPs are "registered", not licensed, and therefore cost less to employ than licensed MSWs. They are thus more likely to be hired by the Department of Medical Assistance Services (DMAS) than licensed social workers. This is complicated by the fact that we define masters social workers, as non-clinical. The QMHP regulations require only registration while our social work regulations require licensure. As it now stands, in order for LBSWs and LMSWs to compete with a QMHP for DMAS jobs, "they will have to acquire registration as a QMHP from the Board of Counseling in order to be paid by DMAS for providing services that are within the scope of practice of their license." (Per Joe Lynch) This process also "may have created an anti-competitive impact on social workers." The GWSCSW and VSCSW are working together to explore corrections to this potentially unfair employment situation for social workers.
STEP VIRGINIA SERVICES
The Mental Health in the 21st Century Committee of the Virginia Legislature is chaired by Senator Creigh Deeds. I was able to attend the luncheon sponsored jointly by VSCSW and GWSCSW in Charlottesville this summer to honor Senator Deeds. One of the things he wrote about was the creation of "Step Virginia" by the Committee. The services outlined in the steps are presented below, including their progress.
(Note: The services that were "launched" have not been fully implemented.)
www.gwscsw.org PO Box 711 | Garrisonville, VA 22463 | 202-478-7638 | admin@gwscsw.org
