Update on Medicare Telemental Health Expansion

Friday, March 13, 2020 9:59 AM | Jodi Hogue (Administrator)

March 13, 2020

Dear CSWA Members,

Information is changing rapidly about the way that the March 6 bill is affecting our ability to provide covered Medicare telemental health services.  This post corrects yesterday's message about this topic.

Thanks to the sharp-eyed members who saw that the bill requires approval from HHS.  The most current information I have is that this should be coming on March 19.  It will probably be retroactive to February. This is all speculative; I will provide more definite information as I receive it.

Protecting your health and the health of your patients is the primary goal. Be as careful as you can be, recognizing there are no absolutes about whether to stop seeing patients in person. Hand washing and wiping high touch surfaces is the best way to avoid the spread of the virus.  Of course do not see any patients if you or they have symptoms of the illness, i.e., fever, sore throat, dry cough.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

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March 12, 2020

 

Dear CSWA Members,

As many members have begun looking into providing telemental health and telephonic sessions during this time of health risk associated with COVID-19, there have been some questions about how to go about doing so for those who have not previously engaged in it.  Here is a brief FAQ list to help you get started:

  • 1.       Will I be paid for telemental health sessions? This is complicated.  It appears that Medicare will pay for telemental health, videoconferencing only, sessions beyond the rural coverage that was already in place.  There has been no Federal guidance about Medicaid which works in tandem with state government.  Private insurers are all over the map in terms of covering telemental health.  The best way to find out is to have patients call their insurer or HR person to find out.
  • 2.       Will I be paid for telephone sessions? See #1.  Note that Medicare will not currently cover telephonic sessions.
  • 3.       What does it mean to use a platform that is HIPAA compliant? It basically means using a platform that will sign your Business Associate Agreement, to keep your patient material confidential.  Some platforms that are willing to do so are VSee, Zoom, doxy.me, Simple Practice, and Theranest.  Almost all require payment to use. 
  • 4.       Where can I get basic information on how to do telemental health? CSWA is looking into providing a webinar on doing this.
  • 5.       What can I do to get state and Federal approval of coverage of telemental health sessions? It is fine to let your state and Federal legislators and insurance commissioner know that coverage of telemental health is a necessary change for the well-being of LCSWs and their patients.  CSWA is developing more formal advocacy on this.
  • 6.       Can I treat people across state lines if I am not licensed in the patient’s state? No, the requirements that exist to be licensed in both the state in which you reside as well as the state of the patient are still in place. You can seek reciprocity in states that allow it.

There is much more to being HIPAA compliant using telemental health. I did a webinar on this last year which should be in the CSWA Members Only section on the website. I will try to answer questions you have directly, but it may take a little longer than usual to respond.

Be sure to follow all CDC guidelines about hand-washing, social distancing, wiping down high touch surfaces, etc.  CSWA wants you to stay safe and healthy!


Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

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March 9, 2020

Dear CSWA Members,

I just received guidance from CMS on whether we can be reimbursed for telemental health beyond the accepted treatment in rural areas.  Their response is attached.

Basically the answer is no at this time. I recommend calling CMS at1-866-288-8912 to ask for more guidance.

CSWA is developing a Legislative Alert to send to members of Congress to request an expansion of coverage for telemental health during this health crisis.

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

CSWA - Medicare on Distance Sessions - 3-9-20.docx

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March 8, 2020

Dear CSWA Members,

Here is an update on the COVID-19 epidemic.

It appears that the number of cases is spreading, close to 500 with the Seattle area being the heaviest hit (128 cases, 19 deaths as of this writing).  We really don't know when the situation will improve as various cities are just starting to see cases and the tests for confirmation of COVID-19 are still hard to get.

I wanted to pass on some things that members are doing to protect themselves and their patients in addition to the list I sent out last Monday.  Some are cover fabric chairs and couches, even leather ones, with plastic/vinyl material which is easier to clean with antiseptic spray. 

It is important to make sure that any DIY hand antiseptic is at least 70% alcohol, the rest aloe vera gel, with some drops of aromatic oils like tea tree or lavender; unfortunately many areas are completely out of alcohol and aloe vera. Amazon can send in a week.

Those most at risk of being harmed by COVID-19 are people with underlying health conditions and those over 65. Traveling is not recommended for this group in particular.

Many members have asked about whether Medicare will cover telemental health sessions.  The bill signed on Friday provides $8.3 billion for a variety of ways to address the virus but there is no clear guidance on whether CMS will expand their coverage of telemental health yet.  I will let you know when this becomes available. Sen. Ron Wyden did get a provision in to support telemental health but no specific enforcement.  As for private insurers there is no clarity there either.  I suggest having patients request that telemental health be covered if they have private insurance; that is the most likely way to get coverage.

This is a time of anxiety in our personal and professional lives.  We should try to remember that we are all in this together and hopefully can help each other get through it.


Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

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March 2, 2020

 

Dear CSWA Members,

The Covid-19 virus is spreading and LCSWs need to anticipate the impact that this may have on our patients and our practices.  Many of the suggestions below were gathered from the World Health Organization and other sources.  CSWA hopes we may be helpful to you as this health crisis evolves.

More information can be found at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen

Another comprehensive article can be found at https://www.washingtonpost.com/health/2020/02/28/what-you-need-know-about-coronavirus/?arc404=true

Clinical Practice Action Plan:

- Develop a plan for limiting in-person sessions if there is a public health recommended limitation for being in public places, or a perceived need for such limitation

- Review the CSWA Technology Standards for Social Workers if you have not done so recently (https://www.clinicalsocialworkassociation.org/Social-Work-Technology-Standards)

- Check with insurers as to coverage of telephone or videoconferencing

- Make sure that any videoconferencing platform you use is HIPAA compliant (VSee, Zoom, etc.)

- Decide if patients with symptoms should have sessions by telephone or videoconferencing

- Decide if you should be working if you have symptoms

- Discuss a plan with patients in advance of the need to limit in-person contact, including arranging for phone or video sessions

- Sanitizing doorknobs and other surfaces touched by patients

- Be aware of own anxieties and try to contain

- Be prepared to acknowledge the anxieties of patients, should they occur

Public Health recommendations to reduce infection from flu or Covid-19:

- Perform frequent hand washing and use of hand sanitizer after being in public spaces

- Cough into elbow or shoulder, not covering your mouth with your hand

- Stay more than 6 feet away from individuals who are coughing or otherwise appear ill

- Avoid social ways of touching others, including handshakes

- Avoid touching your own face as much as possible

- Avoid public transportation such as buses or trains if recommended distance cannot be maintained

- Use hand sanitizer after going through TSA if flying by plane

- Use sanitizing wipes on plane armrests and tables and rental car keys and steering wheels

- Be aware of countries and cities where Covid-19 virus is increasing if traveling

- Engage in immune enhancing activities, i.e., get enough sleep, reduce alcohol intake, get exercise)

- Do not go to an emergency room unless absolutely essential; for a cough, fever, or other respiratory issues contact your primary care doctor first.

- Self-quarantine at the first sign of illness and wear an N-95 face mask in public spaces

Helping Children with Meaning of Restrictions Due to Covid-19

Suggestions can be found at  https://onedrive.live.com/view.aspx?resid=D589777FC7C86E35!118&ithint=file%252cdocx&authkey=!ALcOpxBYPPJR_h4

 

Striking a balance between being overly cautious and overly optimistic may not be easy but as clinical social workers, I think we can achieve it.  As you may know, here in Seattle we have a cluster of Covid-19 cases and two deaths, so I will be applying these principles to my own practice.


Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY


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