Dear Missouri Society for Clinical Social Work, H.R. 4040, THE ADVANCING TELEHEALTH BEYOND COVID–19 ACT OF 2021 A bill passed the House yesterday which would allow Medicare to cover LCSWs and other mental health professionals for telemental health services until 2024, including audio only treatment. Additionally, the requirement that patients be seen in person every six months was eliminated. The vote was 416-12. This is a huge win for CSWA, clinical social work, and all of the groups in the Mental Health Liaison Group that worked to get this bill passed. The bill now goes to the Senate where it is likely to pass, as long as it is brought to a vote. All CSWA members should send the following message to their senators at https://www.senate.gov/senators/senators-contact.htm?OrderBy=state&Sort=ASC: “I am a member of the Clinical Social Work Association and a constituent. Please ask Speaker Schumer to bring HR. 4040, The Advancing Telehealth Beyond Covid-19 Act of 2021, to a vote. Many patients struggling with mental health problems will be unable to get the help they need unless this bill is passed by the Senate. Thanks for your support on H.R. 4040.” As always, please let me know when you have sent your messages. Laura Groshong, LICSW, Director, Policy and Practice Clinical Social Work Association lwgroshong@clinicalsocialworkassociation.org

9-8-8 Suicide and Crisis Lifeline

Laura Groshong, LICSW, Director, Policy and Practice

July 2022

      July 16, 2022 was the roll-out date for ”9-8-8”, the new US network for people looking for help with suicidality or other emotional crises. This phone number is designed to be used for text or for telephone access to volunteers who will provide initial assistance to callers, then triage them to LCSWs and other licensed clinicians.

      Ultimately, 9-8-8 will become the National Suicide Prevention Lifeline (1-800-273-TALK); the new number will be easier to remember and access. This older hotline will remain in effect for an as yet undetermined period of time while 9-8-8 becomes fully operational. 

       There is no question of need: there has been an exponential increase in suicides and suicide attempts since the pandemic began almost three years ago. Here is what LCSWs should know about the implementation of this new system.

Funding

The $400 million set aside in Federal funding for 9-8-8 is about half of what will be needed to fund the services in every state. So far, the only states that have provided the needed state funding are Colorado, Nevada, Virginia and Washington. Nine states have legislation in progress to provide this funding; 37 states have no plan to provide funding. CSWA encourages members to ask their state legislators to find the state funding for 9-8-8 so that it can be fully functional as soon as possible. To see what your state’s plan is for funding 9-8-8, go to https://reimaginecrisis.org/map/.

Current Statistics

How serious is the issue of suicide? Here are the number of suicides in the most recently recorded year, 2020:

• In 2020, the U.S. had one death by suicide about every 11 minutes
• Suicide was the leading cause of death for individuals between ages 10-34 in 2020
• Over 100,000 individuals died from drug overdoses in the nine months from April 2020 to the end of the year

While 2020 actually saw a decrease in suicides from 2019 overall (17.7%, https://suicidology.org/2021/04/02/2020data/), of grave concern is the fact that there was an increase for young adults and BIPOC communities of all ages in 2020 (https://www.webmd.com/mental-health/news/20211103/suicide-rates-2020-cdc) .

More Information

The Substance Abuse and Mental Health Services Administration has prepared a toolkit to further explain the need for 988. For FAQs and Fact Sheets, go to

https://www.samhsa.gov/find-help/988/partner-toolkit. Also feel free to contact me for more information.

As you know, CSWA has been involved in the development of a Compact which would allow clinical social workers to practice in all states that join the Compact without having to become licensed in individual states. For the past 8 months, Laura Groshong, CSWA Director of Policy and Practice, and I have attended the Social Work Compact Technical Advisory Committee meetings monthly, sponsored by the Department of Defense and Council of State Governments.

A document for the Compact has been created which is now available for review by the public, including CSWA members. I encourage all CSWA members to attend one of the two webinars which will be held on July 30 at noon ET and September 8 at 3 pm ET for more detailed information on the Compact. Keith Buckhout and Matt Shafer of the Council of State Governments will be available to explain the process and answer your questions. Registration for these webinars will be on the CSWA website shortly.

Among the issues that will be addressed are:

• What is an interstate compact?
• How do states use interstate compacts?
• How do states join a compact?
• How many states are required for a compact to be in effect?
• What are the benefits of a compact?
• How do compacts preserve state sovereignty?
• Where do states obtain legal authority to enter compacts?
• How are compacts administered and enforced?
• What are the steps in the compact development process?
• How long can it take to implement a compact?
• How are compacts funded?

To review the document before the webinars, go to https://compacts.csg.org/compact-updates/social-work/

To submit comments or feedback on the draft, please fill out the online survey at https://www.surveymonkey.com/r/socialworkcompact

Please let Laura know if you have any questions and watch for an email later this week from our new Administrator, Angela Katona, regarding how to sign up for one of the two webinars.

Kendra Roberson, PhD, LICSW

CSWA President

president@clinicalsocialworkassociation.org

Laura Groshong, LICSW

CSWA Director, Policy and Practice

lwgroshong@clinicalsocialworkassociation.org

CSWA members have expressed concerns about the way that companies like Betterhelp are providing a kind of mental health treatment based on texting. The lack of direct contact is cause for concern. The asynchronous nature of Betterhelp limits emotional communication. A new article from California Healthline, written by award-winning journalist Harris Meyer, has just come out and has echoed some of these concerns. The article, “Digital Mental Health Companies Draw Scrutiny and Growing Concerns”, can be found at https://californiahealthline.org/news/article/digital-mental-health-companies-scrutiny-concerns/. Both Marlene Maheu, PhD, who presented a webinar on telemental health for CSWA, and Laura Groshong, CSWA Director of Policy and Practice, are quoted in the article.

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

The Clinical Social Work Association (CSWA) is profoundly concerned by the Supreme Court’s Dobbs v. Jackson ruling affirming a Mississippi law that outlaws abortion in the first 15 weeks of pregnancy. The Court added the overthrow of Roe v. Wade to their Opinion. This Opinion also jettisons any person’s right to privacy in health care decision making, and puts the health and mental health of women and their families at risk. By removing any guarantee that women can have access to safe and legal abortion, the Court’s Opinion returns responsibility for reproductive law-making in the hands of Congress and the states. As states respond to this Opinion with their own laws, it appears that in many instances women and families will be prohibited from receiving much needed mental health therapeutic interventions from Licensed Clinical Social Workers (LCSWs).  In the Constitution, the Founding Fathers made no reference to women at all, let alone rights afforded women to bear or not bear children. Similarly, in the 213-page Opinion of the Court majority, there is no mention of the rights or needs of women, or of children-to-be. The Opinion does not acknowledge the physical health or mental health needs of a woman forced by law to carry to term. There is no mention of support for pregnant women, such as pre-natal care, housing, paid sick leave, health insurance, or food stamps. Nor is there acknowledgement of the needs of the fetus in the womb and beyond. There are so many reasons that women consider abortion. LCSWs see the anguish that making this decision entails and work with clients to come to a valid decision. LCSWs are bound by Federal and state laws. This Opinion in essence has accepted forced-birth laws, limiting the way that LCSWs can work with clients. In some states, there may be felony charges for a woman simply asking for emotional support, or an LCSW providing that mental health support. Understanding the laws in their states will be essential for LCSWs to protect their clients. LCSWs know that women who are struggling with their mental well-being need sustained access to care. The data is clear that Black, Indigenous, and People of Color (BIPOC), and Black women in particular, have the highest maternal mortality rates globally and face terrible risk as a result of this Opinion. CSWA is still gathering information on the states’ responses to this Opinion and will keep the clinical social work community apprised. State legislatures and Congress are now responsible for creating the laws needed as a result of this Opinion. What else can LCSWs do? Here is a list that is may help clarify the issue: Combat misinformation about abortion Avoid criminalization of pregnancy Provide information on the impact of Dobbs on privacy Work with groups who provide confidential hotlines No matter what your point of view is, knowing your state laws, vote for legislators who will not criminalize abortion and who will provide the supports mentioned above. VOTING is the most effective way for LCSW voices to be heard.

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

March 2022

Transgender children have been in the crosshairs of conservative groups in the legislature and elsewhere for the past decade.  Amongst legislative attempts to discriminate against them, there have been attempts to ban them from gender-specific bathrooms or from participating in sports consistent with their gender identity.  Support for transphobic attitudes and actions has grown. Now there is an attempt in Texas to lay blame on parents who affirm their child’s gender identity. This bill is one of the most harmful to trans children, but is the tip of the iceberg; there have been over 235 state-based bills that limit the rights of trans children in 2022 (https://www.msn.com/en-us/news/us/nearly-240-anti-lgbtq-bills-filed-in-2022-so-far-with-most-targeting-trans-people/ar-AAVhMSa) . The current law that has passed in Texas, abhorrently describes parental support of trans children as child abuse; though, for now, it has been placed on hold by a Texas appeals court.

CSWA believes that gender identity is an integral aspect of our intersectional identities and that children’s rights to express their identities, and to participate in everyday activities of childhood, regardless of this expression, should be protected.  LCSWs work with trans-children and adults who have been harmed because of their trans identities. To our affiliated colleagues in the Texas Society for Clinical Social Work, we send our support and encouragement to stand strong.  No law can persuade us to ignore our ethical stance on respecting the identity of any individual child, and for parents that support and affirm their children.  Also notable, the Texas law does nothing to prevent the violence directed toward trans BIPOC youth for being themselves. This violence has increased at alarming rates in the last few years.

As reported by Forbes, 30 trans youth were killed in 2020, including 23 that were BIPOC youth. (Forbes, “Transgender America: 30 Killed And Fatally Shot Already In 2020”, 10/2/20, https://www.forbes.com/sites/jamiewareham/2020/10/02/30-trans-woman-have-now-been-violently-murdered-in-america-in-2020/?sh=296cb38564a4). The work of groups like GLAAD (glaad.org), the Trans Youth Equality Foundation (http://www.transyouthequality.org/), and the Transgender Law Center (https://transgenderlawcenter.org/) are crucial to educating the public and advocating across multiple domains to prevent transphobic violence and discrimination against trans youth and their parents.  CSWA supports the work of these groups in preventing harm and protecting trans children.

Good news on the Medicare fee-for-service sequestration front!  The 2% cut which was scheduled for April 14, 2021, has been suspended until December 31, 2021.  See the announcement from CMS below:

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the sequestration payment adjustment percentage of 2% applied to all Medicare Fee-for-Service (FFS) claims from May 1 through December 31, 2020.  The Consolidated Appropriations Act, 2021, extended the suspension period to March 31, 2021. An Act to Prevent Across-the-Board Direct Spending Cuts, and for Other Purposes, signed into law on April 14, 2021, extends the suspension period to December 31, 2021.

Medicare Administrative Contractors will:

• Release any previously held claims with dates of service on or after April 1
• Reprocess any claims paid with the reduction applied

For more information, go to https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2021-04-16-mlnc#_Toc69394754

You have already received information on Open Notes, which is part of the CURES Act.  There is another section which is called Information Blocking, which has eight reasons for not giving patients access to their Medical Records.  Here is a summary of the two concepts for your information.

Disclosure of Patient Information – Open Notes and Information Blocking

There are now two additional HIPAA considerations when disclosing patient information: Open Notes and Information Blocking.

Open Notes builds on the right of patients to have access to their medical record. On 2 November 2020, new federal rules will implement the bipartisan 21st Century Cures Act that, in part, “. . . promotes patient access to their electronic health information, supports provider needs, advances innovation, and addresses industry-wide information blocking practices.” The rules forbid health care organizations, information technology vendors, and others from restricting patients’ access to their electronic health care data, or “information blocking”, except for the eight reasons that Information Blocking allows. Although the Health Insurance Portability and Accountability Act gave patients the legal right to review their medical records, the new ruling goes further by giving them the right to access their electronic health records rapidly and conveniently via secure online portals. Providers must share not only test results, medication lists, and referral information but also the notes written by clinicians. Over the past decade, this practice innovation—known as “open notes”— has spread widely, and today more than 50 million patients in the United States are offered access to their clinical notes."  (https://www.opennotes.org/research/new-u-s-law-mandates-access-to-clinical-notes-implications-for-patients-and-clinicians/)

Information Blocking outlines the information in the medical record which can be “blocked” from disclosure to the patient.  There are eight reasons for engaging in information blocking: to prevent harm to the patient; to comply with state regulations on privacy; to comply with state regulations on security; infeasibility, e.g., natural disaster prevents sharing medical record; when medical records are unavailable due to electronic maintenance or other reasons; lack of interoperability with patient electronic systems; inability of patient to pay agreed-upon fees to access their record; and delays due to the organization licensed to provide the medical record (https://journal.ahima.org/understanding-the-eight-exceptions-to-information-blocking/)

CSWA is pleased to send you the announcement from Sen.  Debbie Stabenow (D-MI), Sen. John Barrasso (R-WY),  and Rep Barbara Lee (D-CA) about the re-introduction of the Improving Access to Mental Health Act of 2021. 

This may be the year that this bill is finally passed with the exponential increase in mental health needs due to the COVID pandemic.  See the text of the announcement below.

Please send the following message to your members of Congress, using your own words if you wish, at https://www.congress.gov/members?q={%22congress%22:117}&searchResultViewType=expanded :

“I am a member of the Clinical Social Work Association and a constituent.  Please consider becoming a co-sponsor of the Improving Access to Mental Health Act of 2021.  As a clinical social worker, I have been working twice as hard during the pandemic, learning to work through telemental health, and handle a substantially increased caseload.  However, I am still being paid 25% less by Medicare than other mental health clinicians. I need your help to give clinical social workers, the backbone of the mental health treatment community, fair compensation and recognition of the way we are helping to maintain the mental health of our citizens.  Thanks for your consideration.”

Thanks for your help.  As always, let me know when you have sent your messages.

Laura W. Groshong, LICSW, Director, Policy and Practice

Clinical Social Work Association
lwgroshong@clinicalsocialworkassociation.org
CSWA - "The National Voice for Clinical Social Work"
Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY

FOR IMMEDIATE RELEASE

March 18, 2021
Eliza Duckworth (Stabenow)
Eliza_Duckworth@Stabenow.senate.gov

Barrasso Press Office (Barrasso)
Press@barrasso.senate.gov

Sean Ryan (Lee)
Sean.Ryan@mail.house.gov

Senators Stabenow, Barrasso and Representative Lee Introduce Bill to Increase Seniors’ Access to Behavioral Health Services

WASHINGTON, D.C. — U.S. Senators Debbie Stabenow (D-MI), John Barrasso (R-WY) and U.S. Representative Barbara Lee (D-CA-13) today reintroduced their bill to increase seniors’ access to behavioral health services. The Improving Access to Mental Health Act of 2021 would ensure clinical social workers can provide their full range of services to Medicare beneficiaries and increase the Medicare program’s reimbursement rate for clinical social workers, aligning it with that of other non-physician providers.

“Increased stress and isolation during the COVID-19 crisis has resulted in an urgent need for behavioral health services, especially among our seniors,” said Senator Stabenow. “Seniors should be able to receive care from the provider of their choice, and this bill ensures that clinical social workers are among those providers.”

“As a doctor, I know how vital it is for seniors to have access to mental health services,” said Senator Barrasso. “In particular, for those living in rural communities, finding a mental health provider is challenging. This is why I am proud to support bipartisan solutions that help more patients get the care they need.” 

“As a former psychiatric social worker, I know the critical high-quality mental health services and care social workers provide in our communities,” said Congresswoman Barbara Lee. “Especially during a pandemic impacting the mental health of many, it is critical that we ensure Medicare beneficiaries have access to the essential mental health services provided by clinical social workers on a daily basis. I’m proud to join fellow social worker Senator Debbie Stabenow in reintroducing this critical bill and working to expand mental health services for all.”

The Improving Access to Mental Health Act of 2021 would increase the Medicare payment reimbursement rate for clinical social workers from 75 percent to 85 percent of the physician fee schedule. This would align Medicare payments for clinical social workers with that of other non-physician providers such as nurse practitioners and physician assistants. This new payment structure would incentivize trained and licensed professionals to care for more seniors in their communities. The bill also ensures clinical social workers can provide psychosocial services to patients in nursing homes, and the full range of Health and Behavior Assessment and Intervention (HBAI) services within their scope of practice.

The Improving Access to Mental Health Act of 2021 is supported by Aging Life Care Association, American Academy of Social Work and Social Welfare, Clinical Social Work Association, Congressional Research Institute for Social Work and Policy, Council on Social Work Education, Gerontological Society of America, National Association of County Behavioral Health and Developmental Disability Directors, National Association of Social Workers, National Association for Rural Mental Health, the International OCD Foundation, and the Jewish Federations of North America.

“There is great need and a demand for mental health and behavioral health services due to the COVID-19 pandemic, especially among individuals of color and underserved communities who are disproportionately impacted,” said Angelo McClain, PhD, LICSW, NASW Chief Executive Officer. “This legislation ensures a sufficient number of clinical social workers will be there to provide much-needed support and services to Medicare beneficiaries.”

For years, Senator Stabenow has been a champion for increasing access to behavioral health and addiction services. She created a new permanent funding system through the creation of Certified Community Behavioral Health Clinics, which provide a comprehensive set of high-quality behavioral health services. Her bipartisan Excellence in Mental Health and Addiction Treatment Act secured the most significant expansion of community mental health and addiction services in decades.