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.

Clinical Social Work Association
The National Voice of Clinical Social Work

On June 29th, the US Supreme Court declared in Students for Fair Admissions inc. v. President and Fellows of Harvard College that race-conscious admissions programs at Harvard and the University of North Carolina violate the Constitution’s guarantee of equal protection. Affirmative action is a policy that has long aimed to address historical discrimination and promote diversity in the United States. Discussions about its implications for education, employment, and society as a whole have ensued based on the Supreme Court's most recent decision.

What are the potential consequences to this ruling?
1. Reduced Diversity:
One immediate concern following the end of Affirmative Action is the potential decline in diversity within educational institutions and workplaces. Affirmative action strived to create equal opportunities for underrepresented groups, ensuring a more inclusive environment. With its elimination, there's a possibility that minority representation may decrease, affecting perspectives, experiences, and social interactions within these spaces.

2. Widening Achievement Gaps:
Affirmative Action sought to bridge the achievement gaps faced by marginalized communities by providing additional opportunities. Without this policy, disadvantaged individuals may face increased barriers when competing for higher education or job opportunities. This could potentially reinforce existing disparities and hinder progress in closing achievement gaps.

3. Social and Economic Impact:
The end of affirmative action has the potential to perpetuate socioeconomic inequalities. Historically marginalized groups may face difficulties in accessing quality education and securing well-paying jobs, ultimately impacting their upward mobility and economic status. This shift could undermine efforts to achieve social justice and equality.

What does this mean for social workers?
The US Supreme Court's decision to end affirmative action can potentially have an impact on social workers. Affirmative Action policies were put in place to address historical disadvantages faced by certain groups in society, and this included providing equal
opportunities in employment and education. With the removal of such policies, social workers may need to adapt their approaches to address these disparities in a different way. They may need to actively work towards promoting diversity and equal opportunities
within their practice, ensuring that individuals of all backgrounds have access to the support and resources they need. It is also important for social workers to stay updated on any new laws or regulations that emerge in response to this decision, as this could impact the way they navigate issues related to discrimination and inequality in their work. What other consequences arise from this decision? How can social workers find new ways to promote equal opportunity? Comment below.

By Laura Groshong, LICSW, Director, Policy and Practice
Here are two issues which I hope you will all address with your members of Congress and your state legislature.
For Members of Congress:

• H.R. 2474 is a bill which would improve Medicare reimbursement rates by using the rate of inflation as the way to adjust reimbursement each year instead of the Physician Fee Schedule (PFS) which does not use inflation as a factor. 
• H.R. 2474 would also tie reimbursement to the Medicare Economic Index which is based on provider expenses and other economic trends.
• Medicare rates have not increased since 2001, making payments 26% lower today than they were then, when adjusting for inflation. This is one of the major reasons that LCSWs are opting out as Medicare providers. There is a freeze on updated reimbursement until 2026.
• Though this is a House bill, please let your Senators know as well.  You can contact them all at https://www.congress.gov/contact-us .  Here is a message you can use or change it to use your own words: “I am a Licensed Clinical Social Worker and a constituent. Please support H.R. 2474 which will make Medicare reimbursement more equitable for mental health services. Reimbursement rates have not increased since 2001 and are therefore 26% less when adjusted for inflation. LCSWs are opting out as Medicare providers, leaving vulnerable beneficiaries without adequate mental health services. Thank you for your support.”

For State Legislatures:

• The Social Work Compact is now available to be passed by state legislatures. There are 10 states which have begun the process of getting the bill passed; Missouri has already passed the bill. We need six more states to create the Commission to oversee the Compact. 
• Here is a map of the 26 states that have passed the Counselor Compact, https://counselingcompact.org/map/. These states should be open to passing the Social Work Compact as well.
• For more information on how to make your state legislators aware of the Social Work Compact, go to the CSWA website at https://www.clinicalsocialworkassociation.org/Announcements/13212620.

Please let me know when you have sent messages to Congress and members of your state legislatures. Thanks for your help.

Contact:
Laura Groshong, LICSW, CSWA Director of Policy and Practice
lwgroshong@clinicalsocialworkassociation.org

​BREAKING NEWSII  WE HAVE A NEW COMMISSIONER FOR THE DEPARTMENT FOR
BEHAVIORAL HEALTH, DEVELOPMENTAL AND INTELLECTUAL DISABILITIES (BHDID)
Please see Acting Commissioner Stephanie Craycraft’s note below and extend a welcome to Dr. Katie Marks
 
Please join me in welcoming Dr. Katherine Marks to the position of Commissioner of the Department.  I know that Dr. Marks will bring the same energy, enthusiasm, collaborative spirit, and dedication to the role of Commissioner as she has her previous role as the Project Director for the Kentucky Opioid Response Effort (KORE).   Her efforts have been key to the expansion of a comprehensive, recovery-oriented system of care which has changed the lives of countless individuals in the Commonwealth who have been affected by the opioid epidemic. 
The Department’s efforts to facilitate recovery for Kentuckians affected by substance use and mental illness and to support those with intellectual or other developmental disabilities will undoubtedly be strengthened under Dr. Marks’ leadership. 
It has been a privilege to serve in the role as acting Commissioner for the past several months and to collaborate with our dedicated partners who are committed to meeting the needs of the people we serve.  I look forward to continuing to our collaboration as I revert to my role as Deputy Commissioner. 
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As of May 31st, the first round of required Medicaid renewals is in the books…and the results so far are very bad.  Despite the best efforts of KY DMS, providers, the MCOs and advocates, only 50% of the 74,004 individuals who needed to renew their Medicaid coverage by the end of May actually did so.  There were terminations of Medicaid coverage for 34,124 Kentuckians.  Of nearly 6,000 Kentuckians who then became eligible for a Qualified Health Plan on kynect, only 460 have enrolled!  24,521 individuals on Medicaid have not responded at all to letters, calls or other communications to return the required paperwork...but they still have time!! 
DMS and the MCOs will continue to reach out to those 24,000+ Kentuckians who can still easily respond and keep their coverage retroactive to May 31st.  After 90 days, they can still respond, but will need to reapply for Medicaid which will become active with their application.
We must ALL reach out to every Kentuckians we know, work with or serve to urge them to respond to their letter from DMS or to contact a DCBS office or a kynector who can help them get their Medicaid coverage and benefits going again!  

On May 11, 2023, the World Health Organization announced the end of the federal COVID-19 PHE declaration.
Unfortunately, this does not mean that coronavirus does not exist anymore, rather that Covid-realated deaths
have substantially decreased. The U.S. government’s approach to coronavirus will change, but how does this
impact social workers?
The end of the PHE has caused concern for LCSWs who work via telehealth with clients on Medicare (CMS).
Firstly, the coverage of telehealth has begun to be limited by some insurers. This is concerning because
telehealth increases access to healthcare providers, and limiting access to that may cause clients to stop
receiving the care they need. Fortunately, The Consolidated Appropriations Act of 2023 extended Medicare
coverage of telemental health until December 31, 2024 but many commercial insurers did/do not follow CMS
guidance. Secondly, after the December 31, 2024 date, clients will be required to be seen in-person at least
once a year. Due to health risks, transportation issues or more, this could be virtually impossible for some
clients. Audio-only telehealth appointments will not be covered following the The Consolidated
Appropriations Act of 2023 further alienating some clients from care.
LCSW’s who use platforms such as Skype will need to change mediums. According to the Office of Civil Rights
(OCR), using such platforms was not seen as a violation of HIPAA rules during the PHR. Now, LCSW’s will be
required to use a HIPAA compliant platform, such as ZoomPro, Doxy.me, and other platforms offer a Business
Associate Agreement (BAA).
Finally, there are changes to codes and modifiers for Medicare:
● 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
○ Additionally, the modifier for Medicare claims is “GT” though “95” can be used for other
claims.

More information can be found on the Clinical Social Work Association website.
Info: https://www.clinicalsocialworkassociation.org/Announcements/13134039
https://www.clinicalsocialworkassociation.org/Announcements

As social workers we are constantly working for our clients and ensuring we give them the best care possible. How are you showing up for yourself and caring for yourself? One way to focus long-term on your needs is to be aware of the public student loan forgiveness (PSFL) program. PSLF is a program for people who work in public service in federal, state, tribal, or local government, or for a non-profit organization. If you qualify look into this. Your student loans could be forgiven and if you're doing the hard work anyways, you should also benefit from it. Self care is about more than taking a bath, going for a walk, or reading a book. It is a way of life, which includes planning for your future. 
If you would like more information on this program check out the website here: https://studentaid.gov/pslf/

If you are interested in attending a training to learn more information check out below:
Public Service Loan Forgiveness - Current Rules and Tips for Success
June 1, 2023 | 5:30 pm to 7:00 pm Eastern Time via Zoom

Presenters: Jennifer Noblet, LCSW-S and Sabrina Golling
Target Audience: Anyone who works for a non-profit or governmental organization and has a federal student loan
About the webinar: This presentation will review the current rules of the Public Service Loan Forgiveness Program as well as provide tips for how to be successful in achieving forgiveness through the program. Please note that CEs are not offered for this event.
About the presenters:


Jennifer Noblet lives in Houston, Texas and works for an academic health center where she manages the development and delivery of clinical social work services and behavioral health programing. She received her Master of Social Work from the University of Michigan has over 10 years of experience as a therapist as well as prior work in psychiatric research. Jennifer has been a student loan advocate and moderator for the Public Service Loan Forgiveness group on Facebook since 2021 and personally received student loan forgiveness through the PSLF program in October 2022.


Sabrina Golling lives in Raleigh, North Carolina and works in rural capacity building and organizational development. She received her Master of Social Work from the University of North Carolina at Chapel Hill, and has professional experience as a nonprofit leader for a crisis intervention/suicide prevention hotline and in social work research at the intersection of mental health and criminal justice. Sabrina does work in student loan advocacy as a volunteer and in a professional capacity, and anticipates receiving PSLF in 2030. Her personal areas of expertise are around the Limited PSLF Waiver and the One Time IDR Account Adjustment.
Fee & Registration:
The cost is $25 for both CSWA members and non-members. Registrations will be accepted until 24 hours prior to the start of the presentation or until it is full. Cancellations must be received 24 hours prior to the live event to receive a refund. Each registered participant will receive zoom log-in information via email from administrator@clinicalsocialworkassociation.org one day prior to the webinar.

Register here: 
https://www.clinicalsocialworkassociation.org/EmailTracker/LinkTracker.ashx?linkAndRecipientCode=tG6gTEbV7PXLQxW4DpELnrocmmrgdKcE0rB%2bcs3kj0VfgEMT7W9tu9pcl%2fr9nh0XQ211Qulpe%2fdHFaa1tPXdHmOmPNK60SzmBwnANuceOBQ%3d

Social workers around the state have been nervously keeping up with SB 150. SB 150 has been widely critiqued by social workers, as it essentially bans gender affirming care for children. This bill will require students in schools to use pronouns and use bathrooms based on their assigned gender. Governor Beshear vetoed this bill in late March, however the Senate quickly voted 29-8 to override the governor's veto. The measure then went to the House for consideration, where lawmakers voted 76-23 to override the veto. SB 150 will go into effect in late June. 
This bill is harmful because it directly targets an already marginalized population of Kentuckians and severely restricts and undermines parental choices under the guise of protecting and supporting parental rights. This bill may subject trans and questioning youth to harm in bigotry. 
So what should we do now? It is more important now more than ever to be supportive to the entire LGBTQ+ community. This includes being supportive to our friends and family in our personal lives, as well as supporting LGBTQ+ organizations within our communities. If you know any LGBTQ+ organizations in Kentucky, that could use our support, please write them in 
the comments! 
There are also several lawsuits filed to challenge SB 150 on the grounds that the bill is unconstitutional. I will be sure to update this blog, if any of those lawsuits come to pass. 
References: 
https://www.lex18.com/news/covering-kentucky/supporters-opponents-of-senate-bill-150-hold-r allies-at-kentucky-capitol 

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April is Alcohol Awareness Month, a time to focus on the dangers of alcohol abuse and addiction and to promote healthy drinking habits. With alcohol being the most commonly used addictive substance in the United States, raising awareness about the risks associated with excessive drinking is essential.
Alcohol Awareness Month was established in 1987 by the National Council on Alcoholism and Drug Dependence (NCADD) to encourage people to assess their drinking habits and seek help if needed. Since then, it has grown into a nationwide observance, with organizations and communities coming together to raise awareness about the effects of alcohol abuse and to promote prevention, treatment, and recovery resources.
The theme for Alcohol Awareness Month 2023 is “Awareness is Key: Sustaining Healthy Communities.” This theme emphasizes the importance of raising awareness about alcohol abuse and addiction and how it affects individuals, families, and communities. It also highlights the need for communities to come together to support those struggling with alcohol addiction and to create a culture of responsible drinking.
Excessive alcohol consumption can have serious health consequences, including liver disease, cancer, and heart disease. It can also lead to addiction, which can cause a range of social, emotional, and financial problems. In addition to the health risks, alcohol abuse can contribute to car accidents, violence, and other harmful behaviors.
To promote healthy drinking habits and raise awareness about the risks of alcohol abuse, the NCADD recommends the following:

1. Educate yourself and others about the dangers of alcohol abuse.
   
2. Set limits for yourself and others when it comes to alcohol consumption.
   
3. Know the signs of alcohol abuse and addiction.
   
4. Support those struggling with alcohol addiction by connecting them with resources and treatment options.
   
5. Be a role model for responsible drinking.
   

Throughout April, organizations and communities across the country will host events and activities to raise awareness about alcohol abuse and addiction. These events may include educational seminars, community outreach programs, and fundraising events for local addiction treatment centers.
Alcohol Awareness Month is an important reminder that alcohol abuse and addiction is a severe problem that affects millions of people across the country. By working together to raise awareness about the risks of excessive drinking and promoting healthy drinking habits, we can create a safer and healthier community for everyone.

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On March 27th, Nashville, TN joined the 13 communities that have experienced a school shooting this year. This morning, a gunman opened fire at Covenant School, a private elementary school for students in preschool through sixth grade. At the time of this blog post, at least 7 individuals are dead after this tragedy, including the shooter.

For a list of the 350+ school shootings that have taken place since Columbine, click here: https://en.wikipedia.org/wiki/List_of_school_shootings_in_the_United_States_(2000%E2%80%93present)

The United States holds the record for most school shootings, following the US is Mexico with 8 school shootings.

This information begs the question: What can we do to stop mass school shootings?

1. Demand gun control. It’s a fact: US states with more relaxed gun control laws and higher rates of gun ownership have higher rates of mass shootings. For example, in Texas it’s alarmingly easy to buy and openly carry a gun and, not surprisingly, is close to leading the US in school shootings. We know what we need to do. Lobby and advocate for gun control laws. These laws can include raising the age to purchase semi-automatic firearms, require background checks on all gun sales, and/or pass extreme risk laws. 
2. Build a culture of secure gun storage. This can include enacting and enforcing secure firearm storage laws.
3. Foster a safe and trusting school climate.  According to a study done by Alfred University, only around half of students would tell an adult if they heard another student talk about shooting someone at school. We need to foster an environment where students feel safe to talk to adults when they hear alarming information. You can check out the study here: https://www.alfred.edu/about/news/studies/lethal-school-violence/can-we-prevent.cfm
4. Initiate trauma informed emergency planning. This ensures that staff can secure schools and law enforcement can respond quickly when there is an emergency in schools. 
5. Avoid practices that can cause harm and traumatize students. This is a no brainer. Protect our students.

References:
https://wisevoter.com/country-rankings/school-shootings-by-country/
https://www.scientificamerican.com/article/the-science-is-clear-gun-control-saves-lives/
https://www.usnews.com/news/best-states/articles/2022-05-27/states-with-the-most-school-shootings

​

Laura Groshong, LICSW, Director, Policy and Practice
March, 2023
The Public Health Emergency (PHE) is ending on May 11, 2023. This has caused some concern for LCSWs who have been working through telemental health since the pandemic began in 2020. The question of whether psychotherapy will be covered when the PHE ends is a complex one. Here is what we know about telemental health coverage at the moment:

• Coverage of Telemental Health – The Consolidated Appropriations Act of 2023 extended Medicare coverage of telemental health until December 31, 2024, which is good news. While most commercial insurers tend to follow CMS guidance, this time it appears that this may not be the case. Some insurers have already begun to limit telemental health coverage; this may increase after May 11. It is not too early to have patients check with their insurers about the likelihood that telemental health will be limited/no longer covered going forward.
• Meeting In-Person – The CMS requirement that Medicare patients be seen in person at least once a year when the PHE ends has been delayed until December 31, 2024.
• Audio-Only Telemental Health – CMS coverage of Medicare patients through audio-only telemental health will continue until December 31, 2024.
• If a patient’s insurer is planning to stop telemental health or audio only coverage in some way, it would be helpful to have patients talk to their HR person about keeping telemental health coverage in place. It may also be helpful to file a complaint with state insurance commissioners if insurers are unwilling to continue coverage of telemental health treatment.

There may be other questions that members have about the way that the end of the PHE will affect LCSW practices. Please let me know if you do.  For more information on these topics go to https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/policy-changes-after-the-covid-19-public-health-emergency#permanent-medicare-changes . CSWA will be tracking these changes for members.