To all social workers. Please see the message below from the Clinical Social Work Association regarding legislative updates:

1. Compact Delay – as you know, the Social Work Compact, which would allow LCSWs to practice in any state that joins the Compact, has been in development since October of 2021. CSWA President, Kendra Roberson, and I are members of the Technical Assistance Group (TAG) which has provided information about what the Compact should look like, along with representatives from other clinical social work and social work organizations. The process is being overseen by the Department of Defense and Council of State Governments. DoD and CSG had told us that the document, which will be submitted as bills to state legislatures, would be ready at the end of 2022. Unfortunately for several reasons, that deadline could not be met. Correspondingly, Kendra Roberson and I will be attending a meeting in Washington, DC in early February to finalize the document. We are hopeful that the document will be ready by early spring and will keep you posted on how to support the compact in your state legislatures when it is ready. CSWA knows how many members are looking forward to the Compact, as is CSWA.
2. Medicare Rules – there are two issues regarding new Medicare rules that have caused confusion. First, the need for in-person meetings with patients will not be put in place until 151 days AFTER the end of the Public Health Emergency. With many regions seeing increases in COVID and other viruses at this time, it is unlikely that the PHE will end any time soon. Second, the ability to see Medicare beneficiaries across state lines will not be in place until the end of the PHE as well. Please keep this in mind.  We are all looking forward to the ability to work across state lines. CSWA will let you know when that becomes a reality.

As the holidays come to an end and we begin a new year, it's time to focus on some important  changes that are happening that impact social workers. Recently congress passed a Medicare $1.7 trillion spending bill. See below for the details:
​
The rule addressing working across state lines is for LCSWs who are Medicare paneled and working with Medicare beneficiaries. This does not apply to LCSWs who are opted out, or not opted in or out. The rule does not apply to commercial insurers. ~LWG
 
Medicare in $1.7 Trillion Spending Bill – Effect on LCSWs
December 21, 2022
Congress just passed a $1.7 trillion spending bill which has some impact on LCSWs through Medicare coverage. Now it is up to the President to sign it. Here are the ways that our practices will be affected if all these changes take place on January 1, 2023:

• Medicare Rates – We had anticipated a 4.5% cut to Medicare reimbursement in 2023 and instead, this cut was 2%. It is better than expected. We will continue to advocate for a change to the RVU that determines what LCSWs are paid through Medicare, which is currently 25% less than what psychologists and psychiatrists are reimbursed for the same psychotherapy codes we use.
• Telemental Health Extension – Coverage of telemental health was supposed to end 151 days after the end of the Public Health Emergency. There is a new extension of telemental health (and all health care) until Dec. 31, 2024. This is a positive development which increases the likelihood that telemental health will be made permanent.
• Practicing Across State Lines – There is a provision that ends the requirement that providers be licensed in the same state as the patient receiving care, allowing more types of practitioners to provide telemental health services, including audio-only services.  This change is one that CSWA has been advocating strongly for and hopes will remain in place.
• Delay In-Person Requirement – There is a delay in the requirement to see patients in-person via telehealth. The previous requirement had been that patients would have to be seen 6 months or 12 months every year in-person. For the foreseeable future, there is no need to see patients in person that are being seen virtually.
• Telemental Health Services in FQHCs and RHCs - The bill would also extend telemental health services through 2024 for federally qualified health clinics and rural health clinics.

This two-year extension is not without future implications. The bill instructs the Secretary of Health and Human Services to study how telehealth has affected Medicare beneficiaries’ overall health outcomes and whether there are geographic differences in use. It also calls for a review of medical claims data. The initial report is due by Oct. 1, 2024. 
One more item – the Good Faith Estimate is supposed to be given to patients every year so look at when you gave your patients their first GFE and prepare to repeat the process.

​UPDATE: Medicare Coverage and Parity Changes for LCSWS
There continue to be questions about the change to Medicare policy about treating patients across state lines. Different regions have different policies in this regard. Look at the section in yellow below and call your MAC to get information about a region you wish to practice in. Here is more detailed information on the telehealth changes: https://telehealth.hhs.gov/providers/billing-and-reimbursement/medicare-payment-policies-during-covid-19/
Telehealth Policy Changes
The federal government announced a series of policy changes that broaden Medicare coverage for telehealth during the COVID-19 public health emergency.
Some important changes to Medicare telehealth coverage and reimbursement during this period include:

• Location: No geographic restrictions for patients or providers
• Eligible providers: All health care providers who are eligible to bill Medicare can bill for telehealth services, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
• Eligible services: See the list of telehealth services from the Centers for Medicare & Medicaid Services
• Cost-sharing: Providers can reduce or waive patient cost-sharing (copayments and deductibles) for telehealth visits
• Licensing: Providers can furnish services outside their state of enrollment. For questions about new enrollment flexibilities, or to enroll for temporary billing privileges, use this list of Medicare Administrative Contractors (MACs) to call the hotline for your area
• Modality: The 2022 Physician Fee Schedule has codified the ability for behavior health services to do audio only. It is still required to complete an in-person appointment every 6 months.

Mental Health Parity
There is one more piece of good news in the omnibus bill. You may recall that when the parity act passed in 2008 there was a loophole that allowed public plans to opt out of having a mental health benefit at all. That meant that they did not have to have a benefit AT PARITY with medical/surgical benefits. That loophole has been closed in the omnibus bill. This means a million more people will have mandated mental health treatment. More information can be found at https://www.thekennedyforum.org/blog/these-major-employers-have-opted-out-of-providing-adequate-mental-health-addiction-coverage/
H.R. 432, Mental Health Access Improvement Act
The Mental Health Access Improvement Act passed as part of the omnibus bill. This means that LMFTs and LPCs are now Medicare providers. Their reimbursement rates will be 75% of psychologist rates, like LCSWs, or 80% of their usual and customary rates, whichever is less. This is possibly more than what LCSWs are paid and CSWA will be looking into keeping LCSWs at the same reimbursement level.
These changes were passed by the House this morning so the President should be signing the bill shortly.