Mental health has long been overlooked as a crucial factor in overall health and well-being. However, recently mental health has recently taken center stage in public health discussions across the nation. Like every state, the state of Kentucky faces a unique set of challenges regarding mental health and mental illness ranging from substance abuse problems to suicide to depression & anxiety. Of the major concerns that arise with these varying mental health concerns, one that is often ignored is the victims’ access to the appropriate healthcare. Most Americans, approximately 164 million have insurance plans via their employers. Despite that, in many states including Kentucky, insurers can set their own standards regarding what they deem as a medical necessity. Often instances occur where an insurance company interposes itself between the mental healthcare provider and the client sometimes threatening the provider’s job security, often assaulting their dignity, as well as sifting through case notes with sensitive details. Social workers, healthcare providers, therapists, psychologists, etc., commonly deal with these ethical dilemmas which often leaves them in a situation where they wish to act morally but cannot given the constraints of their predicament. In some instances, this leads to our most vulnerable communities being denied access to proper health care due to the insurance companies interfering with the process. 
In recent years Kentucky has made several critical legislative moves to address the mental health challenges our state is facing. Our state wants to make mental health care more affordable and accessible to ensure individuals receive the care that they need. One of the most significant changes in mental health law in our state was Tim’s Law in 2017, which allows for court-ordered outpatient treatment for individuals who have been involuntarily hospitalized multiple times. The law is aimed at preventing a vicious cycle of hospitalization and release by ensuring those with severe mental illness remain in treatment. So instead of cycling through the system of state hospitals, or in many cases jails, Tim’s law gets people with the most severe mental illness into outpatient treatment. Tim's law has become a valuable tool is assessing the need for treatment in unique cases of mental illness. Recently, in June of 2022, Govenor Andy Beshear signed for two bills aimed at helping more individuals across the state access mental health services. The first bill, House Bill 127, expands access to assisted treatment. This bill allows the courts to order outpatient care for individuals with serious mental illnesses. This method is intended to ensure that every individual with a severe mental illness is guaranteed the treatment they need even if they do not have the means to access treatment on their own. Second the Govenor signed house bill 562 aimed getting first responders across the state access to the mental health care they need. The bill has sanctions allowing for peace officers, firefighters, EMS workers, and any other first responder to take 48 hours leave after being involved in a criminal incident. The incidents could refer to anything from a car accident to the death of a colleague. Each of these bills, House Bill 127 in particular, is aimed at expanding Tim’s law (2017) by allowing for greater access to those who would benefit from outpatient treatment by modifying the criteria for medical necessity. House Bill 127 also requires more thorough evaluation of individuals who may receive court-ordered treatment. Another way this Bill expands on Tim’s law is by helping to cover additional treatment costs necessary to ensure successful re-entry into the community. Our state has made big strides in making mental health care affordable and accessible to those who need it most.  
There are still more laws that need to be passed to reduce interference from insurers regarding those who still experience barriers to accessing treatment. In many states, including Kentucky, insurers are often able to set their own standards for defining when mental health services are medically necessary. This is alarming considering our state does not have any laws or sanctions that regulate how insurers conduct reviews of behavioral healthcare. This subjects both clients, and those in need of treatment, to the judgement of an insurer and prevents providers from being able to act morally given the constraints of their predicament. There is no guideline in the NASW’s code of ethics that specifies for providers how to balance the disparity of profit-motives and service to vulnerable populations and creates a persistent ethical challenge that many healthcare providers as well as policy makers must navigate. The federal Mental Health Parity and Addiction Equity Act of 2008 banned some of the harsher restrictions insurers had for those seeking treatment for mental health. However, since the passing of this act insurers have turned to utilization reviews, in which they can request progress notes from the providers which are full of sensitive details and as part of their assessment process. Healthcare providers have found that these reviews are only used as a means to dispute the necessity of further treatment. 
References  
Team Kentucky (2022). Gov. Andy Beshear Signs Two Bills Supporting Mental Health Access 
https://www.kentucky.gov/Pages/Activity-stream.aspx?n=GovernorBeshear&prId=1381#:~:text=Since%202017%2C%20Kentucky%2C%20along%20with,it%20out%20on%20their%20own. 
NASW. (2021) Code of Ethics of the National Association of Social Workers  
https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English 
Annie Waldman and Maya Miller (2024, August 27) What Mental Health Care Protections Exist in Your State? 
https://www.propublica.org/article/mental-health-wiltn-states 
Centers for Medicare and Medicaid Services. (2024). The Mental Health Parity and Addiction Equity act (MHPAEA). 
https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity 

Submitted by William King, BSW Practicum Student, University of Kentucky
 
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Updates regarding the Social Work Compact:
The Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), announced the first-ever Licensure Portability Grant Program, which is an investment in a multi-state social worker licensure compact. This grant will provide $2.5 million in support of the Social Work Compact. This welcome support will make the implementation of the Compact easier and less of a financial burden for LCSWs who live in states that have passed the Compact and choose to join as individuals. Please visit the U.S. Department of Health and Human Services website for more information.
More details about the Compact will be forthcoming after the September 17 meeting to establish the Commission that will be running the Compact, which I will be running as Interim Chair. CSWA will continue to provide information about the Compact as it develops.

What does this mean for social workers? This could provide more options for our clients, for work opportunities, and for the growth of mental health care throughout the United States. Stay up to date with all the current news with KSCSW.

Change is a universal human experience and with it comes a multitude of experiences, emotions, and challenges. There are critical junctures in life, often referred to as life transitions, that bring about a significant amount of change for an individual due to quickly and vastly evolving circumstances. Some people find that they move through these transitions relatively easily, while others may require more support in adapting to the changes that may come. This article explores the concept of life transitions and how counseling for life transitions can help clients to build resilience and find positive personal growth during such periods of transformation.
WHAT ARE LIFE TRANSITIONS?
The term life transition refers to a significant change in an individual’s personal, professional, or social life requiring one to adapt to new circumstances, responsibilities, or roles than previously held. Life transitions are often marked by important events but they can also occur as a result of unmet expectations for one’s life.
Types of Life Transitions
Anticipated life transitions are changes that you expected to happen. Because anticipated life transitions may allow for some level of predictability, an individual might experience a greater sense of control than for other types of life transitions. Examples of anticipated life transitions include graduating from high school, having a child, or entering into retirement. 
Unanticipated life transitions are changes in life that occur without notice and without the ability to plan. Unanticipated life transitions might include experiences such as the death of a close family member, an unexpected medical diagnosis, or the loss of a job.
Non-event life transitions are changes we expected to occur in life but do not. Non-event life transitions stem from unmet expectations an individual might have for their life, for example, not having children when one expected to or not being able to retire at the anticipated age due to financial difficulties.
Examples of Common Life Transitions
Among many others, the following are some common types of life transitions that people might seek a counselor for:

• Developmental transitions – change that occurs at milestone ages such as entering into adulthood at 18 or entering into retirement age
• Relational transitions – adjusting to a change in relationship status such as navigating a divorce, entering into marriage, or losing a loved one
• Career transitions – marked by a change in job status such as retiring or being promoted from a current position
• Health transitions – navigating a medical diagnosis or change in health status such as adjusting to life with a chronic illness or experiencing a major injury that impacts one’s lifestyle
• Identity transitions – adjusting to changes in culture such as during a significant move or getting involved in a new community

HOW DO LIFE TRANSITIONS AFFECT INDIVIDUALS AND HOW CAN COUNSELING HELP?
Any considerable transition comes with acute stressors that may affect an individual’s mental health. The overarching goal of counseling for life transitions is to support the client in processing the change and navigating its effects in a way that is meaningful to them. Because people react differently to stress, there is no one size fits all method to counseling but sessions may often focus on building resilience and confidence while learning how to manage stress and its many effects on health and lifestyle for a better experience of the life transition. A counselor’s role in supporting positive coping mechanisms is important and ever-evolving. For those interested in advancing their knowledge of how to support such clients, the Kentucky Society for Clinical Social Work provides helpful continuing education trainings and events to help clinicians further their skills and education.
Effective Strategies in Counseling for Life Transitions
The following are common techniques used in counseling for life transitions to specifically target the challenging experience of and emotions surrounding major change:

• Resilience training

In order to increase adaptiveness and manage resistance, which is often a natural response to change, counselors can engage clients in techniques that promote resilience such as goal setting, reframing of unhelpful thoughts, practicing acceptance, and the development of problem-solving skills.

• Emotional support through active listening

It is widely believed that one of the most effective tools of counseling is the therapeutic relationship itself. Creating an environment of trust and support through active listening can help the client break through resistance, process difficult emotions, and find easier direction in goal setting during transitional times.

• Mindfulness practice

Practicing mindfulness during challenging times can bring greater clarity and rationality while processing difficult emotions. Mindfulness brings us into deeper awareness of our bodies, helps us use curiosity to explore different feelings as they come up, and supports the maintenance of healthy routines which all allow for more effective processing of the experience of change and the emotions that may come with it. The Kentucky Society for Clinical Social Work has an excellent database of mindfulness resources that can be downloaded and used with clients.

• Identifying and building support networks

Helping clients to foster connections with others who understand their circumstances or who clients can turn to during difficult times is an important tool for building and maintaining resilience. Supporting clients in prioritizing relationships helps to decrease isolation, which can be a common response to experiencing challenging times, and encourages opportunities for positive emotional connection.

• Self-reflection and personal growth learning

Change can be good but there is a mindset shift that must occur in order for an individual to find growth in the midst of a difficult transition. An important role of the counselor is to support clients in reflecting on both past and present experiences and how the changes they have experienced throughout life have shaped who they are and who they would like to become.

• Goal setting

Major life transitions are often difficult to process because they can leave a person feeling directionless. Where one may previously have found purpose in their routines, responsibilities, or roles, the changes that have occurred may result in a sense of loss. Clinicians can help clients gain clarity in their goals for the future and find direction during a time of cloudy vision by breaking down values, establishing important objectives they may have for the future, and identifying steps toward achieving these goals.

• Cognitive-behavioral techniques

Counselors can help clients manage transition-induced stress, anxiety, and other difficult emotional states by teaching and practicing coping skills that combat the negative mindset often perpetuating such feelings. Among other interventions, useful techniques may include cognitive restructuring, relaxation exercises, skills training, and successive approximation.
CONCLUSION
There are a number of therapeutic frameworks and techniques that are helpful in treating clients moving through periods of significant change. Because change is an inevitable part of life, it is important for clinicians to understand how to support clients through major life transitions in meaningful and beneficial ways.
Among other resources, the Kentucky Society for Clinical Social Work hosts peer supervision and support for clinicians through a monthly group, where counselors may seek advice for treating clients through major life transitions.

--Peyton Fisher, MSW




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​A 2023 Gender and Politics study by PRRI found that half of Americans feel strongly that there are only two genders. Science, and the diverse experiences of intersex individuals, tells us otherwise. Experts estimate that up to 1.7 percent of people are born with intersex traits, meaning their biological sex does not neatly fit into typical definitions of either male or female.
While we generally think of female as a genetic “XX” and male as “XY,” there are many variations in chromosomal combinations, hormonal patterns, reproductive organs, and anatomy. So far, medical professionals have identified over 40 intersex variations, with more being discovered as science advances.
For many years, the medical community has defaulted to involuntary “corrective” surgeries for intersex infants and children, conducting non-lifesaving procedures to change natural variations in genital appearance or reproductive anatomy. The United Nations Office of the High Commissioner for Human Rights supports bans on these types of surgeries.
According to the Trevor Project, mental health challenges among intersex youth are disproportionately high compared to LGBTQ youth who are not intersex. interACT, an advocacy organization for intersex youth, has a great resource for therapists that underscores the person-centered and strengths-based approaches that are integral to social work, while providing additional context on lived experiences.
For more context on individual experiences, the documentary Every Body (2023) tells the stories of three intersex individuals and discusses the harmful physical and mental effects of these surgeries. Additionally, intersex activist Pidgeon Pagonis published a memoir last year, Nobody Needs to Know.
It's important for social workers to understand this context as we advocate for the dignity and worth of each person, and their right to self- determination. Whether we are working with clients with intersex traits, or with parents as they navigate caring for a child who is intersex, we need to be aware that individuals who are intersex face unique challenges.

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
[email protected]