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:
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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.

The holidays can be triggering for many individuals. A time that can bring joy and laughter to some may bring tears and sadness to others. The holidays can be triggering for some individuals. How can we help our clients during these times:

1. Help your clients make a plan for the holidays. Identify possible triggers or stressors, coping/adaptive skills, and individuals they can reach out to when feeling triggered.
2. Have your clients identify a "roadmap" of at least 3 things they can look forward to during the upcoming month (these can be small things). Be willing to be creative with identifying these.
3. Teach clients how to set boundaries with unhealthy family members or friends. Teach them how to say "no" to prevent feeling overwhelmed or burnt out.
4. Normalize that it is okay to not always feel happy and excited about the holidays.

Helping connect clients with supports in an important part of preparing for the holidays. Some resources include:

https://mhanational.org/blog/looking-support-during-holidays-check-out-these-free-resources

https://onlinecounselingprograms.com/resources/mental-health-resources-holidays/

https://www.thetrevorproject.org/

Don't forget to take care of yourself and utilize self care techniques!

Policy affects practice
The NASW said it best, the social work profession was founded in social change. Social workers are there for those who need it. They are the public's biggest advocates in times of need. They also see the effects of law every day in practice, and those who endorse the laws can be moved by the important stories social workers have to tell. 
Why is law important to know? 
Social workers help all kinds of people. They assist in adoption, therapy, poverty, addiction, unemployment, disability, abuse, discrimination, and so much more. All these things that they help with, have laws that are attached. 
Being involved with legislative action keeps social workers up to date on current issues and issues to come. Being engaged in legislative action also prepares them to better serve their clients. They can help shape policy and help constituents by working with federal, state and local agencies to get individual appropriate assistance. For social workers to help change law, it is important for them to stay current on laws. 
If social workers want to create new policies, it is best to first understand why existing policies were developed. They can then be able to identify problems in these policies, find ways policies could be improved, and design solid proposals to help move towards change. In the end, these changes can help all people and improve humanity. 

How do social workers advocate for policy change?
Social workers can interact with their communities to learn more about the challenges they face. They can then raise awareness about those issues by educating everyone, from the lawmakers to nonprofit groups and empower community members to advocate for policy change. Social workers can also go to their elected officials and working within their agency to make a change.

To get policy updates, go to:
http://www.socialworkers.org/Advocacy/Policy-Updates 
To see policy issues, go to:
https://www.socialworkers.org/Advocacy/Policy-Issues 
To stay informed, act, or to get legislative alerts from the NASW to:
https://www.socialworkers.org/Advocacy/Legislative-Alerts 

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It is that time of the year again. A time where you, the sovereign individual, can express any concerns or support of ideas through way of voting. Fortunately, voting turnout has reached record-breaking numbers in the past few years. In the U.S. 2020 general election, upwards of 158.4 million people voted, amounting to about 62.8% of people of voting age (Desilver, 2022). That marks the largest voter turnout in U.S. history, and Kentuckians did their part. With over two million Kentuckians doing their civic duty, the state saw the highest number of voters in a Kentucky election (Shreve, 2021). So, it is evident we are all doing our part in the U.S. general election, but what about voting for our local representatives? Unfortunately, for this year's primary election, the unofficial turnout for the state only reached 19%, which was short of the 31% turnout we had for the 2020 primaries (Watkins, 2022). 
Luckily, we have another chance. The general election in Kentucky is Tuesday, November 8th. This is our last chance of the year to cast our vote and fight for what we believe in. A common theme amongst people who do not vote is that their vote will not matter or that their lives will not be affected whether they vote or not. This thought could not be further from the truth. If you decide not to vote, you simultaneously decide not to have a voice. The consequences will affect your job, family, healthcare, and overall way of life. Use your freedom. Use your right. Moreover, use the most essential tool any human has at their disposal, their voice. And use it by going out to vote!
Voting Deadlines

• Early voting (in-person absentee voting) is Nov 3-5
• In-person is November 8th.

Resources

• Find your polling location: https://elect.ky.gov/Voters/Pages/Polling-Locations.aspx 
• Candidates running for open positions: https://www.ballotready.org/ky 
• Learn about local issues (to Lexington): https://www.civiclex.org/ 
• Voter guide: https://www.kentuckyelection.org/  

References
Desilver. (2022, November 1). Turnout in U.S. has soared in recent elections but by some measures still trails that of many other countries. Pew Research Center. Retrieved from https://www.pewresearch.org/fact-tank/2022/11/01/turnout-in-u-s-has-soared-in-recent-elections-but-by-some-measures-still-trails-that-of-many-other-countries/ 

Shreve. (2021, January 14). 2020 Saw Kentucky’s Highest Voter Turnout Ever. 2020’s Record-High Kentucky Voter Turnout. Retrieved from https://spectrumnews1.com/ky/louisville/news/2021/01/14/kentucky-2020-election-turnout-highest-ever 

Watkins. (2022, May 19). Voter turnout figures are in for Kentucky’s primary. Here’s how they compare to past years. The Courier-Journal. Retrieved from https://www.courier-journal.com/story/news/politics/2022/05/19/kentucky-primary-election-2022-how-voter-turnout-compares-prior-years/9826730002/ 

Vote “NO” November 8th!
Right now, abortions are not currently being performed in Kentucky except for medical emergencies because the Supreme Court struck down Roe v. Wade earlier this year. Pro Choice groups have filed lawsuits stating that the ban is unconstitutional, but the
Supreme Court will not even hear the case until November 15th, which is after the election.

The right to abort should be between the patient and the provider, not the governments and politicians decision. Some may not see it, but abortion is absolutely part of health care. Women's health should be for theirs to decide. No one should be allowed to make
that decision for them and their health.

In 2021, 34 girls, ages 15 and younger received abortions because of first degree rape. Why would someone force a child to raise a child? The thought is imaginable! The wording on the ballot will ask if you’re in favor of amending the state constitution. The question will be at the end of the ballot. This is how the question will appear:

“Are you in favor of amending the Constitution of Kentucky by creating a new Section of the Constitution to be numbered Section 26A to State as follows: To protect human life, nothing in this Constitution shall be construed to secure or protect a right to abortion or
require the funding of abortion”

So, if you vote “no” it means you do not support the proposed changes.
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Vote for reproductive freedom, vote “NO” on 2!

Why Is This An Important Topic? 
Currently, there are 2.3 million people incarcerated in our jails and prison systems. The United States incarceration rate is more than 7 times the average in European Union countries. The best available data suggest that about 84,000 individuals endure extreme conditions of isolation. Solitary confinement is extremely bad for a person's mental and physical health. Correctional officials often defend their frequent use of solitary confinement as an effective means of maintaining order and preventing violence and gang activity but, relying on solitary confinement ignores the large number of studies demonstrating the harmful and often long-lasting effects it wrecks on the human mind and body. Usually, when the incarcerated individual gets out of jail or prison, usually they are worse off mentally, than when they went in. 

Effects Of Solitary Confinement 
Researchers and formerly incarcerated people made it clear that any “positive” benefits correctional institutions gain by using solitary confinement are outweighed by the severe and often permanent damages caused by prolonged isolation. Even if someone does not enter solitary confinement with a mental health condition, it is possible for them to develop a specific psychiatric syndrome from the effects from the isolation. Solitary confinement also increases the risk of premature death after they get released. Deaths by suicide, homicide, or opioid overdose after being released from prison are more likely for those that spent any amount of time (even one day) in solitary than those who never did. Prisons, juvenile systems, and jails are already inherently harmful, and placing people in solitary confinement adds an extra burden of stress that has been shown to cause permanent changes to people’s brains and personalities. Also, people who experience solitary confinement are more likely to develop anxiety and depression along with physical damage such as vision loss, chronic pain, and fractures. Solitary confinement does not help anything or any situation, in fact it does the opposite. Solitary confinement increases violence, causes more behavior problems, and increases institutional and public safety. 

What Can We Do? 
Go to https://socialworkersasc.org (Social Workers Against Solitary Confinement Website) and join the task force, and participate in the monthly call to see how you can help!
Go to https://solitarywatch.org/ ,which is the National Solitary Confinement Watchdog Group and review the information about legislative campaigns in your state. 

With help and support, we could end solitary confinement and help save lives and mental health. Lets advocate for those who cannot advocate for themselves!

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Yes, you read that correctly. How is it possible that in 2022, there are still laws not only allowing but protecting the practice of conversion therapy? Aside from this being true, it is also preposterous and appalling beyond belief. According to Ban Conversion Therapy Kentucky, a nonpartisan movement dedicated to protecting the youth from the tortures of conversion, more than 700,000 LGBTQ people have been affected by the terrors of conversion therapy. In addition, around 80,000 LGBTQ youth will undergo this unethical and improper therapy in the coming years.

Long Lasting Effects of Conversion Therapy
The attempt at changing a person’s sexual orientation or gender identity by shaming tactics, causing emotional trauma, or in many cases, causing actual physical pain in the individual, so that they associate those feelings with their LGTBQ identities leaves lasting effects. Ban Conversion Therapy Kentucky cites that in 2009, the American Psychological Association found that risks of conversion practices include “depression, guilt, helplessness, hopelessness, and suicidality,” amongst many other adverse effects. More shockingly, “42% of youth who experienced conversion therapy report suicide attempts” (Trevor Project National Survey on LGBTQ Youth Mental Health, 2019).

What We Can Do Today to Help
Aside from holding no empirical evidence of success, having no support from the nation’s leading professional mental health associations, and being downright unethical, some progress has been made in the battle to ban conversion therapy in Kentucky. The “Youth Mental Health Protection Act,” or Senate Bill 137 (SB 137), has made its way to the Health and Welfare Committee in the Senate. Governor Andy Beshear endorsed SB 137 and its companion bill in the House (HB 12). While good progress is being made in the Senate, according to QueerKentucky.com, there are three easy ways you can help in this effort:

1. Call 1-800-372-7181 to contact Senators on the Health and Welfare Committee saying you support Kentucky’s kids and SB 137.
2. Call 1-800-372-7181 to leave a message for House leadership asking for HB 12 to be assigned to a committee.
3. Follow BCTK (Ban Conversion Therapy Kentucky) on social media to stay updated with  all the new developments and learn more about the names of House and Senate members who have co-sponsored the legislation.

Social Workers take care of people all day long. There are many ups and downs involved in this career. Social workers work with patients and clients in a variety of settings to help them handle, solve, and cope with both everyday problems and more serious problems that they encounter in their lives. While some clients may face joyous situations, such as adopting a child, many seek
the help of a social worker to assist them during times of hardship. Social Workers may feel burnt out over time because as they take care of everyone else's needs, they may neglect their own needs.

If a Social Worker is burnt out or has compassion fatigue, then the client sufferers as well. A professional in social work stated that, “As social workers, we really do often put the needs of others before our own, thinking we will eat after everyone has gotten enough food. The problem is we continue to go undernourished until we fall ill or breakdown; then no one gets fed,”. Self care is important for Social Workers to implement into their daily lives.

Here are some self care suggestions:
● Create a self care plan that is designed for you.
● Make sure to get plenty of rest, eat nutritionally, and go on occasional walks.
● Leaning on trusted others for support.
● Paying attention to when your body signals you to slow down and listening to it, and not pushing yourself to the point of breakdown.
● That simple word, “no” is both rare and powerful, an expert notes. “Self-care means
saying yes when you mean yes and no when you mean no, and letting the chips fall where they may. It’s a matter of evolving out of being a people pleaser and learning to set healthy boundaries to be better able to serve the greater good”.
● Ask for help when needed and accept the help!

Social workers help relieve people's suffering, fight for social justice, and improve lives and communities. Remember to take care of yourself, because after all, Social Workers are rockstars!

“Almost everything will work again if you unplug it for a few minutes, including you.”— Anne Lamott

Background 
It is estimated that over 2 million people have an opioid use disorder, which includes prescription pain medication containing opiates and heroin. For some people, rehab is not an option because it means putting their life on hold for a period of time, they would have to be away from their jobs, loss of financial security, being away from family, or other reasons. 

What is Medicated Assisted Treatment? 
Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Using a combination of therapy and medicine is a great way to overcome substance abuse disorder. Drug usage and mental health go hand in hand and combating these two together makes for a very successful outcome and help people sustain recovery. MAT is also used to prevent or reduce opioid overdose. 

How Does MAT Work? 
MAT is primarily used for the treatment of addiction to opioids such as heroin and prescription pain relievers that contain opiates. The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative and euphoric effects of the substance used. For some, it is hard to all of a sudden become abstinent from drug use. MAT uses progress and success by small improvements, to big improvements. For instance, if a drinker normally has 10 drinks, and with MAT they only have 5, that is a successful implementation of the harm reduction treatment/MAT. Medicated assisted treatment has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services for these individuals. MAT provides a more comprehensive, individually tailored program of medication and behavioral therapy that addresses the needs of most patients. 

Successes of MAT 
There is huge success when it comes to medicated assisted treatment. People gain control of their lives, improve employment opportunities, decrease illicit opiate use and other criminal activity among people with substance use disorders, and are more productive in their daily living. MAT also helps with successful birth and pregnancy outcomes among women who have substance use disorders while pregnant. Research shows that these medications and therapies can contribute to lowering a person’s risk of contracting HIV or hepatitis C by reducing the potential for relapse. There are so many benefits of medicated assisted treatment, not only are lives saved, but lives are changed! 

What are your thoughts about medicated assisted treatment? 
Do you know someone who did MAT and had a success story? 

To find treatment facilities confidentially, 24/7, please call 1-800-662-4357 (HELP)

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