What Do I Need to Know?

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CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency

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HB 980 (Fierro) has been left pending in the House Insurance Committee since April 13th.

 

This bill would provide parity in reimbursement for telehealth services with in-person therapy.

 

PLEASE CALL/EMAIL THE MEMBERS OF THE HOUSE INSURANCE COMMITTEE

requesting that a vote be taken in the Insurance Committee to pass this bill out of committee favorably.

 

House Insurance Committee:

Chair   Tom Oliverson (R) Cypress   512 463-0661   tom.oliverson@house.texas.gov 

Vice Chair   Hubert Vo (D) Houston   512 463-0568  hubert.vo@house.texas.gov 

 

Members:

Jessica Gonzalez (D) Dallas   512 463-0408   jessica.gonzalez@house.texas.gov 

Lacey Hull (R) Houston   512 463-0727   lacey.hull@house.texas.gov 

Celia Israel (D) Austin   512 463-0821   district50.israel@house.texas.gov 

Mayes Middelton (R) Wallisville   512 463-0502   mayes.middleton@house.texas.gov 

Dennis Paul (R) Houston   512 463-0734   dennis.paul@house.texas.gov 

Ramon Romero (D) Fort Worth   512 463-0740   ramon.romero@house.texas.gov 

Scott Sanford (R) McKinney   512 463-0356   scott.sanford@house.texas.gov 

 

Thank you for advocating for your clients.

We at CSWA collectively breathed a sigh of relief yesterday as the guilty verdicts for ex-officer Derek Chauvin were read by the judge. We acknowledge the monumental task of the prosecution team, the on-going protests by people around the world, each sign posted on a lawn or in a window, each hashtag crying for justice for George Floyd. This decision, after years of police murders of Black and Brown people with no accountability, is one to celebrate. The guilty verdicts serve many purposes; they break the long-standing policy of acquittal for police who have murdered Black and Brown people.  They affirm what was a matter of fact – that George Floyd’s life was taken without cause. They provide a way forward that is necessary in dismantling unjust, rogue policing that has created a justifiable mistrust in institutions we all should feel protected by.

 

CSWA stands in support of these verdicts.  We consider it the duty of all citizens, and clinical social workers in particular, to repudiate institutionalized racism and support policies that further encourage police accountability. One such potential law is the George Floyd Justice in Policing Act of 2020 introduced in June, 2020, passed by the House last month. A summary of H.R. 7120 is listed below.

 

This bill addresses a wide range of policies and issues regarding policing practices and law enforcement accountability. It includes measures to increase accountability for law enforcement misconduct, to enhance transparency and data collection, and to eliminate discriminatory policing practices.

The bill facilitates federal enforcement of constitutional violations (e.g., excessive use of force) by state and local law enforcement. Among other things, it does the following:

• lowers the criminal intent standard—from willful to knowing or reckless—to convict a law enforcement officer for misconduct in a federal prosecution,

• limits qualified immunity as a defense to liability in a private civil action against a law enforcement officer or state correctional officer, and

• authorizes the Department of Justice to issue subpoenas in investigations of police departments for a pattern or practice of discrimination.

 

H.R. 7120 would also create a national registry—the National Police Misconduct Registry—to compile data on complaints and records of police misconduct. It establishes a framework to prohibit racial profiling at the federal, state, and local levels.

 

Finally, H.R. 7120 establishes new requirements for law enforcement officers and agencies, including to report data on use-of-force incidents, to obtain training on implicit bias and racial profiling, and to wear body cameras.  CSWA will be advocating for passage of this bill.

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Today the Department of Justice has announced a full investigation of a “possible pattern of misconduct” of the Minneapolis Police department. CSWA welcomes this investigation and hopes it will be one step forward, with many more needed, in the fight for a socially and racially just America.

 

Kendra Robeson, LICSW, President 
Clinical Social Work Association 
president@clinicalsocialworkassociation.org

The project sponsored by Department of Defense and Council of State Governments to create an interstate compact for clinical social workers is moving along.  CSWA is one of the three main stakeholders. The formal kickoff will be on May 20 at 2 pm EDT. 

 

All CSWA members are invited to attend.  This meeting is informational but will be helpful in giving an overview of how the project will move forward.

 

The event is free but you must register which you can do at https://csg-org.zoom.us/meeting/register/tZUqdOqqpz8jE9JjZpkwTn2_gHKIuCbtRmpN

 

To see the original announcement of the event go to https://www.defense.gov/Newsroom/Releases/Release/Article/2537098/dod-receives-approval-for-grants-to-develop-interstate-compacts-for-licensure-p/

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HB 2670 (Gullian)   related to adding social workers for the Texas Heroes Program which provides for down payment assistance.

TO BE HEARD TODAY APRIL19th on HOUSE Floor

 

HB 140 (Rose)   related to exempting individuals experiencing a psychotic episode from the death penalty

TO BE HEARD TODAY APRIL19th   House Criminal Jurisprudence Committee

 

Chair  Nicole Collier (D) Ft Worth  512 463-0716   nicole.collier@house.texas.gov    

Vice Chair  Keith Bell (R) Forney  512 463-0458   keith.bell@house.texas.gov 

Members:

Jeff Cason (R) Bedford   512 463-0522   jeff.cason@house.texas.gov 

David Cook (R) Mansfield   512 463-0374   david.cook@house.texas.gov 

Jasmine Crockett (D)  Dallas   512 463-0586   jasmine.crockett@house.texas.gov 

Gina Hinojosa (D) Austin   512 463-0668   gina.hinojosa@house.texas.gov 

Ann Johnson (D) Houston   512 463-0389   ann.johnson@house.texas.gov 

Andrew Murr (R) Junction   512 463-0536   andrew.murr@house.texas.gov 

Cody Vasut (R)  Angleton   512 463-0564   cody.vasut@house.texas.gov 

 

HB 706  (Moody)   related to alignment of reimbursement for all mental health providers within Medicaid.  Currently LCSWs are reimbursed at 70 % of the rate paid to Psychologists...AND

would allow LMSWs/LPC  Associates/LMFT A  Associates to bill Medicaid for psychotherapy.

LMSWs would have to be under supervision for the LCSW license.

HEARING TUESDAY APRIL 20th in the House Human Services Committee

 

Chair   James Frank (R)  Wichita Falls   512 463-0534   james.frank@house.texas.gov 

Vice Chair Gina Hinojosa (D) Austin  512 463-0668   gina.hinojosa@house.texas.gov 

Members:

Lacey Hull (R)  Houston  512 463-0727   lacey.hull@house.texas.gov  

Stephanie Klick (R) Ft Worth 512 463-0599   stephanie.klick@house.texas.gov 

Thresa Meza (D) Irving  512 463-0641  terry.meza@house/texas.gov 

Victoria Neave (D) Dallas  512 463-0244  victoria.neave@house.texas.gov 

Candy Noble (R) Lucas  512 463-0186  candy.noble@house.texas.gov 

Toni Rose (D)  Dallas  512 463-0664   toni.rose@house.texas.gov 

Matt Shaheen (R)  Plano  512 463-0594   matt.shaheen@house.texas.gov 

 

HB 4   related to extension for telehealth including audio-only for state insurance plans and Medicaid

PASSED THE TEXAS HOUSE and REFERRED TO THE TEXAS SENATE for assignment to a Senate Committee

 

HB 980   related to parity in reimbursement for telehealth.

Hearing April 13 House Insurance Committee   Pending

 

SB 29 (Perry)   related to the participation by students in UIL activities and prohibiting transgender youth from competition except as indicated by their biological sex listed on birth certificate.

PASSED THE TEXAS SENATE and REFERRED TO THE TEXAS HOUSE for assignment to a House Committee

 

Please call or email the members of the committees regarding your Support/Concern for these bills.

 

THANK YOU FOR ALL YOU DO FOR YOUR CLIENTS

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/)

Action is Needed Today

 

HB 980 by Fiero is being heard in the House Insurance Committee tomorrow Tuesday April 13th.  This bill would support parity for TDI regulated plans.  This is especially important because it would provide for the same level of reimbursement for telehealth as for in person services.  There are other bills filed which would mean less reimbursement for telehealth than in person services.

 

Please call or email the House Insurance Committee {listed below} 

     

Tell them that you are a licensed clinical social worker and you are in support of HB 980 by Representative Fiero as it would provide for the same level of reimbursement for telehealth services as for in person mental health services.  This would continue to provide needed mental health services though telehealth for those persons who have difficulty coming into a health care provider's office.

     

Governor Abbott's emergency orders have ensured that mental health and substance services are available through telehealth since the beginning of the pandemic.  HB 980 would provide for both telehealth and in person services to continue to be reimbursed fairly.

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House Insurance Committee

Chair     Tom Oliverson (R) Cypress   512 463-0661   tom.oliverson@house.texas.gov 

Vice Chair   Hubert Vo (D) Houston   512 463-0568   hubert.vo@house.texas.gov 

Members:

Jessica Gonzalez (D) Dallas   512 463-0408   jessica.gonzalez@house.texas.gov 

Lacey Hull (R) Houston   512 463-0727   lacey.hull@house.texas.gov 

Celia Israel (D) Austin   512 463-0821   celia.israel@house.texas.gov 

Mayes Middleton (R) Wallisville   512 463-0502   mayes.middleton@house.texas.gov 

Dennis Paul (R) Houston   512 463-0734   dennis.paul@house.texas.gov 

Ramon Romero (D) Fort Worth   512 463-0740   ramon.romero@house.texas.gov 

Scott Sanford (R) McKinney   512 463-0356   scott.sanford@house.texas.gov 

 

Thank you for advocating for your social work clients!

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Questions?

Please call TSCSW Governmental Affairs Chair, Kathy Rider at (512) 921-0127

CSWA Tapped to Work With DOD to Develop an Interstate Compact for Licensing Portability

 

We are delighted to inform you that we will be working with the US Depa­­­­­­rtment of Defense, National Center of Interstate Compacts and other key social work stakeholders to establish clinical social work reciprocity across states.  This effort has become increasingly important as we work utilizing telemental health; the requirement that we be licensed in the state where the patient is located is burdensome and amounts to restraint of trade.

 

Below is the message that CSWA received today from the US Department of Defense:

 

We are excited to inform you that the U.S. Department of Defense has selected your profession to receive technical assistance from The Council of State Governments to develop an interstate compact for occupational licensing portability. Based on the applications received from three organizations representing social work, DoD believes the Association of Social Work Boards is best suited to lead compact development efforts on behalf of the profession.  

 

However, we believe that CSWA will be a crucial stakeholder in developing a compact for social workers. CSG would like to invite representatives from CSWA to join the compact technical assistance group that will engage in compact development activities jointly with ASWB and other social work regulatory stakeholders.  

Thank you for your commitment to removing barriers to multistate practice for licensed practitioners. We will be in touch in the coming days to set up a call with our team at CSG. Please do not hesitate to reach out if you have any questions. 

 

Sincerely, 

National Center for Interstate Compacts 
The Council of State Governments 
1776 Avenue of the States, Lexington, KY 40511 

 

CSWA will keep you informed on the progress of this helpful project.

 

Kendra C. Roberson, PhD, LCSW | President & Education Committee, Social Work Consultant 
president@clinicalsocialworkassociation.org

 

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

Timely News From Our Affiliate CSWA

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Below is an excellent summary of the legal protections for telehealth services, including behavioral health treatment, in all 50 states and District of Columbia (seven states do not have laws about telehealth coverage - AL, ID, PA, NC, SC, WI, WY) put together by the law firm of Foley and Lardner. 

 

The link can be found here. 

 

The areas covered include state laws about coverage for telehealth and audio-only treatment; reimbursement requirements; how long coverage will last; the actual language of the laws in each state; and more. 

The Texas Behavioral Health Executive Council Approves Three Rule Changes Proposed by the Texas State Board of Social Work Examiners

 

The Texas State Board of Social Work Examiners (TSBSWE) met on January 5th, 2021.

They voted on and approved rule changes which had been previously published in the Texas Register for public comment on November 13, 2020 and December 4, 2020.  These rules addressed Licensing of Persons with Criminal Convictions (781.420); Supervision plans for clinical and non-clinical supervision (781.102;  781.302;  781.401;  781.402;  781.404;  781.406); Severity Levels within Standards of Sanctions (781.803); and the Reporting of Changes in Employment Settings (781.805).  These rule changes were sent to the Texas Behavioral Executive Council (BHEC) for their approval at their meeting on January 12, 2021. TSBSWE also discussed the Alternative Method of Examining Competency which was a program previously available to persons who had not passed the licensing exam three times.

 

Licensing of Persons with Criminal Convictions

The Licensing of Persons with Criminal Convictions was changed to reflect current statute as to eligibility for licensure.  

 

Supervision Plans

Supervision Plans will no longer require preapproval of a supervision plan in order to accrue supervised experience required for the issuance of a license as a clinical social worker (LCSW) or for independent practice recognition for a baccalaureate social worker (LBSW) or a master social worker (LMSW).  Supervised experience will still be required, at the same requisite level that is currently in place, BUT no preapproval of the practice site will be required. The documentation of the supervised experience will now only be submitted to BHEC when the licensee is applying for either the LCSW license or for the independent practice recognition. THEREFORE, do not send your supervision plan to TSBSWE or BHEC for pre-approval.  This is RETROACTIVE.  If you have already sent a supervision plan for pre-approval you can begin your supervision now.  

 

Change of Address Requirements

There is no longer a requirement to notify TSBSWE or BHEC of a change of address related to employment settings.

 

If you want to read these rule changes you can go to either the TSBSWE site and click on the materials for the January 5th meeting OR go to the BHEC site and click on the materials for the January 12th meeting.

 

Reminders: 

• Can renew online

• Must complete the free Human Trafficking Course before renewal

• Beginning February, you must do an in person fingerprinting.  When you submit your renewal, instructions will be sent as to how to complete the fingerprinting requirement

 

BHEC

The Texas Behavioral Health Executive Council met on January 12th and approved the  rules forwarded to BHEC by TSBSWE.

 

The Request for an Attorney General's Opinion as related to whether or not BHEC can make rules related to Code of Conduct for the four behavioral health boards has been submitted and the AG's office will respond in the next 180 days.

 

The 87th Texas Legislature

The Texas Legislature convened for 140 days at Noon on January 12th.

There are several bills that were pre-filed pertaining to school social work, expansion of Medicaid, parity with reimbursements for Medicaid and conversion therapy.  Stay tuned.

Texas Behavioral Health Executive Council Released New Information About License Renewals

 

The Texas Behavioral Health Executive Council voted to discontinue printing and mailing renewal permits at its October 27, 2020 regular meeting. This decision was made in-part because licensees are no longer required to display a renewal permit alongside their license and because the information contained in renewal permits is now available through the Council’s online license verification system. 

 

Beginning November 16th, the Council will no longer print or mail renewal permits when licensees renew their license. Licensees may verify whether their license has been renewed through the Council’s online verification system and print out the status of their license if proof is needed, e.g. to submit to an insurance company. The information available through the online verification system is both accurate and based upon agency records, and is considered primary source verification.

Lastly, licensees can still order a renewal permit through the Council’s online licensing system, if they so desire. The cost for ordering a renewal permit is $10.

The Texas State Board of Social Work Examiners (TSBSWE) on Monday, October 12, 2020, in a joint mtg with the Behavioral Health Executive Council (BHEC) approved the proposed rules which had been previously published in the Texas Register with public comment for 30 days.                                                                                                                       

Additionally an unexpected recommendation came on Friday afternoon the 9th from the Governor's office requesting the removal of protection against discrimination by a licensee from the Social Work Code of Conduct regarding "sexual orientation; gender identity and expression".  The reasons for this recommendation is not known.  It was ruled by the Attorney General's office that this recommendation was not a substantive change and therefore the rule change does not have to be posted in the Texas Register.  The TSBSWE voted to approve the recommendation with the rules which had been posted in the Texas Register.                                                                                                                             

After hearing public comment, Chair Conseco of BHEC added this rule change to the BHEC meeting agenda for October 27th.  The Governor's Office indicated that this recommendation to change this rule was based on the premise that agency rules cannot be more expensive than what is in state law.                                                                                                                            

Chapter 505 of the Texas Occupations Code authorizes TSBSWE to promulgate rules regarding the ethical delivery of social work in Texas.

 

The current Code of Conduct (781.201), prior to the change on Monday, read 

  (1) A social worker shall not refuse to perform any act or service for which the person is licensed solely on the basis of a client's age; gender; race; color; religion; national origin; disability; sexual orientation; gender identity and expression; or political affiliation.

 

The Texas Society for Clinical Social Work (TSCSW) strongly objects to this action by the TSBSWE removing protections against discrimination by social work licensees for disability, sexual orientation, gender identity and gender expression from the Social Work Code of Conduct.

 

The Mental Health Coalition, which includes TSCSW, NASW/Texas, Texas Counseling Association, Texas Association for Marriage and Family Therapy, and Texas Psychological Association, has also expressed their concern and dissatisfaction with this rule change.  A similar rule change was made earlier this year in the rules related to licensed professional counselors.  BHEC may have the authority to establish a non-discrimination rule for all member boards.  However, rule proposals originate with the member boards of BHEC.

 

Now is the time for all social workers to advocate on behalf of our clients. Legal regulation exists for the protection of the consumer and the public. We need to be the voice for our clients on this important issue.

 

If you would like to view the proceedings of the joint October 12th meeting of TSBSWE and BHEC, you can view it on https://youtu.be/DvrnvUF283E.  The discussion on the Governor's recommendation begins at the 25:38 mark.

 

You can contact the Governor's office (https://gov.texas.gov/contact) and share your concerns about this recommendation and change to the Social Work Code of Conduct.

 

You can contact your Texas State Senator and Texas State House Representative to share your concern and opinion.  You may call their office or email here  https://www.texastribune.org/directory/  

 

Also, you can give public comments at the Tuesday October 27th BHEC hearing. This meeting has not been posted yet.  However, if you scroll to the bottom of this page

https://www.bhec.texas.gov/index.html  you can sign up for updates from BHEC.

The October 27th BHEC meeting will be a virtual meeting so your opportunity to speak will be on Zoom. 

 

TSCSW will send another practice alert as the meeting information becomes available.  For more information, please contact Kathy Rider, LCSW, BCD, the TSCSW Governmental Affairs Chair, at (512)921-0127. 

Payment Parity For Telehealth

 

Austin - Governor Greg Abbott announced that Texas' major health insurers have agreed to continue reimbursing network health care providers for telehealth appointments at the same rate which they pay for office visits through the end of 2020.  While the agreement applies only to state-regulated plans, both the Employee Retirement System and the Teacher Retirement System will continue telehealth payment parity through the end of the year as well.

 

"Since the COVID-19 pandemic began, the State of Texas has expanded telehealth options and availability so that Texans can continue to access the health care services they need", said Governor Abbott.  "Millions of Texans have chosen to use telemedicine over the past several months, and this new agreement with Texas network health insurers will help ensure that Texans can continue utilizing telehealth options.  I thank the health plans for stepping up to meet the needs of our state during the COVID-19 pandemic."

 

Telehealth allows patients to receive health care services in a location separate from their provider through virtual and other technological communications platforms.  According to a new study by Accenture, an estimated 4.5 million Texans have begun using virtual healthcare services since the onset of the COVID-19 pandemic.

Important Message from the Clinical Social Work Association Regarding Medicare Reimbursement Rates

 

On September 16, you should have received a Legislative Alert to members of Congress regarding the proposed cut to Medicare reimbursement for LCSWs scheduled for January 1, 2021.  Many thanks to the hundreds of members who have sent these messages.  If you have not done so, it is not too late.  While the issue of Medicare cuts is being opposed in the House through Rep. Rush’s letter, it is fine to send your message to Senators as well.  All messages must be sent by October 5, 2020.

Now I am asking you to send another message directly to CMS (Centers for Medicare and Medicaid Services), the organization that oversees reimbursement rates for all Medicare providers, including LCSWs.  Both messages are necessary to make our position on this issue clear by October 5, 2020.  Send the following message (use your own words if you like) to the following

 

https://www.federalregister.gov/documents/2020/08/17/2020-17127/medicare-program-cy-2021-payment-policies-under-the-physician-fee-schedule-and-other-changes-to-part

 

“I am a Medicare provider [if you are] and wish to express my concern about the proposed rate reduction for Clinical Social Workers set to begin on January 1, 2020.  Clinical Social Workers are already paid 25% less than other mental health providers for the same CPT Codes as other mental health providers. Though some psychotherapy CPT codes have increased, the 10.6% cut will result in a net reduction of about 7%.  My fixed costs have not changed and I cannot afford this reduction in my fees for my mental health services.  The onslaught of COVID-19 has increased the need for mental health services.  Please make it possible for me to continue to provide them by eliminating the proposed Medicare reimbursement cut.”

Medicare Reimbursement Rates Threatened

 

There is a proposed cut to Medicare reimbursement for many health care providers, including LCSWs, scheduled for January 1, 2021.  This 7% cut is connected to Evaluation and Management services, for diagnostic and treatment services that LCSWs provide.  It is imperative that all LCSWs contact their members of Congress as soon as possible to let them know how damaging this would be for LCSWs.

We are fortunate to have the support of Rep. Bobby Rush (D-IL) and 93 members of Congress in stopping this cut. 

 

Please check the letter they wrote to Congressional leadership at - https://rush.house.gov/sites/rush.house.gov/files/documents/Letter%20to%20Leadership%20on%20EM%20Code%20Cuts%20General.pdf  and thank your legislator if he or she signed on.

 

Even if you are not a Medicare clinician, please send the following message to your members of Congress at https://www.contactingcongress.org:

 

“I am a member of the Clinical Social Work Association, a Medicare provider [if you are], and a constituent.  Maintaining budget neutrality on the backs of clinical social workers and other mental health providers is a burden that I will not be able to bear.  I am already paid 25% less than other mental health providers for the same diagnostic and treatment services as other mental health providers.  My fixed costs have not changed. The onslaught of COVID-19 has increased the need for mental health services.  Please make it possible for me to continue to provide them by eliminating the proposed Medicare reimbursement cut.”