Questions about how to establish a telemental health practice as we address COVID-19

 

March 16, 2020

 

There have been many questions about how to establish a telemental health practice as we address COVID-19. Here are some ideas about what to consider.

 

1.       Take a course to understand the basic skills that are needed to provide 

telemental health videoconferencing. The TBHI Courses offered by Marlene

Maheu are excellent and can be found here.  There are many others, but Dr. 

Maheu has based hers in part on the ethical standards for clinical social

workers.

2.       Read the Technology in Social Work Standards, that CSWA helped develop, which can be found here .

3.       Find a platform to use for your videoconferencing work. There are several available but the ones that seem to be the best are VSee, Zoom, doxy.me (which has some service problems from recent reports), Simple Practice and Theranest. Most have a monthly charge. Some are more reliable than others. To see comparisons of the platforms, go to Rob Reinhardt’s website www.tameyourpractice.com .

4.       Find a payment method for videoconferencing. The ones that seem to be the best are Zelle and Paypal. Zelle is bank related and have privacy protections; you will need to get the patient’s bank account number. I believe Paypal will sign a BAA.

5.       Develop an Informed Consent form for videoconferencing. CSWA has developed a template which can be found at CSWA - Telemental Health Informed Consent - 3-20.docx .

6.       Check with all third party payers as to whether your patients will be covered for videoconferencing or telephonic sessions. Medicare patients await guidance from CMS and HHS which should be forthcoming in the next two weeks. If patients are not covered, see if arrangements for private pay can be made.

 

If you have any other questions, please let me know.

 

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair

Clinical Social Work Association

The National Voice of Clinical Social Work

Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

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March 15, 2020

 

Dear NASW Members,

 

There have been many questions about the status of the telemental health expansion of Medicare and private insurers as the COVID-19 crisis itself has rapidly expanded. Here is what CSWA knows so far.

 

The emergency bill signed on March 6 allows for an expansion of Medicare telehealth services of all kinds, once guidance from CMS and HHS is made available. There is no definite date when this will happen, but we hope to have it within two weeks. 

 

CSWA, NASW, and the American Psychological Association will be sending a letter to CMS and HHS tomorrow encouraging them to allow a temporary expansion for patients that we have been seeing within the past three years. The option that is currently being discussed per the March 6 bill is videoconferencing only, not telephonic sessions. Of course CSWA hopes that telephone sessions will be allowed as well, but it is unlikely that it will be as soon as videoconferencing is covered. It is a possibility that when videoconferencing is expanded by CMS, it will be retroactive to February, 2020.

 

As for private insurers, there is confusion about what they are willing to cover through videoconferencing and telephonically at this time. Most companies that offer coverage are doing it for in-network providers only, who must use a specific telemental health platform and accept the fee offered. This is generally less than LCSWs are used to being paid by these insurers for in-person sessions. Out-of-network providers may or may not have the option of being covered for videoconferencing or telephonic sessions. It is VERY important to check with any private insurers you have been reimbursed by, if you want to know the facts about their policies at this time.  Having patients call to find out what their policies are and request videoconferencing and/or telephonic coverage if necessary, is a good idea as well.

 

Another question is coverage for patients who live in a jurisdiction in which you are not licensed, for example, a patient has previously come to your office in Washington, DC, but lives in Maryland. You are licensed in Washington, DC, not Maryland, so would be practicing without a ;license if you treat the patient through videoconferencing while they are in Maryland. I recommend calling the Social Work Board in any state in which a patient resides in which you are not licensed, to ask what their policy is on videoconferencing with patients (or telephonic sessions) who reside there. Again, there may not be good solutions here if the state insists that you be licensed in the state in which the patient resides. Have patients call the Social Work Board in their state and ask for an exemption. 

 

Finally, there is the question of what to do if you have already moved to videoconferencing or telephonic sessions to protect you and your patients from becoming infected by COVID-19; it is problematic if you want to continue getting reimbursed by third party payers who currently do not cover videoconferencing. You can continue to provide sessions through videoconferencing with the hope that they will be covered eventually; take a break while this is sorted out; or make arrangements with patients to pay privately. None are ideal. 

 

I hope we will have some clarity on telemental health expansion soon and will keep you posted. This is a unique and troubling time for LCSWs, all mental health professionals, and our patients. CSWA will do everything possible to give us the ability to continue providing our needed services.

 

 

 

Have a Wonderful Day!

 

Diana Fergusson

NASW Washington Chapter

Coordinator of Professional Development and Administrative Affairs

4026 NE 55th St. Suite E-245

Seattle,WA 98105

206.706.7084

www.nasw-wa.org

 

Cancellations:

Suicide Prevention Workshop by Mark Hoagland on April 24, 2020

Dear Workshop Attendees,

 

Due to concerns about the COVID-19 coronavirus health, we are canceling the NASW-WA Suicide Prevention Workshop by Mark Hoagland on April 24, 2020. We got a message yesterday, from the Medical Director for Mental Health and Wellness at Kaiser Permanente in Renton that we need to cancel to minimize the risk of community spread. The King County Public Health Department is recommending that everyone, and especially people over age 60 and those with compromised immune systems, take extra precautions including postponing all non-essential meetings of groups over 10 people.

 

While we regret the need to make this decision, we are committed to community safety. We are very sorry for another change but with this outbreak we need to do our part!

 

Thank you very much for your ongoing support and understanding. We will be processing refunds in the next few days. Our chapter office is available to help answer your questions and concerns.

 

Sincerely,

 

Taylene Watson, Executive Director

NASW Washington Chapter

206.706.7084