COVID-19 Resources

The State of Washington hosts a clearinghouse

for COVID-19 related information at

www.coronavirus.wa.gov

NASW national hosts a page full of information

related to Coronavirus (COVID-19) resources for

social workers at:

https://www.socialworkers.org/Practice/Infectious-Diseases/Coronavirus

 

 

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Tell Us What You Think! NASW-WA Seeks Member Feedback 

 

Washington State Chapter of the National Association of Social Workers (NASW-WA) is a membership organization with a dual mission of enhancing the profession of social work and promoting diversity, inclusion and social justice. Over the last several months, the NASW-WA Membership Engagement Committee created a survey to gather information from our membership. Please take a few minutes to provide your Chapter leadership feedback about:

 

  • Continuing education preferences

  • Methods to promote connections

  • Support and representation in your professional life

 

Your feedback is important: Survey information that you provide will help inform and guide the activities and opportunities to meet Washingtonian social workers' needs during this unique time and space. Your responses are confidential and will be used by Chapter volunteer leadership and staff to develop an agenda for improving our commitment to the social work profession and our local communities.

 

Please click here to take the survey and provide feedback to NASW-WA.

 

We want to hear from you! Thank you for taking a moment to provide your input.

Jeremy Arp, MSW, ACSW

Executive Director

National Association of Social Workers - Washington Chapter

jarp.naswwa@socialworkers.org

www.nasw-wa.org

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Welcome Jeremy Arp!

We are excited to announce Jeremy Arp as the NASW-

Washington State Chapter’s Executive Director! 

The Board of Directors of the National Association of Social

Workers-Washington State Chapter is very pleased to

announce that Jeremy Arp will serve as the full time Chapter's

Executive Director, effective July 1, 2020!

 

Jeremy moved to Washington from Arizona in 2019. His

professional background includes positions with the State of

Washington, 8 years (2011-2018) as Executive Director for the NASW-Arizona Chapter, and service to the Arizona Governor’s Office administering grants and initiatives to enhance community responses to sexual and domestic violence and protections for immigrant victims of crime and their families. He taught social work policy and services as adjunct faculty for Arizona State University and the College of St. Scholastica (Mesa, Arizona campus).

 

Jeremy is a proud graduate of the Arizona State University School of Social Work, having earned a BSW and MSW (with a focus on policy/planning, administration and community practice). He is a past-president of the Arizona Society of Association Executives and a past board member for the Protecting Arizona Families Coalition, an advocacy organization that influenced public policy priorities for the betterment of health and human service funding for vulnerable communities.

 

He looks forward to serving the Washington Chapter as we continue to work to enhance the profession of social work and promote diversity, inclusion, and social justice during challenging times ahead.

 

Jeremy Arp will be a terrific addition and will allow us to continue to add value to NASW-WA Chapter services that you depend on.

 

Please join us in welcoming Jeremy to his new role with our chapter.

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Letter to Members: Policy Action Against Police Brutality

Dear NASW-WA Members,

To follow up on NASW-WA’s promise to pursue a more just society and create policy change in Washington state, we wanted to make a statement about the recent executive order put out by the president. NASW-WA believes that the order signed by the president on 06/17/2020 is a dreadfully inadequate attempt at whitewashing police reform and does not address the underlying causes of systemic racism in our country. The president was very open about his listening to police union voices over the voices of those who have felt the devastating effects of systemic oppression for over 400 years in this country.

 

NASW-WA believes that in order to achieve a truly just society, we must take much more decisive and drastic action. NASW-WA does not endorse NASW National’s apparent satisfaction with the executive order by the president, and we are disappointed that there has been little more done by National to push the White House to do more.

 

In order to further change in our own state, action from our members is needed. Given that NASW-WA’s primary advocacy role is with the state government, we find it necessary to seek out the voices of our members in individual communities around our state to advocate for change at the local level. You know your own communities most intimately AND know what it will take to make your local communities safe for EVERYONE, not just white residents.

 

With that, we ask your help in reaching out to your local municipal and county governments. NASW-WA seeks to lift up the voices of our black brothers and sisters, and to adopt the platforms for change that have been formally announced by organizations such as Not This Time, Black Lives Matter, and others. In doing so, we ask that you organize and advocate for the following NASW-WA endorsed policy changes in local police/law enforcement agencies:

 

● Reallocating funds within police budgets to add social workers and other

mental health professionals on the front lines;

● Making mandatory that there are an adequate number of social workers

embedded into every local law enforcement agency’s budget;

● Adopting an “exhaust all other options” policy when responding to 911 calls in the community;

● Enhancing mandatory crisis de-escalation training;

● Adding mandatory implicit bias training;

● Banning chokeholds;

● Banning “knee to neck” techniques;

● Creating a independently managed state registry for officer misconduct;

mandating all law enforcement agencies to search this registry before hiring any candidate; supporting due process for officers against whom complaints are filed

● Creating a process to decertify officers who are repeatedly found to have

committed misconduct

● Eliminating qualified immunity for officers and other police department

employees;

● Establishing independent inspectors general to conducts routine audits and

oversight of local law enforcement agencies;

● Banning the use of tear gas, other chemical irritants, rubber bullets, and flash-bang and other

explosive devices during protests and demonstrations;

● Creating a civilian led Office of Professional Responsibility that investigates

individual complaints against police; and

● Re-examining education requirements for officers to ensure the police

academies better prepare officers as community oriented and social justice minded.

 

Please reach out to your local authorities, and you may use the following message template:

 _____________________________________

 

Address of local government office you are writing to

 

Dear [Councilmember, Mayor, other local authority],

 

My name is [insert name] and I am a constituent of yours. I am also a member of the National Association of Social Workers, Washington State Chapter. As a social worker, I believe all people deserve to feel safe in our communities and treated with human dignity. I find the continued impact of systemic racism and police brutality on our communities of color to be a violation of these tenants and unacceptable. I demand the following changes to address systemic racism and police brutality in our community:

[insert policies of your choice from above]

[insert any other statements you would like to make as a constituent]

Your actions on these matters will weigh heavily on my decision when I cast my ballot in all future elections.

 

Sincerely,

[Insert Name, Credentials]

_____________________________________

 

Thank you all for your ongoing efforts in pursuit of equality and justice for everyone. Each member is so valuable in the promotion of human dignity in our society. Make sure your voice is heard. NASW-WA will be continuing to make our voices heard at the state level to ensure accountability of our state leaders to administer policies that uphold human dignity and social safety nets, while ensuring the safety that all Washingtonians deserve to feel in their communities.

 

Sincerely,

NASW-WA Chapter Legislative Action Committee

Garrett Hebel, MSW, LSWAIC, SUDP, Chair

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Lethal Force Against People of Color Must Stop

Social Work is rooted in human rights, social justice, and respect for diversity. It is with this lens that the Washington Chapter of the National Association of Social Workers condemns the latest in a long series of police killings – the death of George Floyd in Minneapolis at the hands of police officers -- and hopes to contribute to the work of both healing and of bending the long arc of the moral universe, as Dr. Martin Luther King noted, toward justice.

 

Many people across Washington are protesting Floyd’s death, mostly peacefully. But, pent up anger and rage in communities of color are understandable, and should not be the focus going forward. Instead, we need – and NASW-WA pledges – to work toward systemic change to address baked-in, systemic racism that causes unnecessary pain, suffering and death in communities of color.

 

Yes, economic loss from a small number of people who attach themselves to legitimate protests can be painful. But it is far from the pain caused by the loss of life and liberty that disproportionally falls on our brothers and sisters of color.

 

No mother should have to fear that her black son will not come home because he has been killed by police while simply living his life like any other American. No wife should have to fear her brown husband will die while simply jogging. No one should have to fear they will be shot and killed in their own home while doing nothing wrong, simply because they are not white.

 

And we cannot let the current outrage at the death of Mr. Floyd dissipate. We must continue to work to change the systems that allow this to happen.

 

Our chapter supported stronger police accountability laws championed by Not This Time. We have worked to help alleviate the poverty often caused by systemic racism and an inability to participate in society. We continue to call for economic and housing justice, in addition to equitable access to quality, affordable healthcare in this time of pandemic and quarantine. Furthermore, we will advance the call for social workers to examine our own implicit biases and call out racial bias and micro-aggressions in the administration of healthcare across our state. Our brothers and sisters from minority communities deserve to feel safe both receiving and providing the healthcare they access. 

 

In short, we want and strive for a more just society where we don’t have to mourn the deaths of people such as George Floyd, Philando Castile, Botham Jean, Breonna Taylor, Eric Garner, Michael Brown or hundreds of other people of color who died because of actions of police and our government.

 

As Social Workers, we pledge to do what we can with the skills we have to address mental health needs, social and economic needs, and to work for the political changes necessary to create a more just society.  

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Black Lives Matter

We stand in solidarity with Black social workers who continue

to provide essential mental health services to their clients and

communities. We stand in solidarity with Black social workers

who heal trauma and provide hope for Black clients and Black

families. We stand in solidarity with Black social workers, who

are organizing their friends, families, communities, and the

public to advocate for Black lives. We stand in solidarity with

Black social workers who are social justice warriors, fighting for

their own futures, and the future for our children. We stand in

solidarity with Black social workers.

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COVID-19 Updates

Thoughts on Returning to Our Offices

,

We tell our patients, rightly, that the office is the safest place there is to look at what has caused the hurt/troubled/traumatized feelings they have. We see ourselves as the owner of this safe space and feel safe there ourselves. Pre-COVID, if my patient or I was sick, it was not the potentially life-threatening issue that it is now.  Also pre-COVID, on the rare occasions that a patient or I was sick, I assessed how much of a risk there is for both of us if one of us gets a cold or the flu from the other.  I had never thought that one or both of us might be putting our lives at risk by being in the same room.

 

Now I have those thoughts.  Much as I want to return to my office, it feels like there might be a serious physical risk to one or both of us (or all patients I see).  This feels like a dangerous situation.  I don't know how to be sure that my office is a physically safe space at this point, It doesn't feel like keeping a 6-foot distance, having the right air treatment machines, wearing masks, or all the other adjustments that many are considering will bring back the precious emotional and physical safety that we have lost until we acknowledge that loss.

Painful as it is to lose this safe space for me and my patients, it is a reality. I have been trying to explore this in myself and with my patients. Patients have made many comments about the room I am using at home when we meet online, how it isn’t like the office we used to share and what it means to them. This often leads to some feeling of loss.

To be sure, some CSWA members are more sanguine about working by telephone or videoconferencing. Some had already been working in these ways and did not feel the shift to videoconferencing solely was that different.  I support those of you who are doing well in this way of working and hope you understand that not everyone has the level of comfort with it that you do.

I will be offering members the multitude of issues to be considered when returning to our physical offices in the aforementioned webinars next month. In the meantime, please consider how much we have already lost.  Let’s honestly look at how much we feel that we and our patients have to protect ourselves from each other in the office. In my view, we have to achieve that before we can actually reclaim making our offices a safe space again. Hopefully the loss of our offices won't be going on too much longer, but I am trying to accept the pain that losing it has already caused.

Hope you are all weathering this difficult time as well as possible.

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NASW - Great news: we can declare victory in getting audio only psychotherapy covered by Medicare.

We are grateful to CMS and the administration for the many flexibilities they have provided for telehealth. As you may know, CMS this afternoon issued guidance providing additional rule changes and waivers to increase access to care during the public health emergency.


To see the guidance, go to: https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid

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CSWA - Audio Only Psychotherapy for Medicare Confirmed! - 4-30-20

I am pleased to confirm that LCSWs can now be reimbursed by Medicare for audio only psychotherapy sessions.  More details can be found at https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

The CPT codes are the same as the ones that we use for in-person and videoconferencing sessions, e.g., 98034, 98037, 90791, etc. Any telephonic session that you have conducted since March 1 can be submitted for reimbursement.

The POS code should continue to be 11 as is has been for the past three weeks.  The modifier is 95.

This is the decision that CMS has made for Medicare coverage.  As we know, private insurers often follow the lead of Medicare policy, so there is a chance that we will see more coverage of audio only sessions by private insurers.  Do not take it for granted though, that this is the case. Continue to check the plan that each patient has if you wish to conduct treatment in an audio only format.

This also will not automatically apply to ERISA, or self-insured, plans.  We are continuing to pursue audio only coverage for those plans as well.

This is a big win for LCSWs and you all helped!  When we work together through CSWA, as well as with NASW and the American Psychological Association, we can accomplish great things.

 

Laura Groshong, LICSW, Director, Policy and Practice

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Information on Second Round of Relief Funds for LCSWs - 4-29-20

Many CSWA Members have wondered about the risks and benefits of applying for the second round of relief funds from the CARES Act General Allocation Fund.  Some of the guidance on applying for these funds is as ambiguous as the explanation for the first round of relief funds, but I will give you my understanding of what it means. 

 

First, tomorrow is the last day for accepting or rejecting the first round of funds, which did not require an application, as the second round does. The first round of funding went to any LCSW who saw Medicare patients in 2019. There is some confusion about what accepting these funds, either through active attestation or no response, will mean.  But anyone who does not actively reject the funds by tomorrow will be seen as eligible for the second round of funding. 

To be considered for these new General Allocation funds, information on filing the application can be found at https://chameleoncloud.io/review/2977-5ea0af98f0fd0/prod  .  A couple of changes are 1) you must file your 2019 tax return, and 2) you must estimate your lost income for March and April of 2020.  These funds will be available until they are exhausted and will go out as claims are validated.

 

There is no guarantee that you will receive these funds, or a formula for how they will be distributed.  The main thing to remember is that if you want to be considered for receiving them, apply sooner rather than later.  Giving our tax returns to HHS is a calculated risk.  If the information is accurate, there should be low risk; if not, there could be an audit of your tax return.  Estimating lost income may be difficult and could lead to problems if it is found to be overestimated.  But for some LCSWs, it may be worth the risks of applying for these funds because of the need for more income at this perilous time.

 

Remember - this is a separate source of funding from the Payroll Payment Protection (PPP) funds, which LCSWs are also eligible for. PPP allows businesses to borrow 2.5 times our average monthly “payroll costs”, a bit of a misnomer, because when you look at the actual definition payroll costs include self-employment income, e.g. net income reported on Schedule C.  This program applies to anyone with self-employment income and is a loan which must be repaid. 

I hope this helps you make the decision that is right for you about applying for these funds.  Let me know if you have any other questions.

 

Laura Groshong, LICSW, Director, Policy and Practice

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CSWA - Helping Those in Need During COVID-19 - 4-23-20

I hope you are all making the adjustments that most LCSWs have made to preserve the safety and health of ourselves and our patients.

In addition, there are many people struggling to meet basic needs and solve the ways to prevent COVID-19.  Here are a few that could use your help in doing their good work:

Helping others is a big part of our clinical social work values.  I hope everyone can find a way to chip in for those who are in need.

Laura Groshong, LICSW, Director, Policy and Practice

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CSWA - Concerns about Relief Fund Payments - 4-18-20

There are several concerns about the potential risks of accepting the funds which many members have received as compensation for the potential loss of income due to COVID-19. There is no clear guidance on the meaning of the Relief Fund Payment Terms and Conditions, some of which are ambiguous, but the risk which accepting the funds causes seems less problematic than so have suggested. This is not legal advice, but my best guess about what the likely outcome of accepting the reimbursement will be and factors you may want to consider in making your decision.

Purpose of Funds – This statement in the Relief Fund Terms and Conditions is unclear when applied to psychotherapy: “The Recipient certifies that the Payment will only be used to prevent, prepare for, and respond to coronavirus, and shall reimburse the Recipient only for health care related expenses or lost revenues that are attributable to coronavirus.”  This can be interpreted in the broadest of terms, i.e., that there is anxiety and depression about the pandemic which almost all patient face even if that is not their primary reason for treatment, or in a narrower way, that the presenting problem is specifically emotional distress about being ill with COVID-19, having family members with COVID-19, or fears about this happening.  We must use our judgment about which way to interpret this section.

Meaning of UHC Involvement in Payments – this may be unusual in the way we are generally paid but this public/private partnership should not have any impact on our status as out-of-network providers, if we are. UHC is a pass through in this case, writing checks for HHS; Medicare does not accept out-of-network clinicians so there is no possibility of that option being limited for beneficiaries.

Out-of-Pocket Payments – finding LCSWs to provide services is challenging even without the additional burden of the emotional stress that has been created by the pandemic. Accepting the reimbursement requires us to agree that we have not charged anyone our out-of-network rates if we saw them outside of Medicare and that we will not do so going forward.

Consequences of Attestation – there may be some auditing of how the funds are used but it seems unlikely that the amount of money being distributed to LCSWs will be targeted. Signing the attestation that you have received the funds and intend to use them to treat Medicare beneficiaries with COVID-19 mental health problems seems like it is likely, to one degree or another. It is probably less risky if you affirmatively accept or reject the funds that you have received, after weighing all the factors involved.

Keeping the funds may be appealing and well-earned, but some members have decided to reject them because of the involvement with UHC, the ambiguity about whether the work we are doing meets the criteria for accepting the funds, and the possibility of being audited is not worth the risk.  Each of us will need to come to our own conclusions about this difficult decision.

Laura Groshong, LICSW, Director, Policy and Practice

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CSWA - CMS Reimbursements for Medicare - 4-18-20

Many members have begun to get Medicare ‘reimbursements’ as a result of the CARES Act. This has caused some confusion which I will try to clear up here.

1.   Funding Source - These funds come from the from the $34 billion provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act through DHHS. The CARES Act appropriation is a payment that does not need to be repaid.

2.   Amounts Reimbursed - The amounts are based on the treatment that an LCSW provided to Medicare patients on a fee-for-service basis in 2019; this does not apply to Medicare Advantage patients. The amount is based on the LCSW’s share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.

 

3.   Reason for Reimbursement – Though these funds are primarily for services provided connected to COVID-19 issues, it applies to other mental health problems as well. It goes without saying that there is widespread anxiety and depression as a result of the pandemic which affects almost everyone in the country.

 

4.   United Health Care Role - The reimbursements are distributed by HHS through United Health Care in a public/private partnership. Most reimbursements are under $2000, many under $500 from what I have heard.

 

5.   Attestation - You can either ‘attest’ that you accept the funds directly at https://covid19.linkhealth.com/  or do nothing which will be seen as an affirmative attestation in 30 days from distribution.  There is no penalty if an affirmative attestation is not made.

For more information go to https://www.cms.gov/newsroom/press-releases/cms-approves-approximately-34-billion-providers-acceleratedadvance-payment-program-medicare , hhs.gov/providerrelief  or call the CARES Provider Relief line at  (866) 569-3522.

There is another program which provides loans to LCSWs and other health care providers who need financial assistance as a result of the COVID-19 crisis. The CMS Accelerated and Advance Payment Program has delivered billions of dollars to healthcare providers, including some LCSWs. These accelerated and advance payments are loans that providers must start paying back within 120 days and complete paying back by 210 days. For more information on applying for these loans, go to https://www.cms.gov/newsroom/press-releases/cms-approves-approximately-34-billion-providers-acceleratedadvance-payment-program-medicare

 

I hope this is helpful.  Let me know if you have any further questions.

 

Laura Groshong, LICSW, Director, Policy and Practice

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CSWA - Clinical Issues in Virtual Telemental Health Treatment - 4-16-20

Many clinical social workers have noticed the way that our current shift to working through telemental health platforms has affected the treatment relationship and our own view of our work. This summary of the discussions that we have had in the CSWA "Open Webinars" may help us think through these changes. The summary can be found at CSWA - Clinical Issues in Virtual Therapy - 4-16-20.docx .

Another "Open Webinar" will be held this Sunday at 2 pm ET/11 am PT.  This is an excellent way to connect with colleagues and navigate the brave new world (for some) of telemental health. All CSWA members can register at https://www.clinicalsocialworkassociation.org/event-3814579 . 

Laura Groshong, LICSW, Director, Policy and Practice

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CSWA - Summary of Changes to LCSW Practice due to COVID-19 - 4-8-20

Below is a summary of most of the changes LCSWs have faced in the past few weeks as we have moved to telemental health psychotherapy at CSWA - Summary of COVID Changes for LCSWs - 4-8-20.pdf

Please let me know if you have questions that are not addressed or corrections to the material presented.

Laura Groshong, LICSW, Director, Policy and Practice

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Updates on LCSW Practice Changes - 4-8-20

Below is an update on issues related to the changes to LCSW practice since we started using telemental health practice.

I can't stress enough how important it is to let your members of Congress know about the harm being caused by the lack of access to patients who do not have computers or smart phones. The only way to conduct treatment with them, primarily Medicare beneficiaries, at this time is through telephonic sessions. HHS has the ability to allow expanded coverage of telephonic sessions under the CARES Act. We need to keep up the pressure that Sec. Azar make this change. See the suggested language below to send messages to him and members of Congress.

I thought you might like to see the letter sent by CSWA to Sec. Azar and CMS Administrator Verma which can be found at CSWA - Letter on Audio Only Coverage - 4-7-20.docx

As for those members who have had questions about small business loans for self-employed business owners, the programs that were set up under CARES are swamped. If you have applied, do not expect a response for about a month. Priority is being given to large corporations. I will provide more information on this topic as I have it.

Let me know if you have any other questions in these difficult times. Keep your patients and yourselves healthy, rested and safe.

“I am a constituent and a member of the Clinical Social Work Association. I have patients who are unable to meet with me in person for psychotherapy because of the COVID-19 crisis and do not have access to a smart phone or computer. The Centers for Medicare and Medicaid Services have not expanded coverage of psychotherapy to telephonic sessions, only videoconferencing; however, the only way I can provide services to these beneficiaries is by telephone.

Some enlightened insurers like Cigna and Aetna have already allowed some temporary coverage of telephonic psychotherapy sessions. Some states such as Texas, and Ohio have also required temporary coverage of telephonic psychotherapy sessions by private insurers.

Please tell CMS [and/or private insurers for state legislators and Insurance Commissioners] to approve coverage of telephonic psychotherapy sessions, sorely needed in these fraught times, for Medicare beneficiaries [and other enrollees privately insured] who may be isolated, emotionally fragile, and in need of mental health services."

You can find contact information for members of Congress at https://www.house.gov/representatives and https://www.senate.gov/general/contact_information/senators_cfm.cfm. You can find email addresses for your state legislators and Insurance Commissioners by going to your state websites.

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Updates on Zoom and Medicare - 4-3-20

Below is an update on several issues related to our transition to telemental health services.

1. Zoom – There have been concerns raised about the security of the Zoom platform and Zoom is taking steps to address these issues. A more secure system will be in place by April 5 for the ZoomPro and other platforms Zoom offers.  Here is a summary of what will be happening:

Zoom

We’re always striving to deliver you a secure virtual meeting environment. Starting April 5th, we’ve chosen to enable passwords on your meetings and turn on Waiting Rooms by default as additional security enhancements to protect your privacy.

Meeting Passwords Enabled “On”

 

Going forward, your previously scheduled meetings (including those scheduled via your Personal Meeting ID) will have passwords enabled. If your attendees are joining via a meeting link, there will be no change to their joining experience. For attendees who join meetings by manually entering a Meeting ID, they will need to enter a password to access the meeting. 

 

For attendees joining manually, we highly recommend re-sharing the updated meeting invitation before your workweek begins. Here’s how you can do that:

Log in to your account, visit your Meetings tab, select your upcoming meeting by name, and copy the new meeting invitation to share with your attendees. For step-by-step instructions, please watch this 2-minute video or read this FAQ.

 

For meetings scheduled moving forward, the meeting password can be found in the invitation. For instant meetings, the password will be displayed in the Zoom client. The password can also be found in the meeting join URL.

Virtual Waiting Room Turned on by Default
Going forward, the virtual waiting room feature will be automatically turned on by default. The Waiting Room is just like it sounds: It’s a virtual staging area that prevents people from joining a meeting until the host is ready. 

How do I admit participants into my meeting? 
It’s simple. As the host, once you’ve joined, you’ll begin to see the number of participants in your waiting room within the Manage Participants icon. Select Manage Participants to view the full list of participants , then, you’ll have the option to admit individually by selecting the blue Admit button or all at once with the Admit All option on the top right-hand side of your screen.  For step-by-step instructions, please watch this 2-minute video.

Check out these resources to learn How to Manage Your Waiting Room and Secure Your Meetings with Virtual Waiting Rooms.

For more information on how to leverage passwords and Waiting Rooms to secure your meetings, please visit our Knowledge Center, attend a daily live demo, or visit our Blog.

Please reach out to our Support Team if you have any questions at support@zoom.us.Medicare Issue

Medicare has made several changes in the past few days, revising some previous guidance. Below are some of the most important changes. To see the latest guidance, go to https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient 

2. Medicare Coding – the Medicare coding for psychotherapy continues to be in flux.  Here is Guidance which came out today saying we should now use the POS we would have used had the service been provided in person, e.g., “11” for in-office psychotherapy, and the modifier “95”:

 

Billing for Professional Telehealth Distant Site Services During the Public Health Emergency — Revised (4/3/20)

This corrects a prior message that appeared in our March 31, 2020 Special Edition.

Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. When billing professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with:

  • Place of Service (POS) equal to what it would have been had the service been furnished in-person

  • Modifier 95, indicating that the service rendered was actually performed via telehealth

As a reminder, CMS is not requiring the CR modifier on telehealth services. However, consistent with current rules for telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:

  • Furnished as part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous (store and forward) technology, use GQ modifier

  • Furnished for diagnosis and treatment of an acute stroke, use G0 modifier

 

There are no billing changes for institutional claims; critical access hospital method II claims should continue to bill with modifier GT.

 

3. Medicare Reimbursement – this is the area that has seen the most confusion; previous guidance had stated that reimbursement would be the same for telemental health as in-person treatment.  So far, there have been payments made for telemental health that are 7-8% lower than previous reimbursement, some that have remained the same  This seems to vary by region. Contact your MAC to discuss if you have received a payment that is not consistent with previous reimbursement.

 

4.   Medicare Provider Enrollment - CMS is making it easier for providers to enroll in Medicare. Local private practice clinicians and their trained staff may be available for temporary employment since nonessential planned medical and surgical services are postponed during the pandemic. 

 

5. Telephonic Coverage – this is the area that has caused the most confusion based on the March 30 guidance: “Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. During the public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinician for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only.” The problem with this statement for LCSWs is that there is only one service that is expanded for psychotherapy, e.g., the E/M 10 minute evaluation, NOT psychotherapy sessions.  CSWA is still working hard to get coverage of telephonic sessions by Medicare.  At present, they are not covered. Continue to let your members of Congress know that this is a problem as noted below. 

CSWA will continue to provide information on regulatory changes to members that affect LCSW practices which will likely be continuing for the next month.


Laura Groshong, LICSW, Director, Policy and Practice

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Emergency Reciprocity and More - 3-31-20

Things are changing rapidly to give people better access to mental health services. Here is

some more information that affects LCSWs.

First, a correction. Maryland has not required coverage of telephonic sessions; Gov. Hogan was one of the first states to allow emergency reciprocity for LCSWs not licensed in Maryland. Apologies for the error.

Along these lines, many states have followed his example and are now allowing LCSWs to practice in states where they are not licensed, as long as they are licensed in at least one state. There are many variations so make sure to read the emergency declarations carefully.  The list helpfully created by Shrink Space can be found at https://theshrinkspace.blog/covid-19-teletherapy-across-state-lines/ . It is being updated daily.

Finally, sending a message like the one below to the President would be a good idea. You can send it to www.White House.gov.

I will be sending more information as it comes in. Let me know about any changes to practice in your state/jurisdiction.

“I am a constituent and a member of the Clinical Social Work Association. I have patients who are unable to meet with me in person for psychotherapy because of the COVID-19 crisis and do not have access to a smart phone or computer. The Centers for Medicare and Medicaid Services have not expanded coverage of psychotherapy to telephonic sessions, only videoconferencing; however, the only way I can provide services to these beneficiaries is by telephone. 

Some enlightened insurers like Cigna and Aetna have already allowed some temporary coverage of telephonic psychotherapy sessions.  Some states such as Texas, and Ohio have also required temporary coverage of telephonic psychotherapy sessions by private insurers.

Please tell CMS [and/or private insurers for state legislators and Insurance Commissioners] to approve coverage of telephonic psychotherapy sessions, sorely needed in these fraught times, for Medicare beneficiaries [and other enrollees privately insured] who may be isolated, emotionally fragile, and in need of mental health services."

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Summary of Telemental Health Basics Webinar

The complete change to our personal and professional lives in the past two weeks as the result of the COVID-19 pandemic has been overwhelming.  It has led to feelings of helplessness about how to do our jobs as clinical social workers that many of us have not had to face for decades.

CSWA has tried to outline the changes that most private practitioners are facing and ways to adjust our practices.  Once we get past the shock of feeling disoriented, the shift to telemental health that we need to make for at least the next 2-3 months are manageable.  Below is a brief summary of the areas that should be considered.  The complete hour-long webinar can be found under the Members-only area of the CSWA website.

CLICK HERE TO ACCESS THE EMERGENCY TELEMENTAL HEALTH WEBINAR

 

Practice Considerations:

CSWA is offering more guidance on the changes created by this pandemic.  There will be two Open Webinars to discuss the questions LCSWs have and provide mutual support on March 28 and 29 (see Upcoming Events at CSWA website). There will be a two-hour conference on more detailed discussion of how to provide telemental health.  We want to be your partner in this time of flux and transition.

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CMS Guidance on Medicare Videoconferencing

I spoke this morning with Karyn Anderson, CMS Technical Director as she was about to develop this guidance from CMS on telemental health services.  She was quite receptive to our concerns.

I am happy to report that CMS has approved an expansion of Medicare telemental health to cover anyone we see, new patients or ongoing ones.  Unfortunately, it does not include telephonic sessions. CSWA will keep working to get them included as well.  To see the FAQ on all the changes included see 3.17.20 COVID 19 Telehealth Waiver FAQ Final.pdf 

Please read this carefully and let me know if you have any questions.

 

Laura Groshong, LICSW, Director, Policy and Practice, Government Relations Chair
Clinical Social Work Association
The National Voice of Clinical Social WorkStrengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY

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Info on Videoconferencing

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.

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