Telemental Health Laws by state – excellent summary of the legal protections for telehealth services: https://www.foley.com/-/media/files/insights/publications/2021/02/21mc30431-50state-telemed-reportmaster-02082021.pdf

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.

Even if you think you know your state’s laws about telemental health, this is a good review and offers ways to improve telemental health laws based on what other states have done.

CPT Code Reimbursement Changes

  • 90785 Interactive Complexity -10.2%
  • 90791 Psychiatric diagnostic evaluation +15.7%
  • 90832 Psychotherapy, 30 minutes with patient +3.0%
  • 90834 Psychotherapy, 45 minutes with patient +1.5%
  • 90837 Psychotherapy, 60 minutes with patient -0.1%
  • 90839 Psychotherapy for crisis; first 60 minutes -8.7%
  • 90840 Psychotherapy for crisis; each additional 30 mins -8.4%
  • 90845 Psychoanalysis -9.2%
  • 90846 Family psychotherapy (no patient present), 50 minutes -11.1%
  • 90847 Family psychotherapy (w/ patient present), 50 minutes -11.1%
  • 90849 Multiple-family group psychotherapy -10.2%
  • *90853 Group psychotherapy -9.0%

*Group Psychotherapy, 90853, has been added to the permanent list of telemental health services.

Current Clinical Social Work Policies on Reciprocity

Many of the laws and rules governing clinical social work licensure reciprocity have changed since COVID-19 has impacted our ability to see patients in person, roughly since March, 2020 when the State of Emergency was declared nationally. Beginning with Maryland, whose Governor allowed any LCSW licensed in another state to see patients in Maryland through videoconferencing without becoming an LSCW-C in Maryland, many states have relaxed the rules in place for which LCSWs can provide treatment in their state.  See my article “Guide to Telemental Health Across State Lines” on 11-11-20 for more details on how to find out the current standards on reciprocity for LCSWs in each state. A good link for this information is: https://www.naswil.org/post/state-by-state-guide-to-the-rules-laws-about-telehealth-services-across-state-lines. It is crucial to check these standards in the state in which you are currently licensed and the state in which a patient resides.

National Policies on Reciprocity

Another outcome of the pandemic is the increased pressure for national reciprocity for LCSWs.  Psychologists have been working toward this goal with a group of states that accepts the license of a psychologist from a state which is affiliated with a group of states who agrees on licensure standards, called PSYPACT.  This is a much easier task for psychologists because all   psychologists licensed as psychologists have a doctorate before they become licensed and that process is standardized.  NOTE: psychologists who have a terminal Master’s degree cannot become licensed as a psychologist and generally become licensed counselors.

The Master’s in Social Work is considered the terminal degree for clinical social workers, though there are several ways LCSWs continue to be trained for 2-3 years after receiving an MSW.  The laws and rules governing this training varies widely from state to state and each social work board has a vested interest in the standards that they have created.  Getting social work boards to agree on standards that would allow an LCSW to practice in another state is challenging.  Nonetheless, CSWA in collaboration with ASWB and NASW, is hoping to find a way to do so and have been working on this goal for the past 4-5 years.  There is a special urgency now because all the patients that we are seeing who we can now treat because of relaxed standards may be unable to continue their work with us, and have that work be covered by insurance,  when the State of Emergency ends.

Summary

For all the reasons noted above, there are problems for licensed clinical social workers in creating a way to use our licenses across state lines.   This may come about in time, but the nature of clinical social work licensing is state based and boards are reluctant to give up their right to create standards of practice for becoming licensed or for allowing reciprocity.  For now, the best way to practice across state lines through telemental health is to make sure you are in compliance with the rules of your own state and those of the patient’s location.  This is likely to change when the State of Emergency ends, likely within the next year.