LEGISLATIVE

The Texas State Board of Social Work Examiners is meeting this Thursday, January 30, 2025, at 10:00 AM CST. You may attend, watch and/or testify in-person or through Zoom. You may access this meeting, agenda and public materials by going to Texas Behavioral Health Executive Council…click on Texas State Board of Social Work Examiners…Click on Meeting Dates, Agendas and Minutes…then you can click onto
Agenda and Public Meeting Materials. Instructions are given for attending in-person or joining by Zoom.

On the agenda is a Proposed Amendment
Rule: 781.501. Requirements for Continuing Education.

Comment (TSBSWE): The proposed amendments will clarify the nature of professional development a licensee must receive to maintaining competency when providing services to unique populations.

781.501. Requirements for Continuing Education.
(a) Minimum Continuing Education Hours Required:
(1) A licensee must complete 30 hours of continuing education during each renewal period that they hold a license. The 30 hours of continuing education must include 6 hours in ethics and 3
hours in cultural diversity or competency.

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“cultural diversity or competency” language is being removed and replaced with “designed to ensure competency when providing services to a distinct population, defined as a group of people who share a common attribute, trait, defining characteristic of the licensee’s choice”

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(d) Acceptable cultural diversity or competency hours include, but are not limited to continuing education regarding age, disability, ethnicity, gender, gender identity, language, national origin, race, religion, culture, sexual orientation, and socio-economic status.

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“(d)” This entire section is being removed.

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There will be four (4) opportunities to comment on these changes:
TSBSWE Review January 30, 2025
BHEC Review February 18, 2025
TSBSWE Final Review April 4, 2025
BHEC Final Review June 6, 2025

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Texas Society for Clinical Social Work does that support this change.
 

It is important to note that the proposed amendments change from 3 hours of CEUs of competency in cultural diversity with specified populations To 3 hours of CEUs of competency when providing services to a distinct population, defined as a group of people who share a common attribute, trait, or defining characteristic. This amendment does not remove any groups and broadens the definition related to these specified populations.

The Psychology Board and the LMFT Board have already made this language change.

The LPC Board has this proposed amendment on their agenda for January 31 st .

The 89th Session of the Texas Legislature convenes at Noon on January 14, 2025.

 

The Texas Legislature meets odd years for 140 days starting on the second Tuesday of January and finishes Sine Die on Memorial Day 2025. This format follows the Texas state constitution of “limited government.”

 

The leaders are Governor Greg Abbott, Lt Governor Dan Patrick, and the Speaker of the House. The Speaker of the House is determined by a floor vote, with seventy-six (76)votes being the number needed to elect the Speaker. As of today, the Republicans, as the Majority Party in the Texas House, have not chosen their nominee for Speaker. Dade Phelan was Speaker of the House for the 88th Legislature. Speaker Phelan has withdrawn his bid for another term as Speaker. The election for Speaker of the House is set for January 14th by the full membership of the Texas House. No candidate has secured the necessary 76 votes to be elected Speaker.

 

The Governor called four (4) Special sessions following the 88th Legislature. These 2023 special sessions dealt with vouchers and property tax relief. A special session is thirty (30) days in length and there is no limit on the number of special sessions that may be called by the Governor who sets the agenda for special sessions.

 

First date to file legislation was November 14, 2024. There were over 1500 bills pre-filed.

 

The last day to file legislation is March 14, 2025.

 

The last day for the Governor to Act on legislation (bills) passed by both the Texas Senate and the Texas House is June 22, 2025. The Governor may sign bills into law, may veto bills or allow bills to become law without his signature.

 

The Texas Senate for the 89th Session will be comprised of twenty (20) Republicans and eleven (11) Democrats. Lt Governor Patrick presides over the Senate and determines the committee assignments of members as well as assigning which bills go to which committee in the Senate.

 

The Texas House for the 89th Session will be comprised of eighty-eight (88) Republicans and sixty-two (62) Democrats. The Speaker of the House determines which House members chair the committees and assigns members to the committees.

 

There will be thirty-five (35) new members this session. Two Republicans are not returning to the House and one is not returning to the Senate. In the House, nine chairs of committees are not returning, and ten vice chairs are not returning. Two members of the House Public Education Committee are not returning. On the House

Appropriations Committee, eight members are not returning.

 

Issues for the 89th Texas Legislature:

 

Speaker’s Race (the relationships between the Governor, Lt Governor, and the Speaker are critical to the overall success of the legislative session);

 

Revenue Estimate made by the State Comptroller is projected at $20 Billion. This will be the second consecutive session that has had a surplus projected;

 

Property Taxes; Vouchers; Funding for Public Schools; Border Security; Elections; Energy & Texas Grid; Taxpayer-Funded Lobbying; Federal Policy Changes; and State Water Fund Resources.

 

In the last session, the issues of school vouchers (use of public funds to fund private schools) and funding for public schools were joined together in legislative bills. This session is expected to deal with these two issues separately. The Governor could declare an emergency item, which would cause the Senate and the House to negotiate quickly.

 

Many of the state-wide advocate organizations will be focused on Women’s Health (reproductive rights and Medicaid expansion), Education (vouchers, book censorship, funding, teacher pay, and uncredited teachers), Discrimination and Rights of Marginalized persons, Reducing Gun Violence (age restrictions, and red flag standards), Free and Fair Elections, Equal Pay & Pay Equity (voter registration,

extended early voting and voting by mail), Mental Health (funding, access, and unhoused persons).

 

TSCSW Major Legislative Focus for the 89th Session will be the passage of a Social Work Compact for Texas while continuing to focus on legislation that affects our clients and our practices.

 

Health-Care: TSCSW and NASW/Texas are members of a COALITION OF 12 Health-related professions who are working on Interstate Compact Legislation for their respective professions ( Audiology/Speech-Language Pathology, Cosmetology, Counseling Dentist/Dental Hygienist, Dietitian, Occupational Therapy, Physician’s Assistant, Respiratory Care, Social Work). We have been meeting since Summer 2024 to prepare.

 

Interstate Compacts are legislatively authorized agreements between states that maintain state sovereignty and establish a formal legal relationship among states that are compact states. Texas currently participates in 38 interstate compacts, of which 5 are related to health/professional licensing (EMS, Medicine, Nursing, Physical Therapy, and Psychology).

 

Health-related professional interstate compacts would:

Respond to the state’s workforce needs; provide licensees with opportunities for multistate practices; increase access to care; improve continuity; and address mobility issues for patients and health care providers.

 

The Social Work Compact would allow social work licensees to work in other states without having to become licensed in those states. When relocating, it would allow military personnel and spouses to more easily maintain their social work licenses. Clients relocating to another state would not have to change their healthcare provider. There are currently 24 states which are social work compact states.

 

*** It is important to know who represents you in the Texas Senate and the Texas House.

 

There is a state website for the Texas Legislature where you can learn who your representative is in the Senate and the House, track legislation filed, and find out where a specific piece of legislation is in the bill passage process.

 

TSCSW will send out Legislative Alerts, giving you the information you need to impact a specific piece of legislation.

 

Currently, TSCSW sends out Practice Alerts to all LCSWs and LMSWs in Texas. As we move to the 89th Session, please let us know whether you want to receive these alerts/updates. You can contact Kathy Rider, LCSW and TSCSW Governmental Affairs Chair regarding being included in future legislative updates.

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In the United States, Mental Health (MH) and Substance Abuse Disorder (SUD) collectively pose a major health care crisis.

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In spite of the Mental Health Parity and Addiction Equity Act (MHPAEA} of 2008, issues related to Mental Health and Substance Abuse Disorders have continued to escalate in all our communities across the United States.  Here is some current data:

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• One person dies by completed suicide every 11 minutes and for children/adolescents suicidal/self-harm attempts have increased from 1,058 in 2010 to 5,606 in 2020 with death by completed suicidal among the top 5 causes of death among children/adolescents.

• Overdose deaths exceeded 100,000 in one year period in 2021 in the United States.

• First responders and health care providers continue to experience MH struggles. (KFF, 2022)

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Therefore, the need for mental health and substance abuse services has not only increased, as accessing health care has become increasingly difficult for all people.

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Access to care in the United States is impacted by health plans designed by commercial insurance companies.  Many currently available health plans do not provide treatment as required by the MHPAEA.

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A proposed Rule to improve the enforcement of the MHPAEA has been proposed by the current administration.  The “2023 Proposed Rule” would regulate the financial requirements and non-quantitative treatment limitations that Health Plans use when designing and administering Plan benefits.  This proposed Rule would provide needed increased enforcement and stricter penalties for noncompliance.

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We encourage all members of Congress to support the development of this Rule which will require insurers to develop non-quantitative treatment limitations for Mental Health /Substance Use Disorders (MH/SUD) that are equal to medical/surgical standards.  This would provide access to MH/SUD services by consumers and allow mental health care providers to deliver the services needed.  Along with the Mental Health Liaison Group, a coalition of over 80 MH/SUD groups, we strongly recommend that a version of the “generally accepted standard of care for MH/SUD” or use “Independent professional medical or clinical standards” be used to provide adequate treatment services.

The Clinical Social Work Association (CSWA) is concerned about consumers being limited in their access to mental health services provided by Licensed Clinical Social Workers (LCSWs), the largest group of mental health providers in the country (over 365,000).  Toward this goal, CSWA encourages all members of Congress to support pending legislation S.2173 and H.R.3712.

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Currently, access to mental health services is being restricted by Medicare and commercial insurers in the following manner:

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•  Even though LCSWs are the major providers of mental health services in the United States, patients are having difficulties accessing their services.  More and more LCSWs are choosing to not be a Medicare provider as the reimbursement rates are only 75% of what other Medicare providers receive for the delivery of the same mental health services. Thus, there are fewer providers for more patients.

• Many Medicare patients are in skilled nursing facilities (SNFs) under Medicare Part A. They  are currently unable to receive mental health services by an LCSW practicing independently. 

• Recent legislation passed in 2023 now allows Licensed Professional Counselors and Licensed Marriage and Family Therapists, who have similar training to LCSWs, to practice independently in skilled nursing facilities.  LCSWs had been Medicare providers under Medicare Part A to patients in SNFs since the implementation of Medicare in 1965; this ability was eliminated in 1997. The expansion of LPCs and LMFTs to practice independently in SNFs should include LCSWs.

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Medicare patients need access to mental health services provided by LCSWs.  It is past time to equalize reimbursement rates for LCSW services and allow LCSWs to work independently in Medicare Part A. LCSWs should be added back to the list of Medicare providers that can practice independently in skilled nursing facilities.  Passing pending legislation S.2173 and H.R.3712 would accomplish this goal.

Over half of Medicare beneficiaries are now enrolled in Medicare Advantage (MA) plans.   The MA plans are overseen by commercial insurers, who receive funding from the federal government to provide these plans and make significant profits from MA plans.  Over the past five years it has become clear that the MA plans, while less expensive than traditional Medicare and offering some benefits that Medicare does not, i.e., glasses, dentists, etc., these plans actually provide fewer health care services, including for mental health.  The ‘bait and switch’ tactics which have led to the major increase in MA plans need to be addressed by Congress to stop the ongoing ways that MA beneficiaries are tricked into believing that they will receive more robust benefits than they would by choosing traditional Medicare.

 

There is a philosophical debate going on about the way that health care should be defined. So believe that health care should be seen as a business which can be corporatized and provide profits to investors.  Others believe that health care should be a public service available to all citizens.  Still others believe there should be a range of options which can be available depending on cost and services offered.  In this context, traditional Medicare is in the middle ground, since all citizens over 65 are eligible for Medicare.

 

There is also a debate going on about the profits that should be made by commercial insurers, which have expanded exponentially since MA plans went into effect. Many of the millions of dollars that have been made by commercial insurers have gone to lobby members of Congress ($371,000 million in 2017). 

 

As for mental health and substance use disorders (MH/SUD), the following problems have been noted by CSWA members:

 

• Many MA plans restrict the number of psychotherapy sessions they will cover

 

• Many MA plans reimburse LCSWs working virtually at lower rates than for in person psychotherapy

 

• Many MA plans require prior authorization for psychotherapy, though this is at odds with mental health parity laws

 

• There are significant limits on the providers that will be covered by MA plans

 

At the very least, MA plans should have more oversight and limited profits from their current levels. CSWA calls on Congress to protect consumers from the way that they have been taken advantage of by many MA plans so that our citizens are able to get the MH/SUD services that are so necessary at this precarious time.

Telemental health, which was widely implemented in March, 2020, due to the pandemic, has been found by both therapists and patients to be an effective and efficient way of providing needed mental health care. Mental health conditions went up 20-40% in the past 4 years and show no signs of being lowered to pre-pandemic levels. Here are some reasons that Telemental Health treatment should be made permanent:

 

• The availability of mental health services through Telemental Health is as crucial to the well-being of our population as access to medical services. In 2021, suicides increased by 25% and deaths from drug overdoses were over 100,000.

 

• Many patients will be unable to continue treatment if they cannot continue using Telemental Health.

 

• As of 2025, LCSWs will be required to see every Medicare patient in person every six months.  This is unrealistic if patients are at a distance from the therapist and/or the therapist does not have an office.

 

• The 2022 MHPAEA Report to Congress from the Department of Labor (DOL), the Department of Health and Human Services (DHHS) and the Department of the Treasury recommends that “…Congress consider ways to permanently expand access to telehealth and remote care services.”

 

Because of the inconsistency in availability to telemental health psychotherapy services across the country, we urge Congress to create and pass a law that will rectify this inequity permanently by passing S. 3651/H.R. 3432. This bill would authorize the use of telemental health on a permanent basis, allow both video and audio only as acceptable procedures for telemental heath’s provision, and require parity in coverage and payment to in-person services.

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The ability of Licensed Clinical Social Workers (LCSWs) to work across state lines has been a problem ever since clinical social work licensure went into effect over 60 years ago.  The Clinical Social Work Association (CSWA) has been aware of the difficulties that this limitation creates for the over 365,000 LCSWs in the country. For this reason, CSWA strongly supports the creation of a Social Work Compact. As of this writing, Missouri, South Dakota, Utah, and Washington State have signed on to the Social Work Compact.

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During the pandemic, many laws requiring LCSWs to practice only in states where they had a specific license were relaxed.  The ability to work virtually was also relaxed.  Many LCSWs have been working virtually for the past four years and have patients who want to continue working with LCSWs who are in a different state from their own.  The Social Work Compact would offer patients a pathway to continue working with LCSWs in other states.

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The benefits of the Compact are as follows:

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• Eases mobility if patients and/or LCSWs move to a new jurisdiction

• Allows LCSWs to work in states that join the Compact

• Increased number of LCSWs to provide mental health treatment in Compact states

• Allows use of technology to work with patients in other states

• Preserves home state sovereignty for all LCSWs

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Nursing, psychologists, physicians and 10 other professional health care groups already have Compacts for 10-20 years and have had very few difficulties creating Commissions to oversee them.

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Feel free to contact CSWA for more information about how the Compact developed and how it can help your state.

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Contacts: Laura Groshong, LICSW, CSWA Dir. of Policy and Practice,  lwgroshong@clinicalsocialworkassociation.org

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Judy Gallant, LICSW, CSWA Deputy Director of Policy and Practice, judy.gallant@verizon.net