April, 1999

Inside this Issue:

Senate Bill 903 / House Bill 1848

New Board Members

The Propriety of Billing for Social Work Services under Physician CPT Codes

Demographic Study of BCSW Constituency

New licensees

In Remembrance

Senate Bill 903 & House Bill 1848

The proposed amendments to the Louisiana Social Work Practice Act drafted over the past four years by the Inter-Organizational Committee have been filed in the 1999 Regular Session of the Louisiana Legislature by Senator Jay Dardenne and Representative Sharon Weston. The bills consist of 47 pages which completely rewrite the current Louisiana Social Work Practice Act. We have attempted to list the major changes below but strongly suggest that you purchase a copy of the Bill and reveiw it in its entirety.

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The title of the Board will change to Louisiana State Board of Social Work Examiners.

No individual shall practice social work in Louisiana unless the individual holds a current, unsuspended, unrevoked license, certificate, provisional certificate, or registration issued by the Board. This license, certificate, provisional certificate, or registration shall be conspicuously posted in the office or place of business at all times.

Registered Social Worker (RSW) - requires that all persons with a Bachelor of social work degree from an undergraduate social work program accredited by CSWE register with the Board within one year from enactment of the law. No examination is required for registration.

Scope of Practice: May engage in generalist social work practice based on the application of social work theory, knowledge, ethics and utilizing problem-solving methods to restore or enhance social functioning of individuals, families, groups, organizations, and communities through assessment, prevention, and/or intervention and evaluation, case management, information and referral, supportive counseling, advocacy, research, supervision, community organization, and the implementation, and administration of policies, programs and activities.  A social worker at this level shall work as an employee in an agency and shall not engage in advanced practice or in clinical social work.

Graduate Social Worker (GSW) - requires that all persons with a masters degree in social work from a graduate social work program accredited by CSWE apply for certification with the Board within one year from enactment of the law. Those applying within one year will "grandparent" and will not be required to take the national AASSWB intermediate examination.

Scope of Practice: May engage in advanced social work practice based on the application of social work theory, knowledge, ethics and methods to restore or enhance social, psychosocial or biopsychosocial functioning of individuals, couples, families, groups, organizations, and communities. The GSW practice requires the application of specialized knowledge and advanced practice skills which include prevention or intervention, or both, service or treatment planning and evaluation, case management, information and referral, counseling, employee assistance services, addiction services, advocacy, teaching, research, supervision, consultation, community organization and the development, implementation, and administration of policies, programs and activities. A social worker certified at the GSW level may practice clinical social work within an agency under the supervision of a LCSW. A GSW may only work as an employee in an agency setting.

The Board may issue a provisional GSW certificate to an individual who, except for passing the examination, has completed all requirements for certification as a GSW. The individual may hold the provisional certificate for no more than three years from the issuance of the original certificate and the individual shall take an examination approved by the board at least once a year.

Licensed Clinical Social Worker (LCSW) - All social workers who hold current BCSW licenses at the time the law is passed may be "grandparented" but must do so within one year of the effective date of the new law. Candidates for the BCSW who are in process on the effective date of the new law will continue under the requirements of the existing law.

Scope of Practice: May independently engage in advanced social work practice based on the application of social work theory, knowledge, ethics and methods to restore or enhance social, psychosocial or biopsychosocial functioning of individuals, couples, families, groups, organizations, and communities. The practice of clinical social work requires the application of specialized knowledge and advanced practice skills which include prevention, assessment, diagnosis, and treatment of mental, emotional, and behavioral and addiction disorders. Treatment methods include the provision of individual, marital, couple, family, and group psychotherapy. The practice of clinical social work may include private practice, employee assistance and addiction services, and the provision of clinical supervision.  A licensed clinical social worker may work as an employee in a practice setting or independently in private practice.

The size of the Louisiana State Board of Social Work Examiners will change from five (5) members to seven (7) members as follows:

One RSW with at least five years of social work experience.
One GSW with at least five years of social work experience.
Three LCSWs with at least five years of social work experience.
One member who is either a RSW, GSW or LCSW.
One public member.

All statewide social work membership organizations that have written by-laws and meet all state and federal laws may submit names of nominees for the Board.

The Louisiana Chapter of NASW shall be responsible for the coordination of the nomination process.

Appointments from the nominees list are made by the Governor.

Continuing Education required for all levels, RSW, GSW, and LCSW. The requirment remains 20 clock hours of continuing education but includes three (3) hours of ethics training every two years for all levels. Within the 20 hours, the LCSW must have no less than ten (10) clock hours of continuing education of clinical content which includes diagnosis and treatment of mental disorders.

Although the Board does not intend to raise initial or renewal fees, a fee limit must be included in the Law and is as follows:

LCSW License Fee  - no more than $100
GSW Certification Fee - no more than $75
RSW Registration Fee - no more than $50
Re-examination Fee -    no more than $50
Re-issuance of license, certification, registration - no more than $50
Renewal Fee - no more $100

The bill further delineates the Board's powers for:

New Board Members

Gretchen Goodrich and Dorinda Noble Appointed to the Board

Governor Foster recently appointed Gretchen Goodrich and Dorinda Noble to three year terms on the Louisiana State Board of Board Certified Social Work Examiners.

Dorinda Noble, BCSW, has been an Associate Professor at the LSU School of Social Work in Baton Rouge for the last seven years. She received her MSW at Tulane and Ph.D. in social work from the University of Texas at Austin. Dr. Noble was Director of the Social Work Program at Texas Tech University for twelve years and spent four years as a researcher at the Hogg Foundation for Mental Health at the University of Texas at Austin. She is particularly interested in children's services including family preservation, foster care, residential care and adoption.

Gretchen Goodrich, BCSW, has been in full time private practice since 1982. She received her MSW from LSU in 1977 and worked in foster care for the Office of Human Development and the Office of Mental Health at Margaret Dumas Mental Health Center. She supervises students for Prevent Child Abuse Louisiana and is a member of the National Association of Social Workers, the Louisiana Association of Clinical Social Workers and the American Group Psychotherapy Association and the Louisiana Group Psychotherapy Society.

Board Vacancies - The terms of Cammie Lapenas, BCSW, Baton Rouge area, and Alan Walker, BCSW, Lake Charles area, will expire on July 26, 1999 thereby creating two vacancies on the Louisiana BCSW Board. LSA R.S. 37:2704, mandates the following qualifications for Board members:

The law further states, that at all times the board shall have at least three (3) members who are engaged primarily in rendering direct services in board certified social work and/or at least one member who is engaged primarily in education, training, or research in social work. The remaining board members and their areas of practice are as follows: Gay Lynn Bond, BCSW, educator; Dorinda Noble, BCSW, educator; and Gretchen Goodrich, BCSW, direct practice.

If you are interested in serving on the Board, you should submit a letter stating your interest and a resume to either of the two organizations listed below by May 31, 1999:

Ms. Martha G. Forbes, BCSW, Executive Director
Louisiana Chapter of NASW
700 N. 10th Street, Suite 200
Baton Rouge, LA 70802

Mr. Darryl Ducote, BCSW, President
Association of Clinical Social Work Providers
5329 Dijon Dr., Suite 105
Baton Rouge, LA 70808

The Propriety of Billing for Social Work Services Under Physician CPT Codes

A legal opinion by George M. Papale, Legal Counsel to the Louisiana State Board of BCSW Examiners. Reviewed and supported by Donna Adorno, Legal Section of the State of Louisiana Department of Health and Hospitals.

Social workers are authorized to bill for services under CPT psychotherapy codes subject to mental health criteria which clearly identify the service provider as a social worker and not a physician.

Other CPT codes including 99211 through 99215 do not specifically identify the service provider but all of hte explanatory examples relate to physicians. Under code 99211, the visit is designated for the evaluation and mangement of an established patient, that may not require the presence of a physician. "Typically, five minutes are spent performing or supervising these services." A non-physician could perform some minimal service under this billing code outside the presence of the physician provided that physician supervision is part of the service. However, codes 99212 through 99215 do not dispense with the presence of the physician but require increasing expenditure of physician time in face to face contact with the patient or the patient's family. It is not appropriate for a social worker to bill for services under these codes.

There are many laws that deal with submission of false statements in connection with billing claims. The Health Insurance Portability and Accountability Act provides criminal penalties for billing activities in "federal health care programs" whic have been defined to include any plan or program that provides health benefits directly through insurance or otherwise is funded in whole or in part by the federal government. Prohibited conduct includes billing for services not rendered, misrepresenting the services actually rendered or falsely certifying that certain services were medically necessary. The statute also prohibits the submission of a claim for physician services with the knowledge that the person who furnished the services was not a physician, 42 U.S.C.§§1320a-7b(a)(5). False statements of this sort when payment is requested under a federal health care program constitute a crime classified as a felony. Upon conviction, the person can be fined $25,000 or imprisoned five years or both.

Presenting false information to obtain payment from the government can also be prosecuted under the general criminal claim statue 18 U.S.C.§287 and the Civil False Claim Act 31 U.S.C.§3729-3731. Liability can be imposed for knowingly presenting a false or fraudulent claim if the person has actual knowledge of the information; acts in deliberate ignorance of the truth or falsity of hte information; or acts with reckless disregard of the information. No proof of specific intent to defraud is required. In addition, the Secretary of the Department of Health and Human Services is authorized to impose penalties under the Civil Monetary Penalty Law (CMPL) 42 U.S.C.§1320a-7a(1)(c) when a claim is presented for a physician's service by a person who knows or should know that the individual who furnished the service was not a licensed physician.

Neither claims under the Civil False Claims Act nor the Health Insurance Portability and Accountability Act allow the person to function in deliberate ignorance with respect to information that he "should know." The law makes it clear that sanctions by civil monetary penalties can be imposed for "upcoding" or the sue of incorrect codes when claims are presented for a service based on a code that the individual "knows or should know" will result in a greater payment than the code which is actually applicable to the service provided.

"Upcoding" or coding services by non-physicians under codes that create the impression that a physician's services were provided constitutes violations of federal as well as state law and regulation. Such coding is reasonably calculated to result in a higher level of payment from a federal health program than would otherwise have been obtained had the appropriate billing code been employed. Those persons who know or should know that an inappropriate billing code is being used run a substantial risk of criminal prosecution as well as civil liability. Although the provider submitting the claim for reimbursement may have as much if not more exposure to prosecution and civil liability, the fact remains that those persons knowingly participating in such a billing practice with either actual knowledge, deliberate ignorance, or reckless disregard for the truth, will not escape criminal prosecution or civil liability.

Although it may be appropriate for the social worker to make notations in the progress notes within the patient's medical chart provided that the social worker signs for services actually provided by the social worker, it is not proper or appropriate for the social worker to add the physician's initials. Should the physician wish to countersign the social worker's notes, the physician should do so in his own handwriting.

As with any questionable practice, a social worker who suspects that a CPT code listed for a service is not a faithful match for the service actually provided should bring this matter to the atttention of the employer or agency involved. In the event that a satisfactory explanation is not obtained, the social worker should anonymously contact the fiscal intermediary (such as Blue Cross) in an effort to verify the appropriateness of the coding and billing practice involved. In the event that a satisfactory explanation is given by the intermediary, the social worker should clearly document the conversation, noting the name of the person providing the information, the date the information was provided and any manuals, regulations, or directives which support the ligitimacy of the practice.

If the intermediary states or implies that the practice is illegal and may constitute a false billing, then the social worker should immediately contact the employer or agency to give notice of the potential illegal billing practice. The social worker should decline to actively take any steps which would result in an inappropriate coding of service or the submission of a false claim. All steps taken by the social worker and the actions and responses of those persons so notified should be completely documented.

Demographic Study of BCSW Constituency

In June of 1997, the Louisiana Board of BCSW Examiners included a questionnaire entitled "Profile of BCSW Constituency" with renewal notices sent to all 3054 BCSWs in the state. This study of the BCSW population was designed to develop a profile of the employment patterns and professional interests of the BCSW constituency. The BCSW Board will use this information to develop continuing education opportunities which address the professional concerns of this population. Although completing the questionnaire was optional, 2204 (two-thirds of the state's BCSWs) returned the questionnaire. Data were compiled and assessed by Dorinda Noble, Ph.D., BCSW, Associate Professor at the LSU School of Social Work.

The resulting data show a preponderance of Caucasian females wiht a mean age of 45 years. (75% of the sample were female. 85% were Caucasian and 12% were African-American.) Although all members of the population hold an MSW, almost 4% of the sample also hold a doctoral degree, while 13% hold an additional graduate degree in another discipline. Approximately one-third of the sample has worked less than one decade past the MSW, while a generous second third has worked between one and two decades. Almost 8% of the respondents were retired from the field of social work.

Half of the sample work in mental health or medical settings as clinicians. While almost 30% work as administrators, very few work in policy development or research. More African-Americans in the population were engaged in administration or supervision than Caucasians, who were more likely to be engaged in clinical work. Twenty-eight percent of the population also worked a second job from 1-15 hours per week. The role and setting of the secondary employment usually mirror the primary employment. However, secondary jobs were more likely to be funded by private sources while primary jobs were more likely to be funded by public sources. Thirty-five percent of the respondents identified themselves as having a private practice but only 29% spent more than 25 hours per week in this endeavor.

Over two-thirds of the population are NASW members. Twenty-two percent listed no professional affiliations. The great majority of the sample were originally licensed in Louisiana but some have licenses in other states as well. Half of the population listed no licenses in addition to the BCSW, but some indicated that they were working toward additional certications or degrees. The wide variety of educational and certification pursuits demonstrates a growing interest in interdisciplinary learning which is consistent with the national trend in the profession of social work.

Judging by the high level of education and expertise represented in the BCSW constituency, many BCSWs are well-qualified to run for offices such as school boards and other policy making bodies. Only a very small number of licensees indicated that they had ever held public office.

Welcome New BCSWs

The following social workers have been granted the BCSW license by the Board since the last newsletter.