COVID-19 FAQ & Resources for Practitioners

NASW's National office has recently released the new practice guidance "COVID-19: Practice Guidelines for Reopening Social Work Practices." View the guidance here.

You can also watch our webinar "Preparing to Reopen Your Practice Post-Lockdown."

Effective April 7, Pearson VUE added ASWB candidates to the list of essential workers who are allowed to test in a subset of test centers that have been opened on a limited schedule for testing essential service providers. Availability is first come, first served. ASWB candidates must schedule their appointments online as explained in the FAQs about testing for essential services on ASWB’s exam program homepage on the Pearson VUE website (https://home.pearsonvue.com/aswb).

More information on ASWB testing during COVID and other COVID related licensure updates are available on the ASWB website.  (https://www.aswb.org/covid-19)

Please note that the process for licensure has changed now that the Board of Social Work Examiners is working remotely. Please find the updated process for licensure during COVID-19 here.

New Jersey passed legislation to allow for and regulate telemedicine/telehealth services in 2017, and the NJ Board of Social Work Examiners adopted this legislation into their regulations in 2020. View the NASW-NJ Telehealth Regulations Summary and the NASW-NJ Telehealth Regulations FAQ for more information. Also, reference the memo from NASW's General Counsel regarding general telehealth provisions.

As things rapidly develop on both what we know about COVID-19, policies around telehealth/telemedicine have also been developing alongside of it. The Center for Connected Health Policy has provided an excellent summary of what is covered by various public and private payers based on the information that has been released publicly. Keep in mind that events are evolving and to consider this a living document that could change frequently as new information and new policies become available/are enacted. 

Center for Connected Health Policies Summary (UPDATED 4/30/20, 3pm) 

A note on private insurers: Several health plans have announced that they will make telehealth more widely available or offering telehealth services for free for a certain period of time. Some of the announcements have come from: 

• Aetna
• Amerihealth
• BlueCross BlueShield
• Cigna 
• Horizon BCBS of NJ
• United Healthcare

Some private insurers are now making telehealth services broadly available through in-network providers. Likewise, some insurers are temporarily removing restrictions on the use of audio-only (phone call) telehealth services. We strongly recommend contacting the insurer directly for the most current information. 

We also strongly recommend you directly contact private insurers prior to providing services via telemedicine to find out if your sessions will be covered. Coverage for telemedicine services varies from insurer to insurer and policy to policy. Emergency response policies are rapidly changing as industries respond to COVID-19 and the private insurance market is no exception. Be aware that an insurer who was not covering telemedicine sessions this week could shift policy next week in response to COVID-19.

New Jersey’s telemedicine law requires that telemedicine services be provided via HIPAA compliant software. Standard Skype, Facetime, and other video communications software do NOT meet the requirements for compliance. However, these restrictions have been temporarily removed for the duration of the COVID-19 crisis.

There are several, free or low-cost HIPAA compliant videoconference services that meet state requirements and can be used to conduct telemedicine sessions. These include: 

• doxy.me
• Zoom (Due to recent news reports regarding security concerns with Zoom, we can no longer recommend Zoom as a reliable telehealth platform until the company provides assurances that privacy and security issues have been addressed and are not impacting the Zoom for Healthcare platform). 
• Vsee
• securevideo
• spruce
• G Suite Meet (Google) 
• Theraplatform 

NASW has not vetted these products, nor can we recommend one platform over the other. Practitioners should research each company’s website to ensure they are choosing a HIPAA compliant package and that they provide a BAA (Business Associate Agreement) to ensure compliance with HIPAA regulations. 

Some online practice management systems, such as Simple Practice, offer add-on services (for a fee) that provide HIPAA compliant telemedicine platforms for users. Check with your specific vendor.

As of March 17, 2020, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency. 

While we recognize this as a valid step taken by the Federal government to increase access to telemedicine services during this time of crisis, NASW-NJ recommends providers continue to use HIPAA compliant telemedicine platforms whenever possible, consistent with our Code of Ethics and client confidentiality guidelines. 

It should also be noted that New Jersey has laws and regulations regarding health information and what is required to protect and secure it. It is likely that a separate state action will be necessary to waive HIPAA compliancy provisions in our state's telemedicine law. 

For more information: www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

According to the NASW Standards for Technology in Social Work Practice, “when providing social work services using technology, social workers shall inform the client of relevant benefits and risks.” 

Get the Tele-Mental Health Informed Consent Form: English | Spanish

If you test positive for COVID-19 or are exposed to someone who tests positive, you should notify your clients immediately and move your practice to a telemedicine platform (if you have not yet done so) or make arrangements and referrals for your clients to continue with other mental health providers. 

If a client who has been to your office tests positive for COVID-19 or tells you they have been in contact with someone who has tested positive, you have a responsibility to your other clients to report this information to the appropriate authorities, however there are considerations that should be taken. 

HIPAA Considerations

As a general rule, HIPAA prohibits disclosure of protected health information without the prior consent of the client. The HIPAA Privacy Rule identifies a number of situations where this prohibition does not apply. However, if the state’s privacy law is more protective than HIPAA, the state’s restrictions on disclosure of protected health information will continue to apply. 

HIPAA permits disclosures: 

• When required by law (e.g., by public health law), to an authorized public health authority; 
• For the control of disease, even if not legally required, the minimum necessary information may be disclosed to an authorized public health authority; 

In either case, the social worker must verify the identity of the official, as described below. 

• Notify the client regarding exactly what information will be shared and why; 
• If possible, notify the client in advance and obtain their signed consent before the disclosure; 
• Only the minimum necessary information should be disclosed. For example, their name and the date and type of contact may be required, but not the professional relationship with the social worker. 

NJ's Social Work Licensing Regulations (13:44G-12.3) state: 

a) A social worker shall preserve the confidentiality of information obtained from a client in the course of performing social work services for the client, including after the death of a client, except in the following circumstances. 1) Disclosure is required by Federal or state law or regulation. 2) Disclosure is required by the Board or the Office of the Attorney General during the course of an investigation. 3) Disclosure is required by a court of competent jurisdiction pursuant to a judge's order. 4) The client would present a clear and present danger to the health or safety of an individual if the social worker fails to disclose the information. 

Ethical Considerations 

The NASW Code of Ethics strictly protects client confidentiality. While several provisions of the Code arguably permit the public health disclosures described above, disclosure even of a client’s name might be viewed as a breach of confidentiality. If disclosure is necessary: 

• Notify the client regarding exactly what information will be shared and why; 
• If possible, notify the client in advance and obtain their signed consent before the disclosure; 
• Only the minimum necessary information should be disclosed. For example, their name and the date and type of contact may be required, but not the professional relationship with the social worker. 

Read the full preliminary guidance from NASW National: Social Workers' Disclosure Responsibilities During the Pandemic

Most standard professional liability insurance policies do NOT cover telemedicine services. We strongly recommend you contact your insurance carrier to confirm the details of your policy. You may be required to purchase an additional rider or separate policy to cover telemedicine practice. If you do not have professional liability insurance, you can purchase a plan through NASW Assurance Services. 

For individuals covered under the NASW Risk Retention Group (RRG), they have released a statement noting that "the RRG professional liability policy provides coverage for Tele-therapy as long as it is an accepted practice conducted according to the individual practitioner’s state regulations, state licensing board requirements, and HIPAA privacy standards which vary by state and are continually evolving."

Place of service code for telehealth is generally ‘02’ instead of the usual ‘11’ for an office visit. The use of modifiers is dependent on each insurance company and may be required. Providers should contact their insurance company to inquire if it’s required or not.

As of 4/30/20, Medicare will now accept audio-only sessions for behavioral health services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. The payments are retroactive to March 1, 2020.

Private Commercial Insurance: Guidance issued by the NJ Dept of Banking and Insurance (DOBI) (Bulletin #20-07) directs health insurance companies, health maintenance organizations, health service corporations and other entities issuing health benefits plans to allow for audio-only telephone sessions under telehealth benefits. This guidance applies to insurers who are subject to regulation by DOBI including Horizon BCBS of NJ, the State Health Benefits Plan and the School Employees Health Benefit Plan. Commercial insurers not subject to oversight by DOBI (the majority of commercial insurers are not charted in NJ) are not bound by this guidance.

Medicaid: The NJ Division of Medical Assistance and Health Services (DMAHS) , the rule maker for NJ Medicaid, strongly encourages providers to use telehealth to the greatest extent possible. This includes "alternative technologies for telehealth such as an audio only telephone or video technology commonly available on smart phones and other devices." Read the full March 21 DMAHS bulletin. 

Medicare: April 30 update: CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020. Read the full April 30 guidance from CMS.

CMS has created a list of codes that permit audio-only telehealth delivery. Access the list.

Each state is responsible for setting laws regarding who is eligible to provide telemedicine services to residents of that state. In New Jersey, a practitioner must be licensed in New Jersey in order to provide telemedicine services within the state. If you are considering offering telemedicine services to a client located outside of New Jersey and you are not already licensed to practice social work in that state, NASW-NJ strongly recommends you contact that state’s NASW Chapter for guidance or reach out to that state’s social work licensing authority. 

If your client is currently located in New York State, you can find New York's Office of the Professions COVID-19 FAQ here (refer to question #9). If your client is currently located in Pennsylvania, you can find information about Pennsylvania's telemedicine waivers here. 

In response to the COVID-19 crisis, actions taken by the Federal government have loosened restrictions that prevent practitioners from providing services across state lines. However, these provisions apply only to Medicare, Medicaid, and Children’s Health Insurance Programs (CHIP). The response of private insurers is not governed by the federal government. Some private insurers are taking steps to improve access to services; others have not done so. 

On March 19, 2020 Governor Murphy signed bill A-3862 which grants the authority to the NJ Division of Consumer Affairs to provide licenses to out-of-state practitioners on an expedited basis during the remainder of this crisis. This law will make it easier for professionals licensed in other states to provide services to residents of New Jersey. We are currently awaiting word from the Division of Consumer Affairs and the NJ Board of Social Work Examiners as to how this new law will be implemented. 

The Governor also signed on March 19, 2020 bill A-3860 , which authorizes any health care practitioners to provide telemedicine and telehealth services for the duration of the public health emergency and directs the Commissioner of Health and the Director of Consumer Affairs to waive any requirements in law or regulation necessary to facilitate the provision of healthcare services using telemedicine and telehealth during the emergency. Read the press release here. 

Read the press release from the Division of Consumer Affairs authorizing expedited licensing for out of state social workers. 

Apply for expedited out of state licensure. 

The new law, however, does not provide the ability for New Jersey licensed practitioners to provide services to clients located outside of New Jersey. Each state is addressing its licensure policies individually; the Association of Social Work Boards (ASWB) is working to compile a National list of temporary changes to social work licensure laws nationwide. See the ASWB updates and tracking list. 

Governor Murphy's March 22, 2020 press release indicates that "an announcement regarding a regional telehealth initiative will follow."

The Council on Social Work Education (CSWE) has issued a statement (3/25/20) regarding approval of field hours for this school year. Of note: 

"Under CSWE accreditation standards, programs provide a minimum of 400 hours of field education for baccalaureate programs and a minimum of 900 hours for master’s programs. Due to the impact of the COVID-19 pandemic, students who have completed 85% of the required placement hours (i.e., 340 hours for baccalaureate programs and 765 hours for master’s programs) to a satisfactory level may, at program discretion, be evaluated as having met the field placement requirements. This option for reduced hours is for students whose field completion dates occur by December 31, 2020. Students whose field placement completion dates occur after December 31, 2020, will be expected to complete the full 400 or 900 hours in compliance with standards." 

Remote field activity, as well as field supervision and field seminar hours, may be counted toward the accrual of field hours, per earlier CSWE recommendations. 

If you have specific questions about how the accrual of your field hours will be measured and approved, please contact your school directly.