Legislature(2017 - 2018)BARNES 124
03/05/2018 03:15 PM LABOR & COMMERCE
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HB 353-MARITAL & FAMILY THERAPY LIC. & SERVICES 3:20:52 PM CHAIR KITO announced that the first order of business would be HOUSE BILL NO. 353, "An Act relating to the licensure of marital and family therapists; relating to medical assistance for marital and family therapists' services; and providing for an effective date." 3:21:29 PM BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska State Legislature, presented HB 353 on behalf of Representative Spohnholz, prime sponsor. She presented the PowerPoint "HB353: Marital & Family Therapist Licensure & Services" [included in committee packet]. MS. NISBETT addressed slide 2: What is marital & family therapy (MFT) and why is this important? ? MFTs treat serious clinical issues including depression, marital obstacles, anxiety, individual psychological problems, and child-parent difficulties. ? MFTS are mental health professionals trained in psychotherapy and family systems, and are licensed to diagnose and treat mental and emotional disorders within the context of marriage, couples, and family systems. ? Source: American Association for Marriage & Family Therapy, 2018. MS. NISBETT spoke to "What does this bill do?" in slides 3-6: 1. It requires 1,500 hours of supervision for marital and family therapists (MFTs). 100 hours of individual supervision, and 100 hours of group supervision may be conducted by one or more supervisors. 3:23:25 PM MS. NISBETT addressed slide 4: 2. It specifies that a qualified supervisor for individual supervision must have 5 years of experience in marital and family therapy and a license to practice. Or, that a qualified group supervisor can be licensed as another professional mental health clinician (LPC, LMFT, LCSW, Psy.D, M.D., or ANP). MS. NISBETT addressed slide 5: 3. It defines: ? Direct supervision one or more psychiatrists on- site a mental health physician clinic 30 percent of the time the clinic is open. ? Mental health physician clinic operated by one or more psychiatrists and primarily provides mental health services. ? Psychiatrist a person licensed to practice as a physician under AS 08.64 and is licensed by the State Medical Board as a psychiatrist. MS. NISBETT addressed slide 6: 4. Lastly, it allows the Department of Health & Social Services (DHSS) to reimburse a mental health clinic for services performed by mental health clinicians who are under the direct supervision of a psychiatrist. 3:25:18 PM MS. NISBETT paraphrased from the Sectional Analysis [included in committee packet] which reads as follows [original punctuation provided]: Section 1. AS 08.63.100(a) is amended to clarify that before an individual can receive a license to practice marital and family therapy, they must complete 1,500 of supervised clinical hours. Of those 1,500 hours, 100 hours must be individual supervision and 100 hours must be for group supervision. These 200 hours may be attended by one or more supervisors. Section 2. AS 08.63.120(b) is amended to state that a supervisor who oversees a license for individual supervision must have practiced marital and family therapy for five years, be licensed under this chapter, and meet the minimum standards established by the board for approved supervisors. A supervisor who oversees a licensee for group supervision must be licensed to practice as a professional counselor, a marital and family therapist, a physician, advanced nurse practitioner, psychologist, or clinical social worker. Section 3. AS 47.07.030(b) is amended to add marital and family therapists' services to the list of optional services that the Department of Health & Social Services (DHSS) may offer. Section 4. AS 47.07.030(g) defines "direct supervision," "mental health physician clinic," and "psychiatrist." Section 5. AS 47.07.030 is amending by adding a new section (h) that allows DHSS to reimburse a mental health physician clinic for services provided by a psychiatrist or an individual who works under direct supervisor and is licensed to practice as a professional counselor, a marital and family therapist, physician assistant, advanced nurse practitioner, psychologist, psychological associate, or clinical social worker. Section 6. Authorizes DHSS and the Board of Marital and Family Therapy to adopt regulations necessary to implement this Act. Section 7. States that Sec.6 of this Act will take effect immediately under AS 01.10.070(c). Section 8. Not including Sec.7 of this Act, the effective date of this bill will be January 1, 2018. 3:27:52 PM MS. NISBETT presented slide 16, "Suggestions from Stakeholders": ? Defining "direct supervision" as: ? One or more psychiatrists on-site at a mental health clinic 30 % of the time, OR ? Available by a communication device to provide general oversight. ? Allowing advanced nurse practitioners authorized by the Board of Nursing to practice as a psychiatric mental health nurse practitioner to provide direct supervision. ? Changing "mental health physician clinic" to simply, "mental health clinic." 3:30:06 PM REPRESENTATIVE JOSEPHSON asked what prompted the proposed bill. MS. NISBETT asked whether he was referring specifically to Licensed Marriage and Family Therapists (LMFTs). REPRESENTATIVE JOSEPHSON answered in the affirmative. MS. NISBETT deferred the question to a member of the board. REPRESENTATIVE JOSEPHSON asked why marriage and family therapists are the feature of this bill. 3:32:29 PM DOROTHEA GODDARD-AGUERO, Public Member, Board of Marital and Family Therapy, Office of the Governor, testified in support of HB 353. She explained the proposed bill would clarify the requirements to define who can be a supervisor. She added the board has very few members. She said she doesn't have the whole history of the proposed bill. 3:33:53 PM JON ZASADA, Policy Integration Director, Alaska Primary Care Association, testified in support of HB 353. He identified the association of qualified health centers and said they are operating at 160 sites within the state. He underlined the importance of expanding the billable mental health labor force. He said over 11,000 Alaskans receive primary behavioral health care in community health centers. He underlined the problem that there is a shortage of billable providers. It was recently discovered that Alaska health centers have a shortage of up to 18 behavioral health providers. He added at a conservative estimate, 9,000 additional Alaskans could be served if the labor force were full. MR. ZASADA said that currently health centers can only bill under a bundled rate for services from an MD, a PhD level psychiatrist, or an LCSW. He added centers also employ LMFTs and licensed professional counselors, but they cannot bill Medicaid. He added health centers continue to attract additional investment in behavioral health and substance abuse treatment with the goal of serving more patients in comprehensive care settings. The majority of these funds would be spent on hiring additional providers, but at this time those funds aren't sustainable because additional provider types are not billable under Medicaid. With new federal funding for addressing the opioid epidemic, community health centers expect additional direction and funding to continue to provide these services. He stated LMFTs are a good match for integrated primary care settings, caring for patients through timely intervention, short-term therapy, and collaborating with care coordinators and nurse practitioner prescribers. MR. ZASADA referenced Section 2 of the proposed bill and said the aim is to broaden the definition of a supervisor to include physicians and primary care MDs. He said these are the predominant supervising types in Alaska community health centers. MR. ZASADA spoke to language in Section 4 of the proposed bill. He said additional clarification was being sought that the mental health clinic allows primary care federally qualified health centers to benefit from the provider expansion. 3:38:35 PM REPRESENTATIVE SULLIVAN-LEONARD said she would like more information on Section 2. MR. ZASADA said broader supervision of psychiatrists was being sought. He added that having a psychiatrist creates an additional bottleneck to care and could cost well over $100,000 a year. 3:40:24 PM REPRESENTATIVE KNOPP asked whether there was any concern over asking psychiatrists who have extensive specialized training to be supervised by less specialized professionals. MR. ZASADA answered he is not an expert in supervision practices but said family practice physicians have a level of behavioral health supervision in their training and it is a best practice in other states. REPRESENTATIVE KNOPP reiterated his concern about the discrepancies in education in the groups. MS. NISBETT answered LMFTs must have a master's degree or PhD to practice and have to have 1,500 hours or two years before they can get licensed. She added LMFTs must pass an examination and maintain a clean record. 3:43:03 PM REPRESENTATIVE WOOL asked about the types of therapy covered in the proposed bill. MR. ZASADA answered that in a community health center the trend has been to integrate care in one site, so a care team would likely have an MD, a physician's assistant, and a nurse practitioner, a prescribing nurse practitioner, and a licensed clinical social worker. He said with the proposed bill, an LMFT would be added. He stated addressing behavioral health with medical assistance in one visit helps control the cost of care overall. 3:46:09 PM CHAIR KITO opened public testimony on HB 353. 3:46:19 PM ALBERT WALL, Chief Executive Officer, Peninsula Community Health Services of Alaska, testified in the hearing on HB 353. He clarified the services that LMFTs provide and how LMFTs bill. He said there is currently a way for LMFTs to bill through Medicaid. He said they can bill at a community mental health center that is a grantee of the state. He said the reimbursement rate on the rehabilitation side is very poor, so many of them do not. He explained it is the bottleneck that needs to be addressed. He added right now oversight is limited to psychiatrists and there are not enough in the state to provide oversight for clinicians. MR. WALL said he strongly supports an advanced nurse practitioner being given the ability to supervise as they have specialized training and it would take some of the burden off the smaller providers in the state. He said most small clinics don't have the money to hire a full-time psychiatrist and allowing advanced nurse practitioners to sign off would reduce the administrative and financial burden on the clinic, so it can provide more services for less money. 3:50:20 PM CHAIR KITO spoke to the supervision aspect and said he was confused about a psychiatric nurse practitioner supervising a licensed psychiatrist as they would not have the same experience or be qualified to sign off on mental health experience for licensing. MR. WALL gave the example of his organization. He stated the Chief Medical Officer (CMO) there is a psychiatrist. He added the center is under two separate sets of regulations as they are a federally qualified center and a Division of Behavioral Health grantee. He said there are also two advanced nurse practitioners with psychiatric experience. He added he is more comfortable with advanced nurse practitioners having oversight of LMFTs as they have direct contact with evidence-based practice and clinical work. CHAIR KITO asked whether advanced nurse practitioners provide therapy services. MR. WALL answered they can provide therapy services, but most do not because they tend to bill at the top end of their licensure. CHAIR KITO reiterated his concern. He said he did not think the state would accept that a LMFT could sign off on the therapy hours of a licensed psychologist. MR. WALL said he did not think the proposed bill was asking for LMFTs to sign off on hours. CHAIR KITO stated he was trying to understand the knowledge and experience of the people who would be given the ability to sign off. 3:55:24 PM REPRESENTATIVE JOSEPHSON surmised the aim of the proposed bill would be to expand the number of mental health practitioners that are able to bill for Medicaid. He asked whether that was the case. MR. WALL clarified that the bill is not about supervision of client hours. He said there are two different types of supervision. He explained that when a therapist is going for licensure, they receive 15 hours of oversight in which trainers observe therapy and educate on improvements. He stated that was not in the proposed bill. The supervisors are supervising the actual clinical work only for the submission of the billing process. Currently, psychiatrists are the only people that can do that and LMFTs can't do the work they are trained to do because there are not enough people to provide oversight. 3:59:07 PM CHAIR KITO announced he would leave public testimony open on HB 353. CHAIR KITO held over HB 353.