Legislature(1993 - 1994)
04/14/1994 03:00 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HOUSE LABOR AND COMMERCE STANDING COMMITTEE April 14, 1994 3:00 p.m. MEMBERS PRESENT Rep. Bill Hudson, Chairman Rep. Joe Green, Vice Chair Rep. Eldon Mulder Rep. Brian Porter Rep. Jerry Mackie MEMBERS ABSENT Rep. Bill Williams Rep. Joe Sitton COMMITTEE CALENDAR *HB 545: "An Act including marital and family therapists as providers protected from unfair discrimination under group disability insurance; and providing for an effective date." PASSED OUT OF COMMITTEE HB 458: "An Act relating to certain licenses and applications for licenses for persons who are not in substantial compliance with support orders or payment schedules for child support." HEARD AND HELD IN COMMITTEE (* First public hearing.) WITNESS REGISTER DIXIE HOOD Licensed Marriage and Family Therapist 222 Seward, Suite 210 Juneau, Alaska 99801 Phone: (907) 586-2200 Position Statement: Testified in support of HB 545 SHERRIE MARKIN GOLL, Lobbyist Alaska Association for Marriage & Family Therapists P.O. Box 22156 Juneau, Alaska 99827 Phone: (907) 463-6744 Position Statement: Answered questions on HB 545 REP. JOHN DAVIES Alaska State Legislature State Capitol, Room 400 Juneau, Alaska 99801 Phone: (907) 465-4457 Position Statement: Prime Sponsor of HB 458 MARY GAY, Director Child Support Enforcement Division Department of Revenue 550 W. 7th, Suite 312 Anchorage, Alaska 99501-3556 Phone: (907) 269-6800 Position Statement: Testified in support of HB 458 MATT ANDERSON, Training Coordinator Emergency Medical Services Division of Public Health Department of Health and Social Services P.O. Box 110616 Juneau, Alaska 99811-0616 Phone: (907) 465-3027 Position Statement: Testified in support of HB 458 with considerations PATRICIA J. O'BRIEN Social Services Program Officer Division of Family and Youth Services Department of Health and Social Services P.O. Box 110630 Juneau, Alaska 99811 Phone: (907) 465-2145 Position Statement: Testified in support of HB 458 with considerations PREVIOUS ACTION BILL: HB 545 SHORT TITLE: DISCRIMINATION UNDER HEALTH INSURANCE SPONSOR(S): LABOR & COMMERCE BY REQUEST JRN-DATE JRN-PG ACTION 04/06/94 3155 (H) READ THE FIRST TIME/REFERRAL(S) 04/06/94 3155 (H) LABOR & COMMERCE 04/12/94 (H) L&C AT 03:00 PM CAPITOL 17 04/12/94 (H) MINUTE(L&C) 04/14/94 (H) L&C AT 03:00 PM CAPITOL 17 BILL: HB 458 SHORT TITLE: CHILD SUPPORT NONPAYMENT/LICENSING BAN SPONSOR(S): REPRESENTATIVE(S) DAVIES JRN-DATE JRN-PG ACTION 02/09/94 2320 (H) READ THE FIRST TIME/REFERRAL(S) 02/09/94 2321 (H) L&C, JUDICIARY, FINANCE 04/05/94 (H) L&C AT 03:00 PM CAPITOL 17 04/05/94 (H) MINUTE(L&C) 04/07/94 (H) L&C AT 03:00 PM CAPITOL 17 04/08/94 (H) FIN AT 01:30 PM HOUSE FINANCE 04/14/94 (H) L&C AT 03:00 PM CAPITOL 17 ACTION NARRATIVE TAPE 94-37, SIDE A Number 001 CHAIRMAN HUDSON called the meeting to order at 3:17 p.m., stated there was a quorum present and announced the calendar. He said the committee would address committee substitute (CS) HB 545 dated 4/11/94 and he also mentioned that SB 64/HB 251 would not be addressed at today's meeting. He asked DIXIE HOOD to present the bill. HB 545 - DISCRIMINATION UNDER HEALTH INSURANCE Number 025 DIXIE HOOD, Licensed Marriage and Family Therapist, testified in support of HB 545. She said it was not possible for a board member of the Alaska Association for Marriage and Family Therapy to attend the meeting, but a document from Mercy Dennis, chair of the association's legislative committee, was made available to committee members. She presented the following statement: "My name is Dixie Hood. I am a licensed marriage and family therapist in private practice in Juneau. I am here to ask your support for HB 545. This bill would provide licensed marriage and family therapists parity with other licensed health care professionals in Alaska. In addition to private practice I have worked as a mental health clinician and as a substance abuse counselor with the Juneau Department of Health and Social Services. My training and experience includes working with clients who are experiencing depression, severe anxiety, eating disorders, phobias, schizophrenia and other serious mental disorders as well as clients who are suffering emotional stress from family or work situations. I developed a substance abuse treatment program at the State Correctional Center at Lemon Creek. I mention these things because some of you may have the idea that the work of marriage and family therapists is limited to minor personal problems or marriage and divorce counseling. "I would like to briefly describe my own experience in this profession in Alaska. Because of limited academic resources in this state, I went to California for clinical training. After two years of graduate school, 3,000 supervised hours, and written and oral exams, I earned licensure in California. In California one could not call themselves a counselor or do the work of counseling without such preparations and licensure. I returned to Alaska to work and learned that there were no standards or license for counselors and that only a state business license was required. For this I paid seven dollars and 50 cents. This was ten years ago. I inquired about the standard counseling fees in Juneau. Counselor friends told me that the going rate was 40 dollars per hour because that was half of what psychologists charged. Medical insurance would reimburse 50 percent for services provided by psychologists so 40 dollars was the amount a client had to pay out of pocket. Therefore, in order to compete, counselors charged 40 dollars. It was not a level playing field. As I established myself as a psychotherapist in the community I was able to increase my professional fee to a more supportable income. However, Juneau is a government town with many employees having good medical insurance. When seeking health services, they want maximum reimbursement. Licensed medical doctors, psychiatrists, and psychologists have been regularly reimbursed by insurance companies. When licensed social workers were added to the list of providers not to be discriminated against, that offered another level of service and fee options to perspective clients. Adding marriage and family therapists to this list would not expand the number of clients served or the cost. It would add an alternative level of treatment. This is comparable to nurse practitioners versus physicians for medical treatment. It can actually decrease the costs of service. Marriage and family therapists are qualified to do much of the same work as other licensed mental health professionals and can do it cheaper. In Juneau there is a shortage of psychiatrists. They often see clients only for the prescription and monitoring of medication and not for psychotherapy. There are often waiting lists for psychiatrists and psychologists because of insurance reimbursement considerations. In many smaller communities in Alaska there are neither psychiatrists nor psychologists nor social workers. "Passage of HB 545 would enable clients some reasonable options in choosing treatment. Thanks to lobbying efforts by the Alaska Association for Marriage and Family Therapy and the support of the legislature and the administration two years ago, there are now established standards for licensing marriage and family therapists in this state. Parity in terms of third party payment is the logical next step. The ability to conduct a private practice depends, to a significant extent, upon insurance and other forms of reimbursement. I urge you to move this bill forward. I would be glad to answer any questions." Number 080 REP. MULDER asked about the standards adopted for licensure in Alaska. Number 082 SHERRIE GOLL, Lobbyist, Alaska Association for Marriage and Family Therapy, replied that standards are similar to those in California and consist of a master's degree and 3,000 hours of supervision. MS. HOOD referred to a grandfather clause that enabled those who qualified to become licensed in Alaska last August. She said because she was licensed in California and was also a member of the American Association for Marriage and Family Therapy, she presented the necessary background to become licensed. REP. MULDER asked if there were people grandfathered-in who did not possess the minimum qualifications. MS. GOLL indicated that national standards had to be maintained. REP. MULDER asked if a master's level training was offered in Alaska. MS. HOOD said she thought the nearest program was in Seattle. It was pointed out that neither a social work program nor a master's level training program was available in Alaska. Number 097 REP. GREEN mentioned that nurse practitioners have certain restrictions as compared to physicians. Comparably, he posed a question about the limitations imposed on therapists when dealing with emotional or psychological problems. Number 101 MS. HOOD replied that she was trained and qualified to do psychological evaluations, diagnosis, and treatment within the range of her background experience. She stated she was not able to issue prescription medication or provide psychological testing. She added that some marriage and family therapists have the expertise to do that sort of testing and therefore the limitation would be in terms of experience. She said she has worked at in-patient psychiatric facilities and also at a day care center for chronic schizophrenics, so she has worked with a severely mentally ill population. Number 117 REP. GREEN asked if she would know if she was working with someone who was depressed as opposed to someone who was schizophrenic and needed psychiatric treatment. Number 120 MS. HOOD replied that her responsibility was to do an evaluation and determine if a situation was within the scope of her experience and training; if this was not the case, she would make an appropriate referral. Number 125 REP. MULDER said, "You mentioned it would be less expensive to have you included under this umbrella because you provide many of the same services for less cost. How do your average charges reflect against those of a licensed psychiatrist?" Number 129 MS. HOOD replied that her fee is 75 dollars and she believes the psychiatrists in Juneau charge 100-125 dollars, and psychologists charge 80-100 dollars. Number 134 REP. MULDER asked if it was reasonable to expect that her fee structure would change if insurance was involved. MS. HOOD said she did not think this would be the case. She explained that the Human Affairs Managed Care Organization determines an appropriate rate and will not offer reimbursement if someone charges more than what has been determined as fair. She said she knows of at least one psychologist in Juneau who experienced a problem being accepted as a preferred provider because insurance was reluctant to pay the additional amount that was being charged. Number 149 REP. MULDER asked if any insurance plans currently cover the services Ms. Hood provides. MS. HOOD replied in the affirmative. REP. MULDER asked about the tolerances currently provided by insurance companies. He posed a question about the upper level Ms. Hood could charge and still remain covered by insurance. MS. HOOD said she had not heard a stated figure. Number 150 REP. MULDER said he thought it was common practice that insurance companies allowed up to "x" amount of dollars. MS. GOLL (indiscernible) said the top limit is not really known because marriage and family therapists charge below that limit, and therefore what they do charge is acceptable. MS. HOOD said she thought the Juneau Department of Health and Social Services bills insurance companies at a higher amount for their clinicians than what private practice therapists charge. Number 160 REP. MULDER asked Ms. Hood if her practice was covered by state employee coverage. MS. HOOD said she could see clients who were state employees, but she had to do this in a roundabout way. She explained that a physician's referral and supervisory statement was needed because of the physician's license. She said physicians were very supportive of counseling because it often helped with medical symptoms, such as chronic headaches and stomach aches, which frequently have psychosomatic aspects. She added that she thought it a legitimate consideration to be working under her own license rather than a physician's. Number 174 REP. MULDER asked if the administration viewed this as a cost saving mechanism for health care. CHAIRMAN HUDSON indicated a zero fiscal note and stated that HB 545 simply adds marital and family therapists to the line for insurance so that they might receive treatment similar to that of other professionals. He said they had not received any negative remarks from the administration. Number 180 REP. MACKIE moved to pass CSHB 545(L&C) from committee with individual recommendations and zero fiscal note. Number 184 CHAIRMAN HUDSON, hearing no objection, declared it was so moved. CHAIRMAN HUDSON then announced HB 458 was the next order of business. HB 458 - CHILD SUPPORT NONPAYMENT/LICENSING BAN Number 187 REP. MACKIE moved to adopt CS, 4/14/94 work draft, for HB 458, thereby officially placing it before the committee. Number 194 (Chairman Hudson excused both Rep. Mackie and Rep. Porter from the meeting.) Number 195 CHAIRMAN HUDSON said because of the late date in the session, the committee would honor its commitment to the prime sponsor. He asked Rep. John Davies to explain the difference between the CS and HB 458 that was previously heard. Number 197 REP. JOHN DAVIES, Prime Sponsor of HB 458, presented a list of desirable changes that had been incorporated into the CS. He read these changes to the committee from the document entitled, "Changes to CS HB 458; Work Draft 8-LS1440\E". He referred to the request to include the word "reasonable" and said this was not included because it seemed to be redundant and because of consistency difficulties throughout the document. He also acknowledged that the concern pertaining to "parallel appeal processes" had been addressed. He said if this bill wanted to go to the Finance Committee there could be further discussion about which items should be included on the list given the financial impact. He said, "If you are happy with the way the bill is, if we were to just move it out of the committee so that the CS became the committee substitute, then we could request official fiscal notes to the substitute and that information would then be available to the Finance Committee, if they choose to look at what the fiscal impacts would be for the various licenses on the list." Number 320 MARY GAY, Director, Child Support Enforcement Division (CSED), Department of Revenue, said the changes would enhance the bill and she was pleased that a licensing bill to help with the collection of child support had been brought forth. She said this legislation would serve as a vehicle to induce self-employed people to pay their child support. MS. GAY said last year CSED collected 50 million dollars in child support from 46 percent of the cases with established orders, indicating that child support was not received from 54 percent of the cases. She said a national statistic estimates 46 percent of the population as self-employed. She explained that by estimating 25 percent of self-employed people as not paying child support, an estimated six million dollars could be collected. She further explained that 50 percent of that would be for Aid to Families with Dependent Children (AFDC) cases totaling approximately three million dollars, one and one half million of which would be returned to the general fund. She concluded by saying this would help the state and it would help families. Number 345 REP. MULDER asked if this would assist the division in identifying people who owe money in child support payments. MS. GAY replied that hopefully people would come to CSED because they would want to keep their licenses. REP. MULDER asked if this would diminish CSED's pursuer costs. MS. GAY responded in the affirmative. She mentioned that congress is considering mandating the licensing law nationally so that certain licenses would have to interface with CSED. She commented that Alaskans might have a higher percentage of self-employed people than other places. In response to Rep. Mulder's question about the amount of money in arrears, she said the total amount was 330 million dollars. Ms. Gay considered input from Lorraine Derr and then said she was unsure of the annual arrears amount, but she could check into it. REP. MULDER wondered how big this problem was and if the proposed legislation was an effective means of reaching people. Number 395 MS. GAY said this approach has been helpful in other states such as California, Washington, South Dakota, Minnesota, and Maine. REP. DAVIES interjected and said the following states "go after licenses": Arizona, California, Maine, Minnesota, Pennsylvania, South Dakota, and Vermont. MS. GAY said she had access to more complete information in this regard. Number 410 REP. MULDER pointed out that taking away a person's commercial fishing license or limited entry permit might, in effect, deny that person the opportunity to catch up in their child support payments. MS. GAY said they put liens on permits but do not enforce the sale of permits. REP. MULDER confirmed with Ms. Gay that CSED would be the first in line and would have to be satisfied before the permit could be transferred. He considered this to be a reasonable means. Number 429 REP. DAVIES said the intent of the bill is not to take away licenses, but to get people's attention in order to begin a serious dialogue regarding the level of payment capable of being made. He said experience from other states indicates that 80 percent of the cases come into compliance upon notification. He said the other 20 percent would be worked with to determine possible arrangements. He added he did not think it was CSED's intent to be collecting licenses, although he indicated there might be cases where the ability to pay is demonstrated and yet the person shows contempt for the process. He said in those cases the ability to earn a livelihood is clearly demonstrated and there is no question of taking livelihood away from a person. Number 447 REP. MULDER said this was an important point to have on record. He asked if this legislation could be viewed as helping to establish the connection between payer and payee, thereby resorting to seizure of the license or permit as a means of last resort. MS. GAY answered this was correct. She mentioned that keeping the focus on occupational licenses is most appropriate because what CSED really wants is compliance. REP. MULDER recommended that if the costs of performing computer match-ups proved to be substantive, those costs be charged to the person in arrears so that the state would not bear additional costs. MS. GAY explained that approximately 100 percent of CSED's budget is provided by the federal government and is determined from a combination of federal incentives based on collection, and a 66 percent match. She said the state would not be responsible for the data processing expenses incurred because those expenses could be submitted to the federal government. She added that CSED could feasibly collect three million dollars from AFDC cases and 50 percent of the portion collected would go to the general fund. Number 496 REP. DAVIES added that in a net sense, there would be minimal implementation costs involved in collecting even one million dollars. He also mentioned that in the CS, page 6, line 8, section (o), there is already a provision pertaining to Rep. Mulder's suggestion. Number 500 REP. GREEN referred to the sum of approximately one-half million dollars in fiscal notes and asked if there were statistics from other states indicating their success rates with implementing this type of program. He explained the basis of his inquiry was he wondered about the probable stability of some of the people in arrears and asked if the CSED would have to go back and forth on a given case because people would have a series of excuses, specifically if a lien was put on a license. Number 506 MS. GAY replied that she thought a portion of the people notified would respond and pay, and a portion would ignore their responsibility. She reiterated that noncompliance provided for a 2,500 dollar minimum and explained that liens were put on fishermen's licenses and not on something like a hairdresser's license. She said CSED would not pro-actively be taking licenses away. She explained that a person would have the choice to have a payment plan and to continue their license. She pointed out to Rep. Green that even if a large sum of money were owed, a person could still be in agreement with CSED by paying something toward the arrears. She said this situation is more difficult in court-ordered child support cases. TAPE 94-38, SIDE B Number 019 MATT ANDERSON, Training Coordinator, Emergency Medical Services, Division of Public Health, Department of Health and Social Services, referred to CS page 2, line 9, paragraph (d). He mentioned that his office commonly issues certificates that are 60 days in length and he inquired as to the appropriate method of managing this situation. He suggested the language be changed to read, "up to 150 days". REP. DAVIES said possibly the way to handle this situation was to exempt temporary licenses from the list. Number 039 MR. ANDERSON agreed this would address that particular problem. He then referred to page 8, line 18, and asked if this query was clearly from CSED and not from any other agency. Upon hearing from Rep. Davies's staff that, yes, the query was from CSED, he suggested that the language read, "when queried by an agency under (a) of this section as to the license status..." He said the division is supportive of HB 458 and wants to make sure they can implement it properly. Number 072 PATRICIA J. O'BRIEN, Social Services Program Officer, Division of Family and Youth Services (DFYS), Department of Health and Social Services, said DFYS supports the intent of HB 458 but has concerns pertaining to children's programs. She noted that DFYS is short-staffed and currently recognizes HB 412's "community care facilities" as an attempt to help streamline their licensing process and views this legislation as complicating that process. She also mentioned that if the assisted living bill passes, it might affect adult foster homes and adult residential care facilities. She said DFYS's largest concern with regard to HB 458 is foster homes. She mentioned the 90-day emergency licensing at foster homes and several other reasons as evidence that child foster care facilities should be removed from this list. She mentioned other facilities, such as family child care homes and child care centers, as facilities that might be negatively affected by HB 458. She said with regard to family child care homes, Alaska has one of the most liberal statutes in the nation in that a person can care for four children without a license. She explained that DFYS encourages people to become licensed and because this legislation might dissuade that from happening, the division would prefer that this not apply to family child care homes. She explained that DFYS is concerned about potential litigation and safety for children, and as they do not allow child care centers to operate without a license, they would prefer that child care centers also not be included on this list. Number 137 CHAIRMAN HUDSON said the committee would hold HB 458 and suggested that Rep. Davies contact the Finance Committee. He said he did not want to move the bill on to the Judiciary Committee until they had responded to the concerns expressed in today's meeting. He said Rep. Davies could submit another draft and the committee would be happy to bring the bill back up again. Number 157 REP. DAVIES replied that concerns mentioned today seemed to be straightforward and relatively easy to address. He thought the issue regarding which licenses to include on the list should be approached from a financial context pertaining to a cost benefit analysis of the impact on the agencies. He added that this would be difficult to accomplish until he had a current fiscal note. REP. MULDER said he was particularly sensitive to the concerns expressed by Ms. O'Brien. He said helping one child at the expense of others is not good policy, even if there were economic benefits involved. He said he was interested in the cost benefit but suspected the overall benefit would be toward excluding some categories from the list. Number 179 CHAIRMAN HUDSON said this was a policy call that could be based on costs and other things, but he appreciated the input from Ms. O'Brien. Number 182 REP. DAVIES agreed that testimony from Ms. O'Brien was well received and indicated that he did not see a problem with excluding certain facilities from the list. Number 183 CHAIRMAN HUDSON adjourned the meeting at 4:20 p.m.