Legislature(1993 - 1994)
04/14/1994 03:00 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= 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.
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