Legislature(2005 - 2006)BUTROVICH 205

01/25/2006 01:30 PM HEALTH, EDUCATION & SOCIAL SERVICES


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01:32:39 PM Start
01:38:43 PM SB177
02:18:53 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 177 PRACTICE OF PSYCHOLOGY TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                        January 25, 2006                                                                                        
                           1:32 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Fred Dyson, Chair                                                                                                       
Senator Gary Wilken, Vice Chair                                                                                                 
Senator Lyda Green                                                                                                              
Senator Kim Elton                                                                                                               
Senator Donny Olson                                                                                                             
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 177                                                                                                             
"An Act eliminating the requirement  that persons using titles or                                                               
descriptions   of    services   that   incorporate    the   terms                                                               
'psychotherapy,'  'psychotherapeutic,'  or  'psychotherapist'  be                                                               
licensed  by   the  Board   of  Psychologist   and  Psychological                                                               
Associate Examiners."                                                                                                           
     HEARD AND HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 177                                                                                                                  
SHORT TITLE: PRACTICE OF PSYCHOLOGY                                                                                             
SPONSOR(s): HEALTH, EDUCATION & SOCIAL SERVICES BY REQUEST                                                                      
                                                                                                                                
04/15/05       (S)       READ THE FIRST TIME - REFERRALS                                                                        
04/15/05       (S)       HES, L&C                                                                                               
04/20/05       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
04/20/05       (S)       Scheduled But Not Heard                                                                                
01/25/06       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
Anne Henry, Chair                                                                                                               
Board of Professional Counselors                                                                                                
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community & Economic Development                                                                        
PO Box 110800                                                                                                                   
Juneau, AK  99811-0800                                                                                                          
POSITION STATEMENT:  Supported SB 177.                                                                                        
                                                                                                                                
John Miller, Ph.D., Chair                                                                                                       
Board of Psychologist and Psychological Associate Examiners                                                                     
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community & Economic Development                                                                        
PO Box 110800                                                                                                                   
Juneau, AK  99811-0800                                                                                                          
POSITION STATEMENT:  Supported SB 177.                                                                                        
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR FRED DYSON  called the Senate Health,  Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 1:32:39  PM.                                                             
Present were Senators  Donny Olson, Kim Elton,  Gary Wilken, Lyda                                                               
Green, and Chair Fred Dyson.                                                                                                    
                                                                                                                                
                 SB 177-PRACTICE OF PSYCHOLOGY                                                                              
                                                                                                                              
CHAIR DYSON  announced SB  177 to  be up  for consideration.   He                                                               
informed  members that  the  purpose  of the  bill  was to  bring                                                               
statute  in  accordance  with  regulation   with  regard  to  the                                                               
nomenclature used by mental health  practitioners.  [In committee                                                               
packets was  a proposed committee substitute,  version G, labeled                                                               
24-LS0893\G, Mischel, 1/17/06.]                                                                                                 
                                                                                                                                
1:38:43 PM                                                                                                                    
                                                                                                                                
ANNE  HENRY, Chair,  Board of  Professional Counselors,  said she                                                               
and  John  Miller,  chair  of   the  Board  of  Psychologist  and                                                               
Psychological  Associate   Examiners,  have  worked   with  other                                                               
members of the  mental health community to  expand the categories                                                               
of  mental   health  practitioners  allowed  to   use  the  terms                                                               
"psychotherapist,"  "psychotherapeutic"  and  "psychoanalyst"  to                                                               
describe their professional practices.                                                                                          
                                                                                                                                
CHAIR  DYSON asked  whether members  of the  community of  mental                                                               
health providers  have reached a  consensus regarding the  use of                                                               
those terms.                                                                                                                    
                                                                                                                                
MS. HENRY replied that they have reached a consensus.                                                                           
                                                                                                                                
CHAIR  DYSON asked  her to  describe the  history of  the problem                                                               
that the bill intends to solve.                                                                                                 
                                                                                                                                
MS.  HENRY  replied  that  when the  board  was  established,  it                                                               
limited the categories of practitioners  legally permitted to use                                                               
the  aforementioned  terms  in the  interest  of  public  safety.                                                               
Since  that  time,  Medicaid  regulations  have  allowed  several                                                               
different  groups,  including  Licensed  Professional  Counselors                                                               
(LPCs) and  Marriage and Family  Therapists (MFTs), to  use these                                                               
terms  to   describe  their  practices.     Since   the  original                                                               
limitation  language remains  in statute,  many of  these groups,                                                               
including LPCs and MFTs, are prevented from using these terms.                                                                  
                                                                                                                                
SENATOR GREEN moved to adopted  CSSB 177(HES), version G, labeled                                                               
24-LS0893\G,  Mischel,   1/17/06,  as  the   committee's  working                                                               
document.  There were no objections and it was so ordered.                                                                      
                                                                                                                                
SENATOR OLSON  asked whether  passage of  this bill  could create                                                               
changes in  the amount of  Medicaid reimbursement that  the state                                                               
receives.                                                                                                                       
                                                                                                                                
MS.  HENRY replied  that it  would  not create  any such  changes                                                               
because Medicaid  already recognizes all of  the disciplines that                                                               
would be allowed.                                                                                                               
                                                                                                                                
SENATOR  WILKEN referenced  an April  16, 2005,  letter from  Pam                                                               
Watts  to Chair  Dyson,  prompting the  question  of whether  the                                                               
reclassification  of  terms   would  create  additional  Medicaid                                                               
services and increase the state's Medicaid budget.                                                                              
                                                                                                                                
MS. HENRY  responded that  the bill  would not  create additional                                                               
Medicaid  services  because  it  only applies  to  categories  of                                                               
mental health providers already covered by Medicaid.                                                                            
                                                                                                                                
1:45:34 PM                                                                                                                    
                                                                                                                                
SENATOR GREEN  asked whether  the practitioners  within different                                                               
disciplines receive different rates of Medicaid reimbursement.                                                                  
                                                                                                                                
MS.  HENRY advised  that Medicaid  reimbursement is  $85 an  hour                                                               
regardless of the discipline of  the practitioner or the level of                                                               
education required  to achieve licensure  to practice in  a given                                                               
discipline.                                                                                                                     
                                                                                                                                
1:47:19 PM                                                                                                                    
                                                                                                                                
SENATOR GREEN  remarked that the  committee might benefit  from a                                                               
chart  showing  the  qualifications  of  different  practitioners                                                               
relative to  their typical  rates.  She  asked whether  a private                                                               
health  carrier would  have  to  recognize an  LPC  or  MFT as  a                                                               
psychologist if the bill were to become law.                                                                                    
                                                                                                                                
MS. HENRY offered  to provide the committee with  a chart showing                                                               
a  matrix  of   the  requirements  for  licensure   in  the  four                                                               
disciplines.   She said she  could not  give a concise  answer to                                                               
the question about the private sector.                                                                                          
                                                                                                                                
1:49:18 PM                                                                                                                    
                                                                                                                                
CHAIR DYSON asked  if he was correct in his  understanding that a                                                               
psychiatrist is  a medical doctor  specializing in  mental health                                                               
and a psychologist is a mental health worker with a Ph.D.                                                                       
                                                                                                                                
MS. HENRY affirmed that.                                                                                                        
                                                                                                                                
CHAIR  DYSON  asked  whether  the   rest  of  the  aforementioned                                                               
practitioners are qualified by a master's degree.                                                                               
                                                                                                                                
MS. HENRY replied yes.                                                                                                          
                                                                                                                                
CHAIR DYSON asked if the  reclassification of terms would entitle                                                               
some  practitioners  to   additional  third-party  payments  from                                                               
private insurance companies.                                                                                                    
                                                                                                                                
JOHN   MILLER,   Ph.D.,   Chair,  Board   of   Psychologist   and                                                               
Psychological  Associate Examiners,  replied that  the bill  only                                                               
pertains to practitioners that are already Medicaid providers.                                                                  
                                                                                                                                
1:54:54 PM                                                                                                                    
                                                                                                                                
CHAIR  DYSON reiterated  his question  of whether  private-sector                                                               
practitioners would  be able to  use the aforementioned  terms to                                                               
qualify  themselves  for   additional  third-party  payment  from                                                               
private insurers.                                                                                                               
                                                                                                                                
DR. MILLER replied  that SB 177 would not enable  them to receive                                                               
additional payment from third-party insurers.                                                                                   
                                                                                                                                
CHAIR  DYSON asked  if there  are insurance  companies that  make                                                               
coverage decisions based  on the titles of  practitioners and, if                                                               
so,  whether passage  of the  bill would  allow practitioners  to                                                               
change  their titles  to  receive  additional reimbursement  from                                                               
insurance companies.                                                                                                            
                                                                                                                                
DR. MILLER  replied no, because  insurance companies do  not make                                                               
coverage   decisions   based   on  the   terms   "psychotherapy,"                                                               
"psychotherapist" or "psychoanalyst," but make  them on the basis                                                               
of the type of license that a practitioner holds.                                                                               
                                                                                                                                
SENATOR  GREEN  referenced  the   following  paragraph  from  the                                                               
April 16, 2006, letter from Pamela Watts:                                                                                       
                                                                                                                                
     For Alaskans, this would mean  greater access to needed                                                                    
     services,  often  at  less  cost   to  them  than  they                                                                    
     currently might pay.  They  could receive mental health                                                                    
     services,  and have  greater opportunity  to use  their                                                                    
     own  insurance  to  cover those  services  provided  by                                                                    
     agencies and providers qualified to perform them.                                                                          
                                                                                                                                
She  asked  Ms.  Henry  to  clarify  whether  the  aforementioned                                                               
paragraph indicated  that practitioners would  receive additional                                                               
third-party payments under this bill.                                                                                           
                                                                                                                                
1:56:55 PM                                                                                                                    
                                                                                                                                
MS.  HENRY  replied that  she  does  not  know of  any  insurance                                                               
company that  reimburses payment for  a type of treatment  on the                                                               
basis of its  title.  She said when an  insurance company makes a                                                               
coverage decision,  it does so on  the basis of the  license held                                                               
by the practitioner,  rather than on the title  of the treatment.                                                               
Since the  bill would  have no  effect on  the types  of licenses                                                               
issued by  the board, it  should not  have an effect  on coverage                                                               
decisions made by insurance companies.                                                                                          
                                                                                                                                
2:00:33 PM                                                                                                                    
                                                                                                                                
CHAIR DYSON thanked both Ms. Henry  and Dr. Miller and asked them                                                               
to excuse the  skepticism that the committee has  gained from the                                                               
constant  bombardment from  people trying  to use  whatever means                                                               
necessary to  gain access  to third-party payments.   He  said he                                                               
appreciates  their efforts.    He  added that  his  wife, who  is                                                               
retired, held  one of these  licenses; while he does  not believe                                                               
this represents a  conflict of interest, he wished  to mention it                                                               
for the record.                                                                                                                 
                                                                                                                                
2:02:17 PM                                                                                                                    
                                                                                                                                
CHAIR  DYSON set  aside  the  public hearing  on  the content  of                                                               
SB 177 in  order to  hear the  comments of  the witnesses  on the                                                               
proposed combination of the LPC and MFT boards.                                                                                 
                                                                                                                                
SENATOR OLSON asked  whether combining the boards  could have any                                                               
foreseeable impact on the rates  for malpractice insurance in the                                                               
state.                                                                                                                          
                                                                                                                                
MS. HENRY  replied it is unlikely  that it would have  a negative                                                               
impact on the rates.                                                                                                            
                                                                                                                                
DR.  MILLER  surmised  that,  if anything,  it  might  help  many                                                               
practitioners  with their  malpractice  rates  because the  terms                                                               
"psychotherapist"  or  "psychotherapy"  likely  appear  in  their                                                               
insurance  policies   and  they  cannot  apply   these  terms  to                                                               
themselves under current statute.                                                                                               
                                                                                                                                
SENATOR  OLSON asked  if  combining the  boards  could raise  the                                                               
board fees paid by practitioners.                                                                                               
                                                                                                                                
MS.  HENRY replied  that that  board fees  could increase  if the                                                               
boards  were combined,  because the  larger board  would have  at                                                               
least as  many meetings  as the smaller  boards and  the meetings                                                               
would cost more  because of the larger size. She  did not see how                                                               
combining  the  boards  could  protect  public  safety  any  more                                                               
effectively than the existing separate boards.                                                                                  
                                                                                                                                
2:07:44 PM                                                                                                                    
                                                                                                                                
DR.  MILLER noted,  if the  boards  were combined  into one,  its                                                               
members  would be  subject to  the cost  of disciplinary  actions                                                               
taken against  members of the  other discipline.   He said  it is                                                               
unfair  to expect  individuals to  pay  for the  mistakes of  the                                                               
members of a separate discipline.                                                                                               
                                                                                                                                
2:10:33 PM                                                                                                                    
                                                                                                                                
CHAIR DYSON said  he recognizes that requiring boards  to pay for                                                               
their own  administration has  created a  dilemma for  the state.                                                               
While the state is concerned  about the aforementioned situation,                                                               
it  does  not  want  to create  a  disincentive  for  responsible                                                               
disciplinary practices.                                                                                                         
                                                                                                                                
He continued, saying  one of the boards  had more investigations,                                                               
arguably because it was more  professional, and this caused board                                                               
fees to go  up.  As a consequence, new  graduates moving into the                                                               
state are choosing  to be licensed by the board  with lower fees,                                                               
thus  causing the  arguably more  professional  board to  further                                                               
suffer because  of its professionalism.   He asked  the witnesses                                                               
if  it  is   possible  to  arrange  things   so  the  responsible                                                               
whistleblowers wouldn't have  to assume the entire  cost of their                                                               
police actions.                                                                                                                 
                                                                                                                                
2:14:15 PM                                                                                                                    
                                                                                                                                
MS. HENRY  added that  the difference between  the boards  may be                                                               
explained by  the fact  that when one  board was  established, it                                                               
grandfathered in a  large group of people who  were ineligible to                                                               
qualify  for either  psychology  or social  work  licenses; as  a                                                               
result, a lot of problematic  people were licensed.  She surmised                                                               
that the other, seemingly less  professional board might have had                                                               
fewer  disciplinary actions  because  it  was established  later,                                                               
when many of these people were already licensed.                                                                                
                                                                                                                                
2:16:13 PM                                                                                                                    
                                                                                                                                
SENATOR ELTON voiced appreciation for the work of the witnesses.                                                                
                                                                                                                                
CHAIR DYSON held SB 177 in committee.                                                                                           
                                                                                                                                
CHAIR  DYSON adjourned  the Senate  Health, Education  and Social                                                               
Services Standing Committee meeting at 2:18:53 PM.                                                                            

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