Legislature(2017 - 2018)BARNES 124
03/05/2018 03:15 PM House LABOR & COMMERCE
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| HB353 | |
| Adjourn | |
| HB353 | |
| HB277 | |
| HB309 |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 309 | TELECONFERENCED | |
| += | HB 277 | TELECONFERENCED | |
| *+ | HB 353 | TELECONFERENCED | |
| + | TELECONFERENCED |
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.