Legislature(2013 - 2014)HOUSE FINANCE 519
04/04/2014 08:30 AM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB361 | |
| HB89 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 89 | TELECONFERENCED | |
| + | HB 361 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 361
"An Act relating to licensing of behavior analysts."
8:43:32 AM
REPRESENTATIVE DAN SADDLER, SPONSOR, read from the HB 361
sponsor statement:
Autism is a significant and growing problem in Alaska.
Statistics show that one in 110 Alaska children -
about 1 percent - are born with this developmental
disability, characterized by a diminished ability to
communicate, social isolation, and other symptoms.
While not curable, autism is treatable. Scientific,
peer-reviewed studies have shown that early intensive
treatment in the form of Applied Behavioral Analysis
offers the best opportunity to help people with autism
improve their ability to function productively in
society.
Applied Behavior Analysis is recognized as the basis
for the most effective form of treatment for autism by
the U.S. Surgeon General, The National Institute of
Child Health, and the American Academy of Pediatrics.
You can best understand ABA as behavior modification
therapy: It seeks to encourage appropriate behavior by
assessing and managing the relationship between the
environment and the desired behavior.
Forty years of research shows that nearly half of
people with autism who receive intensive early
intervention and treatment do not require lifelong
services and support -- and half can achieve normal
functioning after two to three years. This can mean
lifetime savings of $200,000 to $1.1 million for a
person through the age of 55.
One of the most important elements in successful
autism treatment is having it provided by well-trained
behavioral therapists - those who hold the nationally
recognized credential of Board-Certified Behavioral
Analyst, or BCBA.
To qualify as a BCBA, applicants must have a minimum
of a master's degree, plus extensive training and
experience requirements of up to 1,500 hours of
supervised practice in the field, 225 hours of
graduate-level classroom work, or a year's experience
teaching ABA at the university level. They must also
pass the challenging BCBA certification examination.
The Board-Certified Assistant Behavioral Analyst, or
BCaBA credential, requires slightly lower standards.
The state already supports the training of BCBAs
through a grant to the Center for Human Development,
at the University of Alaska Anchorage. There are about
20 to 30 BCBAs and BCaBAs in Alaska today, although
not all of them are currently working in the field.
Under current state law, Alaskans with BCBAs cannot
bill health insurance companies or Medicaid for their
services at a rate that reflects their high degree of
training and professional skill because they are not
formally licensed.
HB 361 addresses this situation by providing for those
holding the BCBA or BCaBA credentials in Alaska to be
licensed by the Division of Professional Licensing, in
the Alaska Department of Commerce, Community and
Economic Development. Fourteen other states currently
provide licensing and regulate behavior analysts. This
approach has the strong support of Alaska BCBAs and of
national autism advocacy groups.
8:46:32 AM
Representative Saddler continued reading the sponsor
statement:
By ensuring licensing and higher standards of practice
for BCBAs and BCaBAs, HB 361 will:
· encourage more people to provide autism services in
Alaska
· offer higher reimbursement rates for professional
providers
· provide better outcomes for Alaska children with
autism
· save the state money by avoiding the need for costly
institutional care, and
· improve the quality of life for hundreds of Alaskans
and their families
8:47:03 AM
Vice-Chair Neuman thought the bill looked like good
legislation and was interested in hearing more about it.
Representative Guttenberg thanked the sponsor for bringing
the bill forward. He wondered whether behavioral analysts
would automatically slide into an existing board or
commission. Representative Saddler replied in the negative;
there was not currently a board of professional behavioral
analysts.
Representative Thompson asked for verification that there
were currently 39 Board-Certified Behavioral Analysts
(BCBA) in Alaska. Representative Saddler replied that there
were approximately 24 BCBAs in the state. Additionally,
there were a number of individuals currently going through
the program supported by a grant through the Center for
Economic Development. He did not know the number of Board-
Certified Assistant Behavioral Analysts (BCaBA) in Alaska.
Representative Thompson noted that it was expensive to run
a board. He asked about licensing fees. Representative
Saddler replied that a licensing board would not be
required. Licensing came through the department similar to
mortuary scientists and other small professional groups;
there were not currently fees associated with a
professional licensing board. There were some fees that
members would pay for licensing, but he did not have the
assessment of the cost.
Representative Thompson remarked that Representative
Saddler's response had satisfied his concern related to the
cost per licensee.
Representative Saddler added that BCBAs had been seeking
the licensure and were willing to accept the national costs
and records. He noted the existence of an Autism Insurance
Task Force; one of entity's likely recommendations would be
to seek licensure through the department at low cost and
impact.
8:49:46 AM
Representative Wilson wondered whether any investigations
would take place. She understood that the majority of board
costs were associated with investigations. She asked
whether the board would have an investigator.
Representative Saddler did not believe the licensees would
have an assigned investigator. He detailed that any
investigation work would be conducted by the Division of
Corporations, Business and Professional Licensing under
DCCED. He did not believe many professional boards had
their own investigator.
Co-Chair Stoltze relayed that some [professional boards]
did have their own investigators.
Representative Wilson asked to hear from DCCED related to
investigative work and the difference between professional
boards. She wanted to ensure that licensees were not
saddled with costly investigation fees.
Co-Chair Stoltze commented that the bill would receive the
same scrutiny as any new board due to uncertainty on costs
and revenues. He acknowledged the virtue of the idea
contained in the legislation.
8:52:11 AM
RICHARD KIEFER-O'DONNELL, ASSOCIATE DIRECTOR, UNIVERSITY OF
ALASKA ANCHORAGE CENTER FOR HUMAN DEVELOPMENT, ANCHORAGE
(via teleconference), spoke in support of the legislation.
He detailed that the Center for Human Development was a
federally funded University Center of Excellence on
Developmental Disabilities; its role was to serve the
entire state. The entity supported services and the
development of workforce capacity. He focused primarily on
the backstory associated with the development of the bill.
He referred to work done by the Governor's Council on
Disabilities and Special Education that began in 2006; the
council developed several reports documenting the needs of
children with autism and their families. The council had
recommended that the state invest energy into the
development of autism specialists. He detailed that a
stakeholder meeting had been held in November of 2008 that
included state agencies, the private sector, and families.
The goal had been to develop recommendations about what the
autism specialists should look like. The group had
recommended that the Center of Human Development work to
establish a BCBA training program. He spoke to funding from
a trust and general funds. He discussed the decision to
partner with an existing program due to the high need for
BCBAs.
Mr. Kiefer-O'Donnell relayed that the program was in its
fifth cohort of students (a cohort worked for 2.5 to 3
years) working with children and adults with autism. He
spoke to the success of the program. He discussed program
requirements for certification. Existing BCBAs had been
involved with the private sector, school districts, and the
state. Additionally, they had been centrally involved with
the implementation of the Complex Behavior Collaborative.
He relayed that the program had been well-received and was
cost-effective. He noted the existing demand for the
advanced degree. Program participants were required to have
a minimum of a master's degree. He spoke to the well-
defined structure within the national credentialing board
related to the monitoring of licensees and any associated
grievances.
8:58:13 AM
ANNETTE BLANAS, CENTER FOR HUMAN DEVELOPMENT, ANCHORAGE
(via teleconference), testified in favor of the
legislation. She mentioned the importance of licensure
related to billing and the ability to retain professionals
in Alaska. She discussed the importance of licensure in
terms of quality control of professionals for families.
Currently families with autistic children were desperate
for services. She relayed that with so few options
available, families would take any services they could get.
She detailed that families had nowhere to direct concerns
if services were of poor quality. She believed licensure
would offer a level of quality control for professionals.
Rural communities with limited access to professionals were
at risk of receiving services by unqualified workers. She
detailed that rural communities tended to be isolated from
other professionals that would recognize the issues early
on. The licensure process would provide a venue for
addressing the issues. Lastly, families living in rural
communities were often even more desperate for any type of
services, which could lead families to accept low quality
services. The low quality services could create more
challenges than what may have existed before services were
provided. She stated that licensure provided a foundation
of minimum quality across the profession and in all
communities; it would also implement a way for families to
address ethical concerns.
9:01:18 AM
RACHEL WHITE, DOCTOR AND OWNER, GOOD BEHAVIOR BEGINNINGS,
ANCHORAGE (via teleconference), spoke in support of the
bill. She spoke to her BCBA credentials at the doctorate
level. Her company provided in-home services to children
with autism. She believed licensing providers would help
provide families with access to insurance-covered services.
She relayed that currently some insurance companies would
not cover behavioral analyst services because no state
licensing existed. She communicated that there was a
national board that oversaw behavioral analysts where
ethical concerns could be directed.
9:03:08 AM
LORRI UNUMB, VICE PRESIDENT, STATE GOVERNMENT AFFAIRS,
AUTISM SPEAKS, SOUTH CAROLINA (via teleconference),
testified in support of the legislation. She spoke to her
professional background in the autism field. She worked as
a professor at George Washington University Law School; she
had a son with autism. She pointed to the national trend of
BCBA licensure, which was driven in part by insurance
legislation that had passed in 35 states including Alaska.
At present 15 states had created a licensure or state
certification for behavior analysts; Alabama had recently
passed legislation. She believed Maryland had also passed
legislation the previous day. She added that states were
moving in the direction of licensure to ensure consumer
protection. She had studied the bills nationwide and
believed the current legislation was sound and well
drafted. She detailed that some states had created new
boards and other states had put licensure under existing
boards. She opined that it could work fine either way. She
was in full support of the bill's reliance on the existing
national certification. She noted that the credential had
been examined and approved by insurance companies. She
agreed that the national Behavioral Analysts Certification
Board disciplinary mechanism was a real enforcement piece;
she had seen individuals lose their certification or
receive other reprimands. The bill also created appropriate
exemptions for those who should not require a license and
created temporary licenses for individuals transferring
from other states.
9:06:46 AM
SUZANNE LETSO, CEO, ALASKA CENTER FOR AUTISM AND
CONNECTICUT CENTER FOR CHILD DEVELOPMENT, CONNECTICUT (via
teleconference), spoke in support of the bill. She spoke to
her professional background. She pointed to four documents
she had provided to the committee (copy on file). One
document showed a budget that had been done for Kentucky;
the net cost was roughly $7,000 and included the cost of
running a disciplinary board. She believed one option was
to run disciplinary processes through Alaska by temporarily
deferring to the Behavioral Analyst Certification Board
disciplinary process until an appropriation was made or
sufficient revenue from fees were accumulated. She relayed
that the cost of running a licensing program would be low
because of the BCBA's ability to absorb costs. She
communicated that the state stood to save substantial money
by bringing children back in-state who were currently only
able to be served out-of-state. She referred to a cost-
benefit analysis pertaining to Texas, which determined that
by providing intensive Applied Behavioral Analysis (ABA)
approximately $208,000 had been saved per student
throughout their 18-year education. She referred to a
second cost-benefit analysis from a lifespan approach that
found savings of $200,000 to $600,000 per child (conducted
by Jacobson, Mulick, and Green). Lastly, she pointed to a
document she had created on finances in Connecticut. The
document looked at the cost of providing ABA placement
services in and out of districts; providing the minimum
adult day-service programs for people with disabilities for
60 years saved the state $200,000 per person. She relayed
that if a disabled person could remain at home for 25 years
prior to residential services it would save between $3
million and $4 million per person. She concluded that there
were many ways the legislation could have a very positive
impact.
9:11:30 AM
Vice-Chair Neuman CLOSED public testimony.
Representative Wilson requested to hear from the
department. She spoke about concerns related to a small
board's ability to absorb costs. She wondered if the
professionals could be included under an existing board
instead of creating a new one.
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS,
BUSINESS, AND PROFESSIONAL LICENSING, DEPARTMENT OF
COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, relayed that
there were many variables that went into licensing.
Centralized licensing statutes and regulations required
investigations to take place in response to public
complaints or other red flags (for all professions with or
without a board). She had determined that potential cost to
behavior analysts if licensed, would be fairly minimal. She
estimated a $2,000 per year cost for investigative related
costs. She noted that investigations could be triggered by
license applications when there were requirements for
potential licensees to disclose certain information. The
initial biennium program estimates included one-time
startup costs for a 25 to 42 person program of $700 to
$1,200 for licensure. The number would dramatically
decrease after the one-time startup had been paid with the
first biennium fee (AS 08.01.065 required that all
licensing costs were borne by licensees). She detailed that
licensing fees for the program could be anywhere from $400
to $600 in the out years. She advised that her estimates
erred on the more expensive end.
9:16:23 AM
Representative Wilson believed one of the drivers behind
the proposed implementation of the board was due to lack of
insurance coverage for services. She asked for verification
that insurance would pay if there was a board certification
in place.
Representative Saddler clarified that the program was not a
professional licensing board model. He expounded that the
program would fall under departmental licensure. He relayed
that licensed providers would be subject to reimbursement
from private insurance at a higher rate, which would
benefit the public, providers, and families.
Representative Wilson spoke to a bill from recent years
related to payment by private insurance. She wondered if
the lack of insurance coverage was a primary driver behind
the legislation. She surmised that the proposal [for
departmental licensure] had been used because it was less
expensive for licensees than a board would be.
Representative Saddler replied in the affirmative. He
elaborated that BCBAs had experienced challenges billing
for services in Alaska. Drawing on national experience, one
of the recommendations was that licensing BCBAs would place
them in a more easily identifiable category for private
health insurance purposes.
9:18:23 AM
Representative Thompson appreciated the clarification that
the bill would not establish a board. He spoke to the
expenses of board travel for meetings. He pointed to a
letter in committee members' packets from Premera Blue
Cross (copy on file) that suggested specifying that a
provider was practicing within the scope of licensure or
specialty standards. He asked if the bill sponsor had
reviewed the recommendation.
Representative Saddler answered that he had not thoroughly
addressed the suggestion. He was amenable to the change.
Representative Thompson wondered if Premera Blue Cross may
require the inclusion of the language before it would honor
an insurance claim. Representative Saddler believed the
company had provided its support of the bill in writing.
Representative Thompson agreed that the company supported
the bill, but pointed to its language suggestion.
Co-Chair Stoltze asked the bill sponsor to follow up on the
suggestion. Representative Saddler agreed.
Representative Guttenberg spoke to the fact that the bill
would not create a board. He asked for verification that
investigative fees would be included in license costs. Ms.
Chambers replied in the affirmative. She elaborated that AS
08.01.065 required all costs attributable to a particular
licensing program to be paid by licensees (whether there
was a board or not). There were 20 boards and commissions
and 19 licensed programs without boards or commissions. She
detailed that a board or commission had the governance
power to dig into practice policies that protect the
public; whereas, administrative activities (e.g. issuance
of licenses, performance of investigations, and other) were
departmental requirements. However, a board had a
significant role in driving the level of investigation
within the scope of its sentencing guidelines. She
summarized that investigative activity was a licensing cost
that was legally required to be paid by licensees. She
noted that the topic would be discussed over the interim
with the legislature.
9:22:39 AM
Representative Guttenberg asked for verification that
investigation fees did not include criminal prosecutions.
Ms. Chambers replied in the affirmative. She detailed that
the department had civil authority, but not criminal
authority. She referred to an example she had given in a
separate bill hearing related to a potential prostitution
investigation; the investigation would fall under the
purview of the Department of Public Safety or municipal law
enforcement. However, a conviction may have a domino effect
on an individual's license. She referred to testimony from
the national board that there was a strong opportunity for
the national board to have a hand in effecting the level of
investigation on licensure particularly because the bill
leaned heavily on the certification. She elaborated that if
an individual's certification was revoked by the national
board there would be no cost to licensees, but the state
would then have the opportunity to discipline or revoke a
license as required by law.
Representative Thompson believed the issue was very
important. He believed the cost of going after a licensee
for misbehavior was a responsibility of the state. He did
not support saddling other licensees with the associated
costs. He believed the issue should be addressed in the
future.
Co-Chair Stoltze discussed the cost of the legislation. He
believed the fiscal notes had green lights. He pointed to a
question related to the overall cost, which was an
uncertainty associated with doing anything new in
government. He stated that it was good to hear "autism
speak." He believed it had been a silent and misunderstood
subject, which effected many people. He appreciated the
sponsor's efforts.
Vice-Chair Neuman remarked that the committee was in
support of the collaborative behavioral health program that
worked to help autism patients.
Co-Chair Stoltze hoped to hear the bill again soon.
HB 361 was HEARD and HELD in committee for further
consideration.
9:26:20 AM
AT EASE
9:27:25 AM
RECONVENED