Legislature(2017 - 2018)SENATE FINANCE 532
02/27/2018 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB108 | |
| SB105 | |
| SB165 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 105 | TELECONFERENCED | |
| + | SB 108 | TELECONFERENCED | |
| + | SB 165 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 105
"An Act relating to the licensure of marital and
family therapists; relating to professional liability
insurance for marital and family therapists; relating
to medical assistance for marital and family therapy
services; and providing for an effective date."
10:03:46 AM
SENATOR DAVID WILSON, SPONSOR, read from the Sponsor
Statement:
If enacted, Senate Bill 105 would add licensed Marital
and Family Therapists to the list of independent
licensed practitioners, in order to address the
shortage of Medicaid-eligible behavioral health
providers in the state, afford more options for
beneficiaries, and increase access to care.
He shared that approximately 20 percent of Alaska's adult
population needed mental or behavioral health services;
however, 19 percent of those in need received funding from
Medicaid or the Behavioral Health Fund. He said that
research had shown that Alaska was in need of additional
psychiatrists to meet the state's mental health needs. He
read from the Sponsor Statement:
Currently, licensed marital and family therapists
(MFTs) are only allowed to provide services in
community health clinics of physician mental health
clinics, which limits the number of willing providers
in the mental health care arena. SB 105 expands
medical assistance reimbursement services to cover
those services provided by MFTs.
Specifically, SB 105
• Designated LMFTs as providers eligible to render
and bill for Medicaid-funded services as
independent practitioners under Alaska Statute
47.07.030(b)
• Clarifies supervisory requirements for Marital
Family Therapist Licensees
• Requires Marital Family Therapist Licensees to
carry Liability Insurance for Regulatory
Investigation Fees of at least $30,000
In 2016, the Alaska Board of Marital and Family
Therapy unanimously recommended the statute changes
contained in SB 105.
10:09:44 AM
GARY ZEPP, STAFF, SENATOR WILSON, discussed the Sectional
Analysis (copy on file):
Sections 1 & 2 of the bill impact AS 08.63 "Marital &
Family Therapy" and the subsections 08.63.100
"Qualifications for license to practice" and 08.63.120
"Authorized Supervisors."
Section 1: "Qualifications for license to practice" -
AS 08.63.100
PAGE 2, LINES 17-25: adds a supervision requirement
for martial & family therapists and clarifies that the
required 1,500 hours of clinical contact must include
100 hours of individual supervision and 100 hours of
group supervision and that may be conducted by one or
more supervisors. The intent is to allow doctor A to
supervise and if Doctor A becomes unavailable, doctor
B can continue the supervision a Martial & Family
Therapist associate.
Section 1 continues on:
PAGE 2, LINES 29-31: It requires not less than $30,000
in professional liability coverage for the applicant's
regulatory investigation fees in the state.
Section 2: impacts "Authorized Supervisors"
PAGE 3, LINES 2-18: expands the group supervision to
include professional counselors, marital & family
therapists, physicians who are licensed as a
psychiatrist, an advanced practice registered nurse
who is authorized by the Board of Nursing to practice
as an adult or family psychiatric mental health nurse
practitioner, a psychologist, and a social worker.
Sections 3, 4, & 5 impact AS 47.07 "Medical Assistance
for Needy Persons" and the subsection AS 47.07.030
"Medical Services to be Provided."
Section 3: impacts "Medical Services to be Provided"
PAGE 3, LINE 31: adds marital and family therapy
services to the list of optional services available
through the Dept. of Health & Social Services under
this subsection.
Section 4: impacts "Medical Services to be Provided"
PAGE 4, LINES 8-16: adds a new paragraph (g) to AS
47.70.030 to clarify that the term "direct
supervision" may be performed by one or more
psychiatrists, as long as that supervision takes place
on the premises of the clinic 30 % of the time that
the clinic is open.
The so-called 30% Rule is found in regulation 7AAC
135.030 "Provider enrollment and organization."
Section 5: impacts "Medical Services to be Provided"
PAGE 4, LINES 17-31 & PAGE 5, LINE 1: adds a new
subsection (h) to AS 47.70.030 that allows the
department to reimburse a mental health physician
clinic for services provided by a psychiatrist, or an
individual who works under a psychiatrist and is
licensed to practice as a professional counselor, a
martial & family therapist, a physician assistant, an
advanced practice registered nurse who is authorized
by the Board of Nursing to practice as an adult or
family psychiatric mental health nurse practitioner, a
psychologist, a psychologist associate, and a clinical
social worker.
Section 6: PAGE 5, LINES 2-7: amends the uncodified
law to authorize the Department of Health and Social
Services and the Board of Marital and Family Therapy
to adopt regulations to implement the changes of this
act.
Section 7: PAGE 5, LINE 8: contains the immediate
effective date for Section 6 which refers to the
regulation development.
Section [8]: PAGE 5, LINE 9: provides for a January 1,
2019 effective date for all sections other than
Section 6.
10:13:29 AM
Senator Stevens asked for the licensing timeframe to be
licensed as a marital and family therapist, and whether
temporary licenses could be issued.
Senator Wilson deferred to the invited testimony.
10:14:26 AM
Senator Stevens hoped that the marital and family
therapists would not face the same problems as the medical
practitioners of the previously discussed bill.
Co-Chair MacKinnon OPENED public testimony.
10:15:08 AM
Senator von Imhof assumed that the insurance required in
Section 1 could be obtained after training was complete.
Senator Wilson replied that the insurance language was
intended to cover investigative regulatory issues after
licensure.
10:16:08 AM
RANDALL BURNS, DIRECTOR, DIVISION OF BEHAVIORAL HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, (DHSS) spoke in
support of the bill.
10:16:34 AM
Senator von Imhof read form the Sectional Analysis:
Section 4: impacts "Medical Services to be Provided"
PAGE 4, LINES 8-16: adds a new paragraph (g) to AS
47.70.030 to clarify that the term "direct
supervision" may be performed by one or more
psychiatrists, as long as that supervision takes place
on the premises of the clinic 30 % of the time that
the clinic is open.
Senator von Imhof whether the population of psychiatrists
in rural Alaska could support the requirement in this
section.
Mr. Burns replied that the language was in current
regulation. He said that he was in support of changing the
language at the direction of the committee. He stated that
the division was currently crafting language that was less
burdensome to rural clinics.
10:21:31 AM
AT EASE
10:21:54 AM
RECONVENED
10:21:58 AM
Senator Stevens repeated his question about temporary
licensing and licensing timelines.
Mr. Burns replied that he could not speak to the question.
10:22:54 AM
KAREN CUNNINGHAM, VICE PRESIDENT, MARRIAGE AND FAMILY
THERAPY BOARD, ANCHORAGE (via teleconference), testified in
support of the legislation. She stated that associate
licensure was available; board approval was required before
the license could be issued and there was a 2-year
supervision period. She said that the bill would make the
supervision period more accessible for applicants.
10:24:04 AM
Senator Stevens directed his question to Ms. Cunningham.
Ms. Cunningham replied that applications for associate
licensure were submitted to, and approved by, the board.
Before the application could be submitted the applicant
needed to have a supervision plan laid out for the board to
approve. She relayed that there were currently 18 approved
supervisors in the state.
10:25:41 AM
KEN MCCARTY, DIRECTOR, DISCOVERY COVE RECOVERY AND WELLNESS
CENTER, EAGLE RIVER (via teleconference), testified in
support of the legislation. He shared that the bill would
serve a large need in the state. He expressed concern about
the Section 4 language referenced by Senator von Imhof. He
felt that the language could isolate telemedicine in rural
areas.
10:32:08 AM
ELIZABETH RIPLEY, CEO, MAT-SU HEALTH FOUNDATION, testified
in support of the bill. She said that there were critical
pieces missing for Alaska's continued care for mental
health and substance use disorders; sadly, main paths to
treatment are jails and emergency departments. She relayed
that the Mat-Su Regional Emergency Department was the
number one portal in Mat-Su for people experiencing a
behavioral health crisis, in terms of both volume and cost,
even though the department does not provide behavioral
health services. She shared that in 2016, 3,443 patients
with behavioral health diagnosis went to the Mat-Su
Regional Emergency Department, which resulted in total
charges of $43.8 million, not counting the additional costs
for estimated law enforcement, 911 dispatch, and
transportation. She believed that the state could improve
the situation by providing care in lower cost settings. She
relayed that the average annual growth rate for visits to
the Mat-Su Regional Emergency Department by patients with a
behavioral health diagnosis grew 20 percent between 2015
and 2017, due to the opioid epidemic and lack of treatment
access. She offered further statistics to illustrate the
statewide needs that the bill would address.
10:35:52 AM
Senator Micciche expressed concern with the assumptions
made in the fiscal note. He opined the Medicaid utilization
rate in the state. He voiced concern that the state would
be exposed to increased overutilization.
Ms. Ripley replied spoke of a project called The Alaska
Healthcare Blueprint, which hoped to take a bold look at
the state's health objectives. She asserted that
collaborative work was being done with state partners,
providers, and local delegations to take a comprehensive
view. She contended that significant research had been done
to ensure that health care was being provided efficiently
and effectively. She stressed the need for "whole person
care." She admitted that there would be additional cost
brought on by the bill but that the legislation would be
more cost effective in the long-run.
10:38:47 AM
AT EASE
10:39:10 AM
RECONVENED
Senator von Imhof understood that the cost would be shifted
from expensive emergency room visits to more clinic visits,
where the same population would be served, for the same
ailments but in a different cost environment.
Ms. Ripley agreed.
10:40:19 AM
JON ZASADA, POLICY DIRECTOR, ALASKA PRIMARY CARE
ASSOCIATION, testified in support of the legislation. He
stated that health centers had made major investments in
behavioral health integration and whole person care. He
said that in the last two years there had been a 25 percent
increase in the number of behavioral health providers,
encounters, and patients; over 11,000 Alaskans received
routine behavioral healthcare in Alaska's community health
centers. He lamented that there was a shortage of billable
providers in the state; a study completed in December 2017
revealed that Alaska community heath centers were short 12
to 18 FTE equivalents, which translated into service to
6,000 to 9,000 patients. He stressed that federally
qualified health centers saved the state money by allowing
same-day appointments at a single rate. He stated that if
LMFTs were included in FQHC Medicaid billing a patient
could see a medical provider and a mental health
professional in the same day, for a single charge, instead
of a referral to two sperate charges. He detailed the
various ways in which the bill would serve more patients in
comprehensive, whole-patient settings.
10:43:53 AM
Senator Stevens asked which medical professionals could
currently bill Medicaid.
Mr. Zasada replied that licensed clinical social workers
and psychologists could bill Medicaid.
Co-Chair MacKinnon CLOSED public testimony.
Co-Chair MacKinnon stated that a new fiscal note would be
crafted for consideration during the next bill hearing.
10:45:15 AM
Co-Chair MacKinnon solicited further discussion on the
current fiscal note.
Senator Wilson reiterated that the intent of the bill was
not to create a new expanded care of treatment but to give
patients access to care as primary prevention.
Co-Chair MacKinnon announced that amendments were due the
following day by 5pm.
SB 105 was HEARD and HELD in committee for further
consideration.