Legislature(1995 - 1996)
04/09/1996 03:10 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
CSSB 165(L&C) - PSYCHOLOGISTS & PSYCHOLOGICAL ASSOCIATES CO-CHAIR BUNDE said this was the second hearing on CSSB 165(L&C) and asked Dr. Stokes to come forward to testify. Number 088 DR. ROBB STOKES said the committee had requested he obtain the recommendations of other board members with respect to the length of supervision required. The licensing examiner, Wanda Fleming, was able to get three responses which constitutes a quorum of the board. One board member recommends two years of licensed practice which means three years pre-license, licensure, two years and then petition the board. He noted that current statute requires a person to petition the board, even with the five years. The Chair of the board recommends one year; three years pre-license, supervision for one year post license and then the person would be independent. CO-CHAIR BUNDE asked if that would be independent without petitioning the board? DR. STOKES said the individual has to petition the board in all cases. He stated his recommendation was to leave it at three years pre-license and allow a person to petition the board when they become licensed. It ranges from two, one to zero post license. CO-CHAIR TOOHEY questioned if he is the only board member who agrees with that, what chance does a person have petitioning the board? DR. STOKES replied in his opinion, a very good chance because the board is very flexible. He added that 99 percent of psychological associates who apply, including psychologists, are rejected because they don't have adequate course work as delineated in statute. Plans are set up for these individuals and they complete those plans. If an individual lacks certain courses but can demonstrate they have met the criteria for the course work by presenting a syllabus or a letter from their instructor, the board will accept it. He added that 99 percent of the psychological associates that are rejected because they don't have the course work, do just that. REPRESENTATIVE TOM BRICE arrived at 3:12 p.m. CO-CHAIR BUNDE inquired if 99 percent of the people who petition the board are rejected. DR. STOKES said no, the board does everything they can and 99 percent of those rejected will do whatever needs to be done to get their license. He commented that the committee had not heard testimony from those individuals, but has heard testimony from the other 1 percent. CO-CHAIR BUNDE asked of the people who petition, how many are rejected? DR. STOKES said 50 percent, including psychologists. He added there was no difference in psychologists or psychological associates in terms of rejecting applications and it's almost always because the person doesn't have the course work required by statute. CO-CHAIR BUNDE clarified that of the 50 percent that get rejected, the majority of those individuals are given a remedial course of action, are able to meet the criteria and are then accepted. DR. STOKES responded that was correct and the board is very lenient in setting up plans for them and those people do get licensed. CO-CHAIR BUNDE asked if it was correct that of the people who apply for licenses, 90 percent are licensed? DR. STOKES reiterated if those individuals choose to go back and meet the requirements. CO-CHAIR TOOHEY asked why a student would go to a school that wasn't following the criteria of the Board of Psychological Associates? Also, why would Postsecondary Education allow a student to get a student loan and go to a school that does not meet the academic standards for licensure? DR. STOKES said that was an excellent question and one that has been raised in the past. He explained there is no connection between the university and the board. One of the big problems is that students do not read the statutes and the requirements before they apply. Dr. Kappes, Chair of the Board, has been able to get two courses approved and they will now be taught at the University of Alaska, so psychological associates can meet those requirements. The one course that has been in people's way is called Human Development which Dr. Stokes took as an undergraduate, as do most people. He said he has tried to get that course out because it has stood in the way of almost every psychological associate who has applied, but he has been voted down. However, if students are able to show they have met what the board considers adequate understanding in human development in their course work, the board will grant it. CO-CHAIR TOOHEY said this was appalling to her. She is a nurse who went to school in Alaska, applied for a nursing degree, took the required courses at school, got her degree, took the state board exams and became a practicing nurse. She asked why there is such a breakdown in the psychological field? DR. STOKES commented that the board gets applications from schools all over the country, but he didn't know why there was a breakdown. He added the board is held to the statutes that were in place before they became members of the board. CO-CHAIR BUNDE suggested that perhaps some of the students in Alaska's program would be testifying and the committee could find out if they have the same problems. He said it is kind of illogical to think that an Alaskan school would not meet the Alaska requirements. Number 607 DR. STOKES gave the committee some history to point out his advocacy because it was being alleged that since he had the intelligence and the motivation to get a Ph.D. and do the eight years somehow that was negative. When he applied for licensure the requirement was one year, then licensed, and supervised for the rest of your life. During that time period, it was changed to three years. He petitioned the board to allow him to do the one year, but he was turned down. He and another psychological associate found that untenable and through Senator Fahrenkamp were able to get legislation passed for the five years in order to get independence. He commented that he has worked towards getting psychological associates more independent, not the other way around. CO-CHAIR BUNDE confirmed Dr. Stokes' testimony was that the current bill says three years before licensure, two years after licensure. DR. STOKES interjected the bill before the committee states two years before licensure, take the exams, and then the person is independent. CO-CHAIR BUNDE asked if Dr. Stokes was recommending three years, take the exam and then become independent. DR. STOKES confirmed that and added another board member is recommending take the exam, one year and then become independent; another board member recommends three years, take the exam and then two years. That brings it to an average of one year post getting the degree. He reiterated his recommendation of three years and to get rid of the five years totally. CO-CHAIR TOOHEY asked if three years post was correct? DR. STOKES replied no, it was three years pre-licensure. CO-CHAIR TOOHEY remarked it was three years pre- and one year post, for a total of four years. DR. STOKES stated that was correct. CO-CHAIR BUNDE explained that was only one board member's contention. DR. STOKES pointed out his contention was to get rid of the five years, petition the board and then independence. CO-CHAIR TOOHEY commented that she had lost faith in the board's ability to go back to what she thinks is reasonable. It is her belief that eight years supervision for anyone with a master's degree was ludicrous. Her recommendation was that the board come up with regulations outlining what course work was required and either the schools follow that criteria or they don't get the students. DR. STOKES reiterated that the board is held to the existing statutes and in the four years he has served on the board, to his knowledge the board has never rejected a petition. He added that at the last board meeting there were two petitions by people who had completed the five years and the board granted them independence. CO-CHAIR TOOHEY said she believed there had been testimony at the last meeting that there were 400 people who had graduated and were waiting for their license. DR. STOKES recalled the testimony indicated there were 400 people who had graduated, but only a small amount had applied for licensure. CO-CHAIR BUNDE commented there were people on teleconference waiting to testify. SUSAN BAXTER testified via teleconference from Anchorage that she was licensed in December 1995 after a fairly long process. When she applied to the board the first time for the examination, she was refused. In the process she sought specific guidance from the board in terms of what she might be able to do to meet the requirements. Specifically, the requirement that she lacked was course work at the graduate level in human development. There were no classes available in the state of Alaska at that time in human development; however, the university had taken some steps to infuse that (indisc.) in other courses, so the university felt at that time they were meeting that requirement; however, the board did not recognize that course work. She went through a rather significant process to inform the board of her own qualifications and the course work she had received. Because she had worked in the field of early childhood during her three years supervision, the board found her qualified. She did, however, express concern that the board had requirements which were not possible by their own interpretations. She shares the concerns about the interaction between the university program and the board's interpretation of what (indisc.). There are a number of students caught in the same situation that she was; a change in interpretation of the statute from the previous board to the present board. MS. BAXTER said in terms of supervision, she is now licensed but she had an extra year of supervision which gave her a total of four years supervision. The one year does not count however because the period of time that counts begins at the time the license is issued, so even though she has four years of supervision now, she still has to do an additional five years. Number 1057 CO-CHAIR BUNDE asked if it would be fair to characterize Ms. Baxter's position as supporting the bill in its current form? MS. BAXTER replied yes. Number 1072 SHEILA CLARSON testified via teleconference from Anchorage that she is a licensed psychologist at the Ph.D. level, currently in private practice in Anchorage and secretary of the Alaska Psychological Association. She testified in support of CSHB 165(L&C) and she wished to testify from the perspective of the impact on the rural mental health programs. From 1988-1994, she was employed as the chief psychologist for the Alaska Area Native Health Service and her job was to provide support, technical assistance and training in the development of mental health programs around the state. A major issue had to do with the problems created by the fact that mental health programs in the Bush could not hire master's level psychologists as easily as they could hire social workers or nurse practitioners because it was so much more difficult for the people with a masters in psychology to be licensed as psychological associates. People who wish to work in the rural region and have a masters in psychology from a program, for example at the University of Alaska Anchorage, are at a disadvantage if they do wish to be employed in the Bush because social workers and psychiatric nurse practitioners can be licensed after two years. From the perspective of the mental health programs, in many cases the individual who was thought to be the best person for the job was not licensed and needed to work under supervision because they were a master's level psychologist (indisc.) so a social worker or a nurse practitioner would be hired instead. Her reason for supporting this bill is that she believes it brings master's level practitioners in line with other mental health practitioners like social workers and psychiatric nurse practitioners. She believes that's fair and it provides additional resources to rural mental health programs that want to hire those people. CO-CHAIR BUNDE asked if Ms. Clarson felt the bill as currently written is adequate with two years of supervised practice? MS. CLARSON responded yes, she did. CO-CHAIR BUNDE asked if there were any questions of the witness. Hearing none, he invited Kathryn Carssow to testify. Number 1291 KATHRYN CARSSOW testified via teleconference from Anchorage that she has a master's level degree in clinical psychology and wanted to address a couple of points raised by Dr. Stokes. First, the course work issue regarding psychological associates and the board is a very hot issue presently and is of deep concern to her. However, she didn't feel that was what this bill was about. She believes the board will be taken care of. The Governor's Office has listened to the tapes from the last two board meetings and inasmuch as the board is up for reappointment she is not concerned about that issue because she thinks a reasonable board will take care of it in a fair and just way. This bill has been in front of individual board members as well as the full group for over six months and she feels the inconsistent input on how to change the years of supervision is a little late and poorly done. She said it is representative of this board of not being flexible and felt the board is impulsive, arbitrary and hostile towards the master's level psychological associates. She expressed her disappointment with the board in the way it is reacting. She concluded that she supports CSHB 165. CO-CHAIR BUNDE asked if it was Ms. Carssow's position that the board of which a member teaches the psychological associate program at UAA is hostile to their own students? MS. CARSSOW responded in the affirmative. She added it was her personal feeling that over the years there has been a difference on the faculty, but when she entered the program she had a written statement that said this University of Alaska clinical psychology program, of all the programs provided in the state, was the only one that had a curriculum which provided that students be eligible to sit for licensing. She believed the board was aware of that curriculum and was supportive of it. The university was acting in good faith with a program that in terms of cultural diversity and human development those requirements were infused very purposefully and very thoughtfully in the curriculum. She has a letter from the Dean's Office supporting that approach. Suddenly, a year ago last fall, the board re-interpreted its regulations and started requesting that students go back and get these courses, one of which, human development, was not even provided. The Chair of the board sits on the graduate study committee. She sat in his classes as a graduate student. He also was part of her graduate student orientation and never once did he indicate to her that she may not be eligible for licensure. Instead, she had a written statement that she would be eligible for licensure. She added that it had been insinuated that she had asked to sit for licensing, but in fact she cannot ask to sit for the examination until she has three years of supervision. CO-CHAIR TOOHEY asked if the University of Alaska Anchorage program was accredited by the American Psychological Association? MS. CARSSOW said she would let Mr. Moma answer that question. Number 1463 ALLEN MOMA, Alaska Psychological Association and Co-Chair of the committee that originated this bill, testified the American Psychological Association (APA) does not endorse or certify master's level programs; they only certify doctoral level programs. Currently, the master's level program at UAA is in the process of gaining certification from the North American Association of Master's Level Programs, which he surmised would be in place in the next year or two. He added the UAA does have certification at the university and their product is such that it has been certified by the Collegiate Certification Board (indisc.). CO-CHAIR BUNDE said he understood that, and asked if that qualifies them to teach psychology. MR. MOMA responded that was correct. CO-CHAIR BUNDE asked Karen Forrest to come forward to testify. Number 1540 KAREN FORREST testified that she has a masters degree in clinical and counseling psychology, is working toward licensure as a psychological associate under Dr. Stokes and has two years supervision in at the present time. CO-CHAIR BUNDE asked where she had gone to school? MS. FORREST replied Western Washington University in Bellingham. She said it appeared the biggest controversy focused on the number of years for licensing. She noted a comparison had been made to teachers and how much supervision they might need and urged the committee to look at more similar fields such as clinical social work and marriage and family therapists. She distributed information she had received from the Division of Occupational Licensing on the requirements and the scope of practice for psychological associates, social workers and marriage and family therapists. It seemed like the main defense against the bill was that the scope of practice for a psychological associate was much more extensive. She noted that it is different and asked the committee to review the different scopes of practice and make their own decision in terms of depth of practice. She encouraged the committee in making the decision to think about the purpose of the license; if it is to protect the public, she wasn't sure that more supervision after the two years is going to protect the public. She said she knew of a tremendous number of people who were not seeking licensure at all, and don't fall under the regulations, because of the overwhelming procedure. CO-CHAIR BUNDE asked why it is that people don't realize before they pursue their degree what a seemingly onerous challenge it is to become licensed as a psychological associate. MS. FORREST thought that people begin graduate studies for different purposes. In her particular case, she did not begin graduate studies for the purpose of being a full time therapist in this field, but rather for her own personal reasons, interests and intellectual stimulation. She realized after going through the program, this is what she would like to do. She added there is a lack of consistency between programs throughout the country and licensing requirements in different states. She could have become licensed much more easily in the state of Washington than in Alaska. CO-CHAIR BUNDE asked if Washington has reciprocity with other states? MS. FORREST said she could have stayed and sought licensure there and there would have been reciprocity, but she was born and raised in Juneau and didn't want to give up her Alaska residency. CO-CHAIR BUNDE asked if it was fair to say that people who seek the degree and then choose not to work in the field or not to seek licensure are not necessarily seeking licensure because of the onerous requirements, but because they have chosen to study in that field and will apply it somewhere else or for self-fulfillment. MS. FORREST imagined there were other people like that; she started taking the program for those reasons, but she was aware of a tremendous number of people who had gone through master's level programs and may qualify in another state, but are not seeking licensure in Alaska because of the tremendous procedures involved. Number 1759 REPRESENTATIVE ROBINSON asked Ms. Forrest if she knew what the rules were in Washington State? MS. FORREST stated when she went through the program, it was her understanding there was a grandfather clause that would have allowed her to take the exam when she graduated, but it was being changed to two years of supervision, take the exam and then be independent. Number 1799 KAREN GIBSON testified in support of the legislation as it is written. She noted this bill has received the support of the professional psychology organization. Their subcommittee drafted the bill so the body that represents all the psychologists in the state, whether licensed or not, support it and both universities in Anchorage support it. CO-CHAIR BUNDE asked if it was the psychologists or psychological associates who supported the bill? MS. GIBSON responded that both can be members of the Alaska Psychological Association. She continued that the major thrust of this bill is to seek parity and noted the information before the committee shows the education and supervisory experience required before licensure; however, what it doesn't show is that the educational requirements are different. For example, at UAA a person has to have at least 1,000 hours of supervised clinical experience before graduation even though it's not in statute. The practicum at the university is videotaped for the student and everyone else to critique. To become a licensed social worker, their statutes state that a person only needs a masters degree, but to become a psychological associate a person needs a masters degrees, but it specifies a minimum of 48 semester hours and certain areas must be covered. A person only needs 33 hours to be a licensed marital and family therapist. Even though the bill is seeking some parity in the amount of time after graduation, people who have a masters degree in psychology have received far more training than the other disciplines which are the only comparable disciplines for licensure. That was the point she wanted to stress. Number 1889 REPRESENTATIVE AL VEZEY said he would characterize 33 hours as one academic year. MS. GIBSON responded it would be a tough academic year, but it could be done. REPRESENTATIVE VEZEY commented that he would characterize 48 hours as one and one-half year. MS. GIBSON said it's a two and one-half year program. A person has to do 20 hours a week for a year in a site and there has to be a certain amount of course work before beginning clinical work. The 48-hour program at UAA, which the degree is a 50-hour minimum, takes at least two and one-half years because of the timing of the courses. CO-CHAIR BUNDE asked Mike Tibbles to apprise the committee of the insurance issues that were raised at the last hearing. Catherine Reardon joined Mr. Tibbles at the witness table to discuss the insurance questions. Number 1946 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Commerce & Economic Development, testified she had requested that a person from the Division of Insurance be available to provide some backup information; however, that person was not prepared to testify. CO-CHAIR BUNDE asked what the resolution was to the question that had been raised at the last hearing on the bill. MS. REARDON said having not been present at the last hearing, her understanding was the question related to insurance reimbursements for psychological associates versus psychologists; specifically can the psychological associate bill at the same rate even though a psychologist may have more training than the psychological associate. She stated that both psychologists and psychological associates already appear in the nondiscrimination section of the insurance statutes which indicates that providers can't be discriminated among. She noted that was the same section of statute that was of concern with the physician assistants legislation. It is her understanding that generally insurance companies reimburse for a specific procedure; in this case for mental health care it could be for counseling, and that insurance companies tend to set a standard and customary rate for that procedure or treatment and not to distinguish between which licensed health care professional provides it. When she asked the question if insurance companies could choose to reimburse different amounts depending on which type of licensee provided the service, the answer as she understands it is that it has never been tested in court and perhaps the theory that the treatment is not identical if it is provided by someone with a different background education could be used as an argument for different standard and customary rates. CO-CHAIR TOOHEY believed the committee was given a totally different answer at the last hearing. She felt it was dishonest to be treated by a psychological associate and billed at the rate for a psychologist. She believed it was important that the issue be addressed, particularly at a time when attempts are being made to lower the cost of medical care. The other issue is why should a person become a psychologist when you can get the same fee for being a psychological associate. REPRESENTATIVE GARY DAVIS arrived at 3:50 p.m. Number 2117 REPRESENTATIVE VEZEY said this all points to Title 21 dealing with the insurance discrimination statutes. He noted that two years ago the statute was changed so direct entry mid-wives couldn't be discriminated against and four years ago psychologists, psychological associates and licensed clinical workers were added to that statute. It appeared to him the problem some people were having with the bill was not whether these people could be licensed in two, four or five years, but rather what kind of financial burden would it be compelling the group insurance providers to pay for this service by granting them this license privilege in connection with an anti-discrimination statute. MS. REARDON said she didn't believe this bill would change the situation concerning billing. She explained the state doesn't set the rates health care providers can charge and she assumed the legislature didn't want to get into how much different professionals could charge for their services. In terms of the reimbursement, a professional can charge whatever he/she wants and then the amount that would be reimbursed is up to the insurance policy. Even if the psychologists and psychological associates were removed from the non-discrimination statute, all that would happen is their patients would have to pay for the service out of their pockets. She wasn't sure it would necessarily result in the type of distinguishing between the different professionals in terms of their billings that was being discussed. CO-CHAIR BUNDE commented that an individual had called him earlier and expressed some serious concerns that the insurance companies were really practicing medicine because they were deciding, in essence de facto, by what service they would cover and how much they would pay. The individual offered that perhaps if the non- discrimination clause was deleted, the insurance companies may quit practicing medicine. Number 2234 CO-CHAIR TOOHEY asked what the point was of having the non- discrimination list if the insurance companies were not taking advantage of it? If the insurance companies are paying a fee for a particular service, regardless of who provides the service, she questioned whose responsibility it was to cut the cost of medicine? She maintained it is each persons's responsibility to oversee it and when a particular service is being provided, a person should demand that it be provided by a nurse or physician assistant for example, because it will be cheaper. She believed the Division of Insurance should be looking at those things. Number 2275 JERRY REINWAND, Lobbyist for Blue Cross of Washington & Alaska, said he really hadn't intended to create a problem by raising the question at the last hearing, but he did think there was an underlying issue that gets to the unfair discrimination issue and that's why he had asked the question, "Can, for example, if we get a bill for the same scope of service from somebody who charges $500 an hour or the same person arguably is providing the same scope of service for $50 an hour and under the unfair discrimination statute, which -- can we say we don't pay the $50 and we can pay the $500 one?" In all fairness to the Division of Insurance, he said it was a huge gray area and the division is looking at this very question. His specific question last week was, "Does this bill in any way open the flood gate a little bit more so that because of the unfair discrimination statute that psychologists, psychological associates and clinical social workers are now on the books for, does that somehow increase costs to either the state and/or insurance companies and ultimately policy holders?" He does believe there is a link there. He didn't really want to cause a problem with this bill particularly, but he thinks there is a bigger policy question involved. He added this probably isn't the vehicle to attack the issue, however. CO-CHAIR TOOHEY asked if it would be in the best interest of the insurance company to handle the issue of setting different degrees of pay for different degrees of education, not service. MR. REINWAND replied he really hadn't thought about it in that context. TAPE 96-37, SIDE B Number 001 MR. REINWAND continued he would like to leave the unfair discrimination statute for the committee to consider as he felt it could have some interesting interpretations. He added there have been conflicting interpretations from the division and he would probably be asking the committee to revisit this issue at some point. CO-CHAIR TOOHEY asked if there were three levels of mental health providers - psychological associates, psychologist or a psychiatrist - which one would Mr Reinwand want to pay? MR. REINWAND said probably from the insurance company's point of view and hopefully from the patient's as well, a person would want to go to the health care provider that provided the best service for the least cost; that's ultimately what everyone is after. Whether this bill does that and whether the unfair discrimination statute ultimately results in that is another question. Number 051 REPRESENTATIVE ROKEBERG asked if Blue Cross makes a differentiation between a temporary licensed psychological associate and a licensed psychological associate in terms of paying a fee? MR. REINWAND said he didn't know. He added that he has asked his client, Blue Cross, a series of questions and he hasn't yet gotten any answers back, but he would check on it. REPRESENTATIVE ROKEBERG said he felt that was really the question. There certainly is a differential between the experience level and as far as he could tell, this bill as well as the existing statute does not draw a differentiation between those people that are temporarily licensed and those who are not. CO-CHAIR BUNDE asked if there was any further testimony on CSSB 165(L&C). Number 094 SHARON MACKLIN, Lobbyist for the Alaska Psychological Association said she would try to answer a couple of questions that had been raised. Regarding the scope of practice, she referred to page 3, Section 5, and said that could be coordinated with the last page of the document that had been distributed to the committee on the scope of practice for a psychological associate. She said that is the only section that includes the scope of practice and this bill does not expand the scope of practice that psychological associates would be providing. Another question that was raised had to do with whether insurance companies pay different rates for the cost of services by psychological associates, psychologists, masters of social workers and marriage and family therapists. She said when the issue of unfair discrimination was raised several years at the time when psychologists, psychological associates and masters of social workers were added, part of the testimony brought forward was that these people provided services at a lesser rate and they are more available in rural Alaska and in less urban areas. She added that psychiatrists who are Mds probably charge the most, but are not located all over the state so not everyone has access to mental health services through a psychiatrist. Therefore, more services can be provided by adding other levels of mental health providers and their rates are different. She noted that SB 165 was introduced last year but didn't have any hearings. It's had two hearings in the Senate this year and passed the Senate by a big majority vote. Some of the other insurance companies have had a chance to review this and no questions were raised until now. She invited questions from committee members. CO-CHAIR TOOHEY asked if continuing education was required for psychological associates and psychologists? DR. STOKES responded 20 hours annually was required for both. REPRESENTATIVE ROKEBERG asked Ms. Macklin if she was saying this bill didn't expand the scope of service of a psychological associate? He said, "Correct me if I'm wrong, Ms. Macklin, but it seems it deletes specificity and the specified areas on the license which could be provided or work done by an associate, and expands it to almost anything. I'm not sure that's the intention, but that certainly looks like an expansion of services to me." MS. REARDON responded that under current law the division does license psychological associates as counseling or clinical and that is printed on the license. However, it was her understanding there have not been any distinctions made in terms of what is legal for someone who has clinical written on their license and what is legal for someone else who has counseling written on their license to do. She understood that both types are able to do the whole range of psychological services as long as the person stays within their area of knowledge and competence. It was her impression that although the division is printing a certain thing on the license, it does not come in any way with a list of things that a person should or shouldn't do under that license that really distinguishes one from the other. She said that perhaps Dr. Stokes had a different understanding and deferred the question to him. DR. STOKES said the only difference is under Title 47 which involved civil commitment. Only a psychological associate with a specialty in clinical psychology is considered a mental health professional. Whereas, a psychological associate with a counseling specialty is not considered a mental health professional (indisc.). Number 342 MS. FORREST mentioned that she would like to address Representative Rokeberg's question. She referred to page 3, line 7 of CSSB 165(L&C) which states "A psychological associate shall be licensed to provide psychological services..." and said the statute defines psychological services. Thus, it is spelled out (indisc.-paper shuffling). REPRESENTATIVE ROKEBERG asked Ms. Reardon if the word "temporary" appears on the license? MS. REARDON replied yes. REPRESENTATIVE ROKEBERG asked for verification that it would read "Temporary psychological associate." MS. REARDON clarified that she had been referring to the temporary psychologists license; there are no temporary psychological associate licenses at this time. REPRESENTATIVE ROKEBERG asked if a person under the three year supervision plan is licensed as a psychological associate or is the person not granted a license for those three years? MS. REARDON deferred the question to her Program Coordinator, Barbara Gabier. Number 417 BARBARA GABIER, Program Coordinator, Division of Occupational Licensing, Department of Commerce & Economic Development, said currently there is no temporary license or licensure required while an associate level graduate is getting the three years of experience. CO-CHAIR BUNDE asked if that was because they work under the direct supervision of a psychologist? MS. GABIER confirmed that. CO-CHAIR TOOHEY asked if the person would receive a temporary license for five years after graduation? MS. GABIER replied no. She explained that currently when a person graduates, he/she has to get the three years of supervised experience before applying for the exam. Then after licensure, the person would have to practice for five years before applying for independent practice. CO-CHAIR BUNDE announced there were two additional people in Anchorage who would like to testify. Number 454 MR. MOMA testified that he was with the Alaska Psychological Association. He said with regard to the issue of scope of practice, the underlying theme is based on the American Psychologist Association's ethics guidelines which specify that a person cannot perform a procedure in which they have no training and expertise in performing. He referenced the examples of biofeedback and hypnosis that were given at the last hearing and said he had checked with a variety of people, both master's level individuals and Ph.D. level individuals to try to find out if biofeedback or hypnosis was part of a typical Ph.D. program; both of the areas are not part of a typical Ph.D. program. Both a master's level person or a Ph.D. level person would be required to get additional training in order to perform those types of services. The point is that (indisc.) tried to tie to the national standard for acceptability of practice as opposed to specifying a laundry list of things that a person can or can't do. He said the issue had been raised about why psychological associates or individuals receiving a masters degree were suddenly interested in having a license. He explained that over the last few years, managed care has come into play as insurance companies have become more cost conscious and are starting to require a license of individuals before they will reimburse. That is not just for individuals in private practice, but also for individuals working for agencies. What is happening is that agencies will not hire a psychological associate because they can't get reimbursement from the insurance companies. The (indisc.) is starting to dry up which has made the need for a license more critical now than it has been in the past. MR. MOMA said that insurance companies usually reimburse based on a standard they set internally and usually reimburse at the usual and customary charge for a given service as it is provided. There are mechanisms in place for insurance companies to determine what an acceptable fee is to be charged. Another point that comes into play relating to insurance companies is typically individuals, particularly children in smaller communities in Alaska, are being transported into Anchorage to spend time at North Star, Charter North or some type of facility when that child might be able to receive services in their home community if there were individuals available with the training and the ability to provide services. Presently, a number of smaller communities don't have anyone to provide those services because there is no reimbursement mechanism in place. MR. MOMA conveyed a story relating to the board where an individual in Anchorage had completed her three years of training, had sat for her exam, passed her exam and was at the end of her five year period of supervision. The board at its last meeting decided she didn't have the human development and multi-cultural (indisc.) classes that are part of the board's determination, so the board denied her the ability to practice independently based on not having those two classes. Part of the reason they have implemented the temporary license idea has to do with being able to meet with the board and have a contractual relationship to agree on a proposal for an acceptable standard and an acceptable course of training so at the end of that training a person could get a license. What's happening now, especially with this board, is that the rules have been changed and individuals who have been on a time line for eight years are not being notified and accommodations are not being made for the individual to get the course. In conclusion, he believes this bill provides psychological associates and mental health services in rural communities. Also it improves the oversight of the board on mental health providers who are practicing in the community currently. Number 735 JENNIFER JONES from Anchorage said she had nothing more to add to the discussion on CSSB 165(L&C). Number 745 DR. STOKES said the board is being painted as negative. He pointed out the board did not write the statutes and the individuals who are upset with the statutes should be angry at whoever wrote the statutes. The board is held by law to follow the statutes. His recommendation for the additional year is because of psychological testing. Several years ago, the primary reason for complaints and litigation against psychologists and psychological associates was sexual activity between the therapist and the patient. In the last year that has changed. The primary reason for litigation and complaints filed with the Division of Occupational Licensing has to do with child custody evaluations involving psychological testing. It is his opinion that without the additional year of supervision specific to psychological testing, psychological associates under this bill are setting themselves up for malpractice suits and litigation. His concern is to protect psychological associates by ensuring they are prepared and to protect the public at the same time. Number 804 CO-CHAIR BUNDE closed public testimony on CSSB 165(L&C). REPRESENTATIVE ROKEBERG expressed concern about the definition of psychological services and how it fits into the statute. Also, he was concerned about the length of time, the lack of differential between a temporary license and another license, and also the questions regarding the insurance issue. He felt that additional work was needed and he wasn't prepared to vote on the bill at this time. CO-CHAIR BUNDE announced he would place CSSB 165(L&C) in a subcommittee to be chaired by Representative Rokeberg and Representatives Vezey and Robinson as members. CO-CHAIR BUNDE turned the gavel over to Co-Chair Toohey.
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