Legislature(1997 - 1998)
04/23/1997 03:27 PM House L&C
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 192 - CHEMICAL DEPENDENCY COUNSELORS Number 0234 CHAIRMAN ROKEBERG announced the next item of business was House Bill No. 192, "An Act regulating chemical dependency counselors; and providing for an effective date." Number 0285 REPRESENTATIVE IVAN IVAN, prime sponsor, read the sponsor statement into the record: "The bill before us today establishes a State Board of Chemical Dependency Counseling examiners under Title 8 of the Alaska Statutes. Alcohol and substance abuse is a growing concern for Alaskans. And a requirement of state licensing for chemical dependency counseling professionals provides consumer protection and promotes the best possible professional-quality care for Alaskans seeking and/or in need of treatment services. "This bill changes a voluntary certification process to professional state licensing as a standard of practice. Currently, there is no mechanism in place in Alaska to prevent anyone, with or without specific training or experience, from calling themselves a chemical dependency counselor. "The bill before you establishes minimum levels of academic or experiential training requirements and supervised experience to practice as a Counselor Associate, Counselor Level I, II, or a Clinical Supervisor. "Alaskans age 12 and older sought chemical dependency treatment services 9,165 times in fiscal year 1996 (admissions and re- admissions) from programs receiving some state funding. Additionally, there are an estimated 2,000 individuals who received treatment services through private practice, private hospitals or federal government providers. "There are currently 55 programs providing services, which are certified by the State Alcohol & Drug Abuse office. Currently, there are over 700 certified chemical dependency counselors, and it is anticipated that there will be growth in this field in the near future." REPRESENTATIVE IVAN summarized the bill's purpose: to standardize a certification process for alcohol counselors, with the objectives of consumer protection, quality care, and professional ethics and conduct. He noted that in his own district, with many small communities, there are many places where alcohol-related or drug- related problems affect the community. Number 0554 REPRESENTATIVE IVAN advised members that there are elders in the communities who have provided these services. Some fear those elders may be displaced because of this legislation. "But this legislation certainly will recognize them, and there's ways and means to include those people that are currently practicing their field in providing alcohol counseling," he explained. REPRESENTATIVE IVAN said he would forward eight proposed technical amendments; he offered to discuss them. The Senate Labor and Commerce Committee had also forwarded nine or more changes. Representative Ivan indicated he would come up with a committee substitute. A representative from the Department and Commerce and Economic Development (DCED), Division of Occupational Licensing, would address the fiscal note and any concerns. Number 0663 REPRESENTATIVE JOHN COWDERY asked whether the most prevalent abuse in Representative Ivan's district relates to alcohol or drugs. REPRESENTATIVE IVAN replied, "Alcohol is historically number one." Number 0715 REPRESENTATIVE COWDERY stated his understanding that many villages have voted to be "dry." REPRESENTATIVE IVAN responded that in their efforts to combat problems related to alcohol, communities have utilized the state option of laws to control it. He said, "And in my area, most communities are dry/wet; in some communities ... you can have alcohol in your private possession." He noted that historically in the U.S., something that is banned tends to get there when people can afford it. Number 0763 REPRESENTATIVE COWDERY asked whether Emmonak is in his district. REPRESENTATIVE IVAN explained that while he comes from the Yukon- Kuskokwim delta region, the district he represents from Akiak goes south toward Dillingham. Emmonak, north of the Yukon River, is in Representative Foster's district. REPRESENTATIVE COWDERY asked whether Representative Ivan could estimate the population of Emmonak. REPRESENTATIVE IVAN said he hadn't been there for six years, but he would guess 800 to 900 people. Number 0808 REPRESENTATIVE COWDERY recalled that a few winters ago, 12 youths in Emmonak committed suicide because of alcohol and drugs. He said it is hard to comprehend for such a small village how large an impact that would have. He stated his belief that this is a good piece of legislation. REPRESENTATIVE IVAN replied that certainly that is one of the biggest problems. There have been occasional waves of suicides, including copy-cat activities, which come like an epidemic. Even in his own community and extended family, some have lost relatives from alcohol. Number 0900 REPRESENTATIVE COWDERY reported that he'd talked to elders in rural Alaska who'd indicated it had destroyed the traditional ways of the families; many youths were no longer even going to fish camps. Because of alcohol, sometimes they would get on a snow machine, for example, run out of gas and freeze to death. REPRESENTATIVE IVAN added that many people try to drink up their alcohol, whether they are on a river boat or snow machine, before arriving at a dry community; that is where some of the problems, such as accidents, occur. Number 0963 REPRESENTATIVE JOE RYAN said he has no problem with the bill. Those who would be licensed already have a profession, but now it would be more recognizable and acceptable. He asked, "Is this going to mandate this service for any particular person, or it's still going to be voluntary?" REPRESENTATIVE IVAN replied, "The voluntary aspect is still there; the churches and the community elders have performed that to the maximum." He said this would make the occupation equivalent to other occupations, which come under the Board of Clinical Social Work Examiners or Board of Nursing, for example, to ensure that people are qualified and that they don't abuse those they are treating. It will provide consumer protection. CHAIRMAN ROKEBERG invited Representative Ivan to join the committee at the table. He asked that testifiers restrict testimony to two or three minutes. Number 1061 SANDRA DEASON came forward to testify, saying she chairs the Alaska coalition for licensure. A member of the current statewide certification commission, she was representing rural Alaska through the Association of Rural and Alaska Native Drug and Alcohol Program (ARANDAP) and the Substance Abuse Directors Association. MS. DEASON provided some history. In 1993, there was a voluntary certification commission. That year, the Indian Health Service, which funds a great number of the providers, required higher standards for certification. Ms. Deason noted that her group is affiliated with the National Alcoholism and Drug Abuse Counselors (NAADAC). MS. DEASON indicated at that time, they unified rural and urban Alaska in the certification process. Prior to 1993, there were approximately 200 certified professionals in the field; most were in the urban Anchorage area. Rural Alaska had little accessibility to obtain certification through education, simply because of their remoteness, and they did not have representation on the commission. MS. DEASON stated: "At that time, the rural providers delegated four of us onto the commission, and also the substance abuse directors delegated two people onto the commission. Following the year of 1993, the number jumped up into the thousands, certified professionals. And of that number, most were real providers. As Ivan had stated, consumer protection is definitely the number one priority; and following consumer protection is also accessibility to rural Alaska. "With dwindling dollar amounts, dwindling funding, it is essential that rural Alaska continue to get quality of care and accessibility. We cannot do that by flying people in, from the urban settings, out to provide services in the scenario that you talked of, the 12 youth suicides in the Emmonak area; that was a chain reaction that year, and the amount of money that would have been spent to fly people in to heal the community, versus having providers or resources in that community, I mean, there's no way to equalize it. If there are providers in the communities that can deliver the services, and who are familiar with and fall under some standards to provide services, the quality of health care in all of rural Alaska, all urban Alaska, of course, becomes quality care." Number 1240 MS. DEASON continued: "I am very concerned. I've spent 16 years working in the substance abuse field. My concern is, and always has been, that there are people out there who are providing services who are not ... certified, because it is a voluntary process at this point. And sometimes those services are much more detrimental than they are valuable, as far as a health service. And what we would like to see is that everybody would be required to follow a set of standards to practice. ... So, we wouldn't eliminate rural Alaska; we would want those people who have been out there practicing these standards and providing these services to still have access to licensure, without eliminating them. "And so, what we did is we rolled over our current certification standards into licensure standards, which are quite high standards for certification. I've done extensive research in the last year, with the Lower 48 states, those who have licensure, those who don't, those who have voluntary, those who have mandatory. And ... what all of us did on the coalition is we've ... seen what worked in some states and what didn't in others." She indicated that other than the amendments they have, it is a very clean bill. Number 1304 REPRESENTATIVE RYAN noted that everyone seemed fairly satisfied with the bill. He offered to make a motion to move it. CHAIRMAN ROKEBERG responded that he was going to hold the bill over for "further activities" that would come to light in the testimony. He acknowledged the presence of Representative Dyson and invited him to join the committee at the table. Number 1336 W. HARRISON CHILDERS, Certified Drug and Alcohol Counselor II and Nationally-certified Addiction Counselor II, Charter North Counseling Center, came forward to testify, specifying that he works in the private sector. They see this as a public protection and believe it is in everyone's best interest, including the state's. MR. CHILDERS cited an example of public protection. Under the current voluntary system, people coming out of prison can practice as chemical dependency counselors, and there are no sanctions or ways to control that. He hopes this bill will provide a way to investigate those people and to focus on everyone's best interest. He concluded by saying they favor passage of this bill, which is good for the state and is "just good business." Number 1391 REPRESENTATIVE HUDSON asked: With there being no licensure, how are the bona fides established under the present system? MR. CHILDERS explained that there are about 700 certified addiction professionals in Alaska. There is a voluntary system, with a code of ethics attached to membership in that organization. A board has been put together to investigate allegations. As he sees it, the crux of the issue is that there is no way to "enforce allegations of misconduct" at this point. Although people who are not licensed or even certified counselors have been cited, nobody on the board has power to do anything about that. REPRESENTATIVE HUDSON asked whether it is an ad hoc board. An unidentified speaker said yes. Number 1450 CHAIRMAN ROKEBERG asked who now certifies counselors. MR. CHILDERS said it is the Alaska Commission for Chemical Dependency Professionals. CHAIRMAN ROKEBERG stated his understanding that the existing commission grants certification, but without state authority. Number 1499 REPRESENTATIVE HUDSON asked whether there is public funding for that. MR. CHILDERS said there is some funding; others could speak to that. Number 1526 WILLIAM D. McCOLL, Director, Government Relations, National Association of Alcoholism and Drug Abuse Counselors (NAADAC), testified via teleconference from Washington, D.C., in support of HB 192. With more than 17,000 members, NAADAC is one of the largest national organizations representing the interests of alcoholism and drug addiction treatment and prevention professionals. They've assisted in authoring licensure bills throughout the U.S., and they provided relatively minor technical input into HB 192. MR. McCOLL stated, "NAADAC strongly supports the enactment of state licensure laws. Such laws establish an organized system which ensures that the delivery of this vital health care service is provided by trained and experienced professionals who have met rigorous training requirements prior to being licensed or certified by the state as alcohol and drug counselors. This is important for the protection of consumers of these services in the state of Alaska." MR. McCOLL continued, "Counselors who have met the licensing criteria outlined in this bill will constitute the one group of professionals who specialize in the diagnosis, assessment and treatment of alcoholism and other substance abuse disorders. These counselors possess a constellation of knowledge that is unique to the alcoholism and drug abuse counseling profession and which distinguishes them from other health care professions. We believe that the licensure of alcohol and drug counselors will help to ensure that the citizens of this state who suffer from an addiction disease will receive care from a qualified, experienced and competent professional." Number 1618 CHAIRMAN ROKEBERG asked what the national entry requirements are for education and whether NAADAC provides a national examination. MR. McCOLL replied, "NAADAC does provide a national examination. We are a certifying body. We have three exams. They are for the NCAC, which is our lowest level of certification and which has no educational requirement; the NCAC II, which has a slightly higher educational requirement, a bachelor's degree; and then the Masters of Addictions Counselors, MAC, which, as it states, requires a master's degree." MR. McCOLL continued, "The answer to your first question: The level in the states right now somewhat varies. The trend has been, I think, of late, to enact laws which may contain some educational requirements. However, I would add that that's certainly not uniform. New Mexico just passed a bill without any educational requirements." He added that ten states now have licensure or mandatory certification. Number 1690 REPRESENTATIVE COWDERY asked whether the national exam addresses issues pertaining to Yupik or Alaska Native populations. MR. McCOLL indicated the exam addresses issues considered more universal in addiction studies. He said there are minority concerns within NAADAC itself, and they have established a minority committee which relays those types of concerns. He offered to find out from the persons who create the certification exam whether any questions regard Alaska Natives; however, he doesn't believe that is the case. Number 1749 REPRESENTATIVE COWDERY observed, from his 40 or 50 years here and time spent in rural areas, that elders rather than outsiders may be more respected and looked to for talks and encouragement. MR. McCOLL replied, "I certainly understand your concern. I think that the addiction treatment profession has a very clear commitment to respecting Native rights, and certainly the kinds of questions that we are talking about are very much geared towards a sort-of-a- universalist practice, which can be modified, of course, for (indisc.) under those types of heritages." Number 1802 REPRESENTATIVE HUDSON referred to Mr. McColl's indication that NAADAC had helped other states in their move to licensure. He asked whether most counselors in other states had been grandfathered in or were disenfranchised. MR. McCOLL answered that usually there is a move to grandparent those existing counselors in, depending on the state. For example, he believed that Maine had an eight-year grandparenting clause; however, that included a master's requirement. He pointed out that of the ten states that had enacted laws, only four had enacted any degree requirements. Number 1845 REPRESENTATIVE HUDSON asked whether Mr. McColl was familiar with the "Alkali Lake proposal" a few years before, which incorporated "some pretty peculiar and specific drug and alcohol dependency, primarily alcohol dependency, measures in that area." MR. McCOLL said he wasn't familiar with that specific legislation. Number 1874 CHAIRMAN ROKEBERG referred to educational requirements in some states. He asked whether within the bylaws, or elsewhere, experience levels could be exchanged for education. MR. McCOLL replied that some states had made that an option, and it is well within the tradition. It is clear to him that each state needs to decide. For Alaska, based on its rural population, he believes that type of exchange is quite fitting. CHAIRMAN ROKEBERG asked whether for Mr. McColl's national association, the examination is the primary method of entry into certification. MR. McCOLL said that is correct. He stated, "I'd like to draw a distinction here. NAADAC certification is a private, voluntary certification. And we do certify at three levels, based on educational requirements. ... And many states do use NAADAC's written exams. However, the state certifications very frequently will accomplish ... their goals by doing things like trading off experience levels with years of education, that type of thing. That's not an unusual type of arrangement for a state to make." Number 1935 CHAIRMAN ROKEBERG asked whether any other national organizations work parallel to or in competition with NAADAC. MR. McCOLL said there are other certifying organizations, some national, including the "international certification reciprocity consortium" and the "FECC," for which he knew only the acronym. CHAIRMAN ROKEBERG thanked Mr. McColl and exchanged contact information. MR. McCOLL said he'd send information regarding whether his organization asks questions specific to Alaska Native issues. Number 2050 GARY TURNER, Village Services Manager, Yukon-Kuskokwim Health Corporation, testified via teleconference from Bethel, specifying that he works with the Village Alcohol Education Counselors (VAEC) program. He oversees village-based counselors in 18 villages who serve about 36 villages in total. MR. TURNER expressed concern about the testing. When he'd failed the test by one question, he'd felt incompetent. He believed it was culturally biased, not taking into account traditional values of Natives. He explained, "We have to kind of look at the world backwards to pass this test. We have to look at it the other way, and it goes against all our own values and how we see the world." MR. TURNER said he believes that many of their counselors are Level II counselors out there. He stated, "They've been in appeal for ten years. Just because they can't pass this test, they're not considered Level II in the academic world. And trying to teach these people these things, to try to look at this test differently, has been my goal. I'm taking the test again Saturday, and I feel I'm prepared to do a good job, but that doesn't guarantee me that I'll pass. I'll keep trying." MR. TURNER said he is trying to obtain his degrees; he foresees that if they don't stop this progression of being licensed and needing a certain academic degree, they will lose many Native counselors. Others would come in and provide services without understanding the culture, traditions and values, which would not benefit the Native people. MR. TURNER stated, "The people who are in place now are the ones that should be providing the services and not be limited because of these simple things like you need to be Level II and these are the things you need to pass. Maybe in the future we'll need a degree to do that. And it doesn't take in account that what we have, experience, lifestyle, the things that we've been doing for centuries, is going to benefit our people, not a piece of paper that says you're a Level II counselor or that you have this degree, bachelor's degree in human services. If we go that route, we're going to lose a bunch of our people in the field." Number 2188 CHAIRMAN ROKEBERG asked whether Mr. Turner believes the existing commission could develop an examination that is not culturally biased and that would apply to rural Alaskans. MR. TURNER said with strong input from rural areas, and with rural residents included in that process, he strongly believes they can do that. CHAIRMAN ROKEBERG asked whether, if that were the case, an examination should be required to gain certification. MR. TURNER agreed and said they also propose that someone certified as a Level II, for example, according to current standards, could supervise someone else for five years; that second person could possibly automatically become Level II under that supervision. MR. TURNER restated his recommendation that any test should take into consideration Native values and traditions. He stated, "It doesn't have to be an easy test, but at least we'll have a chance at it without being tricked: Two negatives means a positive; I don't know that stuff. And big terminology like `multifacet,' we don't know what those things mean. So, we take the test already beating ourselves. That doesn't mean we're stupid or we're incompetent." Number 2218 CHAIRMAN ROKEBERG wished Mr. Turner the best of luck on his exam. Number 2292 ARDYCE TURNER, Yukon-Kuskokwim Health Corporation, testified via teleconference from Bethel that she is the new "FAF coordinator/ supervisor." She stated, "This is going to be my third attempt at taking this test. I also found it to be very culturally biased. And what I mean is, my perspective isn't the national perspective, and I found it very frustrating, even though I did study here and there, you know." Her first try, she'd been 15 away from passing. Her second try, she'd been six away. MS. TURNER said she'd wished the NAADAC would send a survey or make recommendations for the rural area; often, it seems like taking a test blindfolded, feeling their way around and hoping for the right answer. She agreed with Gary Turner that there are a lot of trick questions, such as use of the word "multifaceted." She considers herself an educated woman, a parent, a mother, and a student as well. She is still going to school and is a year away from an undergraduate degree. Number 2367 CHAIRMAN ROKEBERG asked whether Ms. Turner would be taking the NAADAC test. MS. TURNER said yes. CHAIRMAN ROKEBERG wished her luck on that. Number 2384 BETH KERSEY, Program Director, Phillips Ayagnirvik (drug and alcohol program), Yukon-Kuskokwim Health Corporation, testified via teleconference from Bethel. She oversees a program with a staff of 60, primarily counselors, of which 27 are village-based. They cover approximately 57 villages in the region. MS. KERSEY thanked Representative Ivan for introducing the bill. She works with both Gary Turner and Ardyce Turner. Although they support licensure and understand its importance, they want to ensure careful consideration of a few points. First, the commission appointed by the governor must reflect Alaska's cultural diversity; Ms. Kersey proposed that the language be stronger. MS. KERSEY said second, they want to make it clear that the strength of rural Alaska lies in its "natural helpers, who may be the young people and certainly the elders." She stated, "And we want to make sure that they're going to fit into the clause that allows them to be able to still turn around and do, kind of, what we might consider counseling but not have to be licensed. So, I would assume that they're going to be able to fit under the clause that says that as long as they're responsible to a tribal group, that then they can be exempt from licensure." MS. KERSEY mentioned the concept of "an inherent training, which would bring people in from the villages." Individuals willing to act as natural helpers would reach out to members in the communities in such a way that licensure wouldn't be required, nor would they be charged with a misdemeanor for doing what tradition has taught them to do. She also expressed concern, as an administrator, about filling vacancies that arise. TAPE 97-47, SIDE B Number 0006 MS. KERSEY mentioned the need to get people to where they can do counseling and respond to their community fairly quickly. She stated, "So, having this counselor associate, where they've got to wait for a year, I have real concerns. I also wonder what we're going to do until they can make that counselor associate level in the year interim, again, because we don't have people with these credentials waiting in the villages." She restated her support of licensure but requested consideration of these other points. Number 0034 CHAIRMAN ROKEBERG asked whether Ms. Kersey was referring to an exemption for "traditional-type" counseling. MS. KERSEY referred to pages 2 and 3. She said it seems that someone who reports to a tribal group could be exempt from any kind of licensure if there were "natural helpers" out there. CHAIRMAN ROKEBERG asked whether they would be employed or paid. MS. KERSEY referred to page 3, lines 2 through 4, which says, "and the person remains accountable to the established authority of the religious denomination or the ruling body of the tribal group and no separate charge is made for the services". She said it appears someone maybe could do this without worrying about being charged with a misdemeanor. Number 0100 PATRICIA WINTYR, American Counselors Association of Alaska, came forward to testify, indicating they are also working on licensure for counselors. She stated, "I definitely support this legislation. And some of the wording potentially limits the practice of counselors, something we've been doing long before there was the drug abuse counseling. On page 2, it says a person who is not licensed under this chapter may not engage in chemical dependency counseling for compensation, et cetera." She specified she was referring to lines 18 through 20. MS. WINTYR referred to page 9, line 31, continuing to page 10, which defines "chemical dependency counseling" as the provision of intervention, assessment, counseling and aftercare for persons who are alcoholics or drug abusers or who participate in inhalant abuse or for the members of their families who are affected by the use or abuse of alcohol, drugs or inhalants. MS. WINTYR suggested eliminating that or rewording it because counselors couldn't be in business if they were unable to counsel those with alcoholism and drug abuse in their families. It is limiting and possibly infringes on established rights of counselors, marriage and family therapists, psychologists and social workers. Although she often sends people to chemical dependency/abuse counselors, she could also counsel them well. One cannot be in the counseling business without learning a lot about working with abuse. She added, "Probably every client I work with is affected by alcohol abuse in their family." Number 0270 REPRESENTATIVE HUDSON asked whether she wanted to remove "for the members of their families." MS. WINTYR said yes. It says on page 2 that a person who is not licensed under this chapter may not engage in chemical dependency counseling for compensation, which is later defined on page 9; those two go together. If she practiced counseling that way, she would be in violation, a class B misdemeanor. "And I don't think that you want to do that to the number of Alaskan counselors or psychologists; I mean, it just doesn't make sense," she added. Number 0318 CHAIRMAN ROKEBERG said they'd not be moving the bill that day. He asked whether she had additional testimony. MS. WINTYR replied, "No, I definitely support the testimony otherwise." CHAIRMAN ROKEBERG asked Ms. Wintyr to provide written comments. Number 0350 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Commerce and Economic Development, came forward to testify, noting that the board and associated licensing activities in this bill would be part of her division. She stated, "I did work with the supporters of the bill to go through the version in the other house, and I have a number of relatively small, from my perspective, clean-up provisions that I think that - I haven't spoken with the sponsor but with some of the folks sitting behind me - seem to be mutually acceptable, ... which I'd hoped you might consider for a draft CS." She asked whether they wanted her to run through those. CHAIRMAN ROKEBERG replied that they'd be sending this bill to a subcommittee. He asked that Ms. Reardon provide those in writing. Number 0406 REPRESENTATIVE IVAN indicated the fiscal note had raised concern in the Senate Labor and Commerce Committee, and he believes the start- up costs for this control board will be substantial. However, he believes once this board is up and running, they could provide the best possible service. In addition, the people who will be counseled or affected by this bill will stay away from the Department of Public Safety, Department of Corrections and Department of Health and Social Services and therefore not impact those departments fiscally in the future. He asked Ms. Reardon to comment on the fiscal note. Number 0458 MS. REARDON referred to page 2 of the fiscal note and said they'd tried to provide a detailed description. She explained, "What I've calculated is that there are approximately 700 licensees, based on the number of people who are currently licensed or certified by the commission. It seems to range from 650 to 800 in their history; so, I picked the number 700. And I estimated that it would take a full-time Range 12 clerk, licensing examiner, to staff the board meetings and work with the licensees, the applicants, and do all of the paper processing and all of that." MS. REARDON said the fiscal note also includes a half-time investigator for disciplinary and complaint investigations, which is the first item under personal services. "It includes $9,100 of travel money for the board to meet, and ... $2,000 of that is for the investigator to go to areas where events might occur that need to be investigated," she said. Number 0522 MS. REARDON pointed out that the contractual services line is a big item in the fiscal note. The smaller parts are the costs of public noticing, regulations, telephones and so forth; the big item relates to examinations, with $75,000 to contract with an outside company to write three exams. "We just picked $25,000 each," she explained. "And that's where the decisions about what happens with exams matter a lot. My understanding is that ... the existing commission has been using the Level I national exam for its Level II ... counselors in this bill. And so, that wouldn't cost us anything to develop, if the board chose to continue using that exam." MS. REARDON said because they are using the Level I exam as the test for Level II counselors, it is her understanding that no existing test remains for "the Level I people or the associates." She believes that is being researched. The board might want to contract out to have those created, or perhaps the existing tests wouldn't be considered acceptable from an Alaska perspective and new tests would need to be written. A big item in the fiscal note, that was part of the discussion in the Senate Labor and Commerce Committee the previous day, because building in that $75,000 made the numbers big and made the license fees come out larger. MS. REARDON stated, "Also, if people are going to be paying us to take the exam and we buy the exam from the national exam company, that money flows through our budget; so, it shows as revenue and expenditures. If they pay the exam company directly, it stays outside our budget; then you don't see it here. So, part of not being sure whether the board will choose to have exams or not, since it's permissive language in the bill, means that ... it's a little bit hard to know whether or not to build it into the fiscal note." MS. REARDON further explained, "My concern was that if I didn't build it into the fiscal note, and two years from now the board wants to get exams written and wants to have everybody take them, I'd say, `Well, I have no expenditure authority to do any of that.' So, I put it in the fiscal note. ... If we had an understanding that the board would not require examinations without going back to the legislature for expenditure authority, then I probably wouldn't put it in the fiscal note." She said that had been one of the big issues the previous day in the Senate. MS. REARDON said in addition, there is $10,200 in the fiscal note for paying the Office of the Attorney General to prosecute the disciplinary cases and do regulation review. She concluded by saying those are the major items in there; she offered to discuss the details if the subcommittee or the sponsor so desired. Number 0668 CHAIRMAN ROKEBERG stated his understanding that the educational and examination formats are issues for the commission to settle. The fiscal note provides a baseline from which the subcommittee and the bill sponsor can work. He suggested that Ms. Reardon could consult with them as necessary. Number 0711 MS. REARDON agreed. She pointed out that, as with all of their programs, the department would fall under the mandate that licensing fees and other fees received for exams and so forth must cover all of the costs. Therefore, the fiscal note will always be a "net wash" to the general fund. However, she expects that the fees will be more expensive than what people are currently paying to the nonprofit commission; she wants people considering licensure to be aware of that. MS. REARDON advised members that fees for what she considers mental health licensing boards, such as for marriage and family therapists, psychologists and social workers, run $350 to $500 every two years, depending on the profession. However, they have smaller numbers of licensees; for example, psychologists have fewer than 200 licensees, compared to 700 here. From the previous day's testimony, she believes those affected by the bill now pay $125 for a two-year license. She expects that even if they take the whole exam issue off the fiscal note, figuring that if exams are developed, it will be through a budget allocation in a future year, the fees would still probably run about $350. Number 0756 REPRESENTATIVE IVAN said he didn't want the fiscal note to kill the bill or slow its progress. He stated his belief that eventually the licenses will become affordable. In addition, he hopes this will indirectly save money, in terms of people they take care of. Number 0784 CHAIRMAN ROKEBERG said he didn't see revenues from the actual license examination fees. He asked about that. MS. REARDON referred to the bottom of page 3 of the fiscal note and explained that she hadn't been sure how many people would be taking the exams. She stated, "So, if we got to it, in a subcommittee, the exam discussion, I could probably, you know, array the costs a little bit." In this fiscal note, however, they had put all of the burden on the actual licenses. CHAIRMAN ROKEBERG said presumably, there would be examinations given and revenues generated by that, which would in turn lower the biannual fees. MS. REARDON agreed. Number 0868 MS. REARDON said she'd move speedily through other issues. She restated that it will cost more than people have been paying, and she doesn't want to take them by surprise. Referring to testimony by Ms. Wintyr, she pointed out there is an exemption for the other licensed mental health professions, such as marriage and family therapists, psychologists and social workers; they wouldn't need to get this license as well. She read from page 3, lines 8 and 9, which says a "person licensed in this state under laws outside this chapter when performing activities that are within the scope of the person's licensure" is exempted. MS. REARDON pointed out, however, that while a psychiatrist with a license would be exempted, Ms. Wintyr is correct that someone not in a licensed profession, such as a professional counselor, which Ms. Wintyr is, wouldn't be exempt and would need to get this license to do chemical dependency counseling. MS. REARDON noted that she had a whole collection of minor issues. She suggested dealing with them at the subcommittee level unless the committee preferred otherwise. CHAIRMAN ROKEBERG said that was an excellent idea. Number 0946 REPRESENTATIVE HUDSON referred to the fiscal note and to testimony about the difficulty some have relating to the exams and qualifications in rural Alaska. He sees the major problem in rural Alaska and doesn't see a lot of people out there making lots of money as licensed professionals. If it costs $500 to get a license, nobody out there would do this kind of service, and it is in rural Alaska that they are needed. "And I would hope that you'd take a hard look at that whole situation and see if there isn't some way in which we can accommodate that or provide it," he said. REPRESENTATIVE HUDSON asked whether Ms. Reardon would have a hand in creating the qualifications for the counselors, particularly in rural Alaska. He noted that in Juneau, Anchorage and Fairbanks, there were many highly educated people. However, the lion's share of the problems are in rural Alaska. He expressed hope that this legislation could lead to professionals not necessarily from a high-academic point of view but from cultural relationships and some training. In addition, he'd like to see an affordable cost that is conducive to encouraging people to acquire these licenses. Number 1061 MS. REARDON responded that the regulation-writing authority will rest solely in the hands of the board. "If I'm around, and if I'm convincing, then ... the director may have a role," she added. The qualifications in terms of training and experience are fairly specifically laid out, "if we ignore the exam issue." She said it is important that the legislature be comfortable with those. MS. REARDON explained, "To enter into the profession as a counselor associate, which is the lowest level, you will need to have ... one year of training in an approved training course, under this law, under the supervision of a licensee. And I don't know whether that's doable or not, but I assume that the (indisc.) believe so." Number 1112 REPRESENTATIVE IVAN said he appreciates Representative Hudson's recommendation and they will look at the level of licenses being offered. He suggested perhaps the costs could be "met at different education or experience levels, versus chemical supervisor license fee costs," and he acknowledged that some of these people aren't making $80,000 to $100,000 a year. Number 1154 REPRESENTATIVE HUDSON stated his belief that they should be leaning towards a program similar to that for health aides in the villages, for example. He suggested devising in the subcommittee a way to get a qualified person in every village, at no cost to the person, who would be selected. "And we should be able to find the moneys, because I think that it's such a high public importance to do that," he concluded. Number 1198 MS. REARDON asked for confirmation that he was referring to having a funding source from the general fund, not from program receipts. REPRESENTATIVE HUDSON said that was his thinking. MS. REARDON said she was looking forward to working with the sponsor and any subcommittee. She was glad they were talking about costs now and working on the issue of the fiscal note, because she didn't want to catch people by surprise and have unintended consequences. Number 1236 CHAIRMAN ROKEBERG asked whether anyone else wished to testify. He announced that they would hold HB 192 over. He expressed the desire to send this to a subcommittee including the Senate Labor and Commerce Committee, the existing commission and the bill sponsor, to develop "a bill that everybody can live with in an affordable and effective manner." He emphasized his belief that this is excellent legislation. He stated, "Hopefully, at a point where it reaches its maturity, we of this committee would be happy to take it back up and move it along in an expeditious manner, when it reaches that point." CHAIRMAN ROKEBERG said the subcommittee should perhaps insert a section on the examination criteria, particularly as it relates to the types of questions, including definitions of terms, making it clear that the examination meets the diverse needs of Alaska and ensures adequate training and knowledge, without the difficulties such as those discussed by the testifiers from Bethel. He suggested that could be done through some "artful drafting in statute." Number 1349 LORI NAMYNIUK, President, Substance Abuse Directors Association, testified in support of HB 192 on behalf of herself and her association. She believes it will ensure consumer protection and enhance the quality of care. It has statewide support, not only from her association but also from ARANDAP and the Alaska Native Health Board. It will also ensure access to services in rural areas. MS. NAMYNIUK referred to concerns expressed from Bethel and said this bill would protect providers like Gary Turner, in that currently within the bill there are no degree requirements; experience is important, as is supervision. "And this would also give us opportunity to be involved in the development of the testing standards," she concluded, thanking the sponsor. Number 1427 CHAIRMAN ROKEBERG appointed Representatives Hudson, Ryan and Kubina to the subcommittee, advising them of their charge to meet with the Senate, the sponsor, and the people involved. He announced HB 192 was being held over.
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