Legislature(1997 - 1998)
04/08/1997 01:43 PM Senate L&C
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SB 122 INS.COVERAGE:MARRIAGE & FAMILY THERAPIST
CHAIRMAN LEMAN announced SB 122 to be up for consideration.
MS. RACHAEL MORELAND , Aide to Senator Leman, said that SB 122 was
requested by the Alaska Association for Marriage and Family
Therapy. It adds marital and family therapists to the list of
providers against whom insurers may not discriminate. It does not
mandate insurers to add coverage of marital and family therapists
where the coverage currently is not provided. It merely requires
that insurers treat marital and family therapists on equal footing
with other licensed mental health providers and extend the same
opportunities for coverage that the insurer offers these licensed
providers.
Currently health insurers offering mental health services may not
discriminate against licensed psychologists, psychological
associates, or clinical social workers. SB 122 would allow those
insured with mental health coverage to choose treatment from a
licensed marital and family therapist.
MS. MORELAND said she wanted to correct a phrase on sponsor
statement at the end of paragraph two. It is incorrect where it
says the insurance company offers the same as in other states. It
should read, "It merely requires that insurers treat marital and
family therapists on equal footing with other licensed providers in
their field.
She said marital and family therapists are licensed or certified in
37 states and are recognized by the U.S. Department of Health and
Human Services as one of the five core mental health disciplines in
the U.S.
CHAIRMAN LEMAN asked if it was correct that if an insurance policy
provides for mental health services, then the insurer cannot
discriminate against marriage and family therapists because they
practice in that area. MS. MORELAND said that was correct for
certain services.
Since there was a quorum present, SENATOR MACKIE moved and asked
unanimous consent that the individuals they listened to for
confirmation for the various boards be submitted to the joint
session for confirmation. There were no objections and it was so
ordered.
MS. BEVERLY LINDELL , President, Alaska Association for Marriage and
Family Therapy, supported SB 122 saying it's very simple. They are
just being asked to be added to the list of providers that cannot
be discriminated against by insurers. It's not a mandate for
coverage; it's not any willing provider language.
MS. LINDELL thought this bill is important because it provides
fairness as marriage and family therapists are one of the five core
mental health professions as identified by the National Institute
of Mental Health. The others are already in this legislation.
They are not asking for special treatment.
She said the second issue is cost, the argument being that it will
increase insurance costs. An opinion from the Division of
Insurance on this question a few years ago came back stating they
could find no evidence of that happening and there is some
suggestion that it could actually decrease costs.
MS. LINDELL stated that there is considerable evidence that the
treatment of mental and emotional disorders is not unproductive.
She said a report prepared by the Mental Health Liaison Group out
of Washington D. C. estimated on a national basis over $1 billion
could be saved with appropriate mental health treatment. Another
study by the Harvard Community Health Plan involved patients whose
symptoms may have still included psycho-social problems and when
group therapy was added, there was a reduction by 50% of doctor
visits.
She said there is now considerable evidence that licensed marriage
and family therapists can complete treatment in fewer sessions than
individual treatment which translates into reduced costs for
consumers and insurers.
The third issue has to do with the rights of consumers, and
allowing freedom of choice of qualified providers is fair. In a
1993 survey of consumers, the American Psychologists found that
marriage and family therapists were the type of therapist most
often recommended by consumers to family and friends.
Finally, she said they have heard a lot about how the American
family is in a lot of trouble. They are the profession that has
special expertise in the treatment and care of families and they
would like the opportunity to do that.
CHAIRMAN LEMAN asked if she supported Senator Mackie's proposed
amendment that would insert a new section on page 2, line 11
saying, "(2) "unfair discrimination" does not include requirements
imposed by an insurer for purposes of utilization review, cost
containment, or standards of clinically appropriate health care
services". MS. LINDELL deferred to the Division of Insurance.
Number 500
CHAIRMAN LEMAN asked what the core mental health groups were. MS.
LINDELL replied the other groups are psychiatrists, psychologist or
psych-associates, social workers and professional nurses. CHAIRMAN
LEMAN noted that they are not in this legislation, but are in the
statute.
CHAIRMAN LEMAN said in a letter of support from Dr. Pollick that
insurers do not compensate licensed marriage and family therapists
equally. He asked if the intent was to mean that they did not have
equal access to insurance coverage. MS. LINDELL said that is
correct and agreed that they do not intend to make compensation
equal to that of a medical doctor.
MS. MARCI WOLFF , licensed marriage and family therapist, supported
SB 122. She has specific training for family therapy rather than
a focus on other areas of psychology such as research or social
policy making. She recited an extensive list of credentials and
said she is currently in private practice and regularly receives
referral from doctors, psychologists, social workers, and other
family therapists, attorneys, military sources, and community
agencies. She receives these referrals because she's effective in
providing quality therapy in a brief cost effective manner. She
said marriage and family therapists need to be recognized and
supported legislatively in providing the services for which they
are uniquely qualified to provide.
CHAIRMAN LEMAN asked if any of her services are currently being
paid by insurance. She replied that many are.
Number 540
MS. TIMA PRIESS said she is a licensed marriage and family
therapist. She said she has been accepted as a provider by several
insurance companies including the Veterans Administration. She has
had the experience of being turned down by insurance companies,
including a company that had certified her under their managed care
program, but would not certify her independently for clients who
use their insurance without the managed care which doesn't make
much sense to her.
MS. PRIESS pointed out under section 47.17.020, the Alaska Child
Protection Statute, professionals who are required to report child
abuse include practitioners of the healing arts. These
professionals are defined in section 47.17.290 (13) as including
marital and family therapists. In addition 47.24.010, the statute
that defines who is required to report abuse of elders and disabled
adults also includes marital and family therapists.
Number 561
MS. MARIANNE BURKE, Director, Division of Insurance, said this
particular section of the code has somehow mutated over time. The
original intent, according to her reading of the enacting
legislation, was the practice of unfair discrimination was to mean
unfairly discriminating against similar professions. For example,
if you were an M.D. licensed to perform an appendectomy, an
insurance company could pay one doctor and not another.
MS. BURKE said regarding cost, that the services provided under an
insurance contract is a matter of a contractual arrangement. You
contract to have particular services covered at a particular rate
or up to a particular cap. As long as there's no expansion of
those services by adding another profession, it would not increase
the cost. Her only concern is if a profession expanded the scope
of services that was provided under the contractual arrangement;
for example, expanding marital and family therapists to include
priests, rabbis, or ministers - all of whom provide counseling.
But this is a licensed group and she does not know their scope.
She understand that this is a credible group and has standards of
practice and conduct to which they adhere.
TAPE 97-16, SIDE B
SENATOR MACKIE asked her if she had problems with his proposed
amendment. MS. BURKE replied the first portion, "unfair
discrimination does not include requirements imposed by an insurer
for purposes of utilization review" is perfectly appropriate. She
said cost containment is not inappropriate as long as it is not
used to dictate that you go to the cheapest available service in
town.
MR. JERRY REINWAND, Blue Cross, said SB 122 raises an issue bigger
than just the issue of family and marital therapists. The proposed
bill really talks about unfair discrimination and there is no
statutory definition of what is unfair discrimination, nor is there
in regulation. While the Division has been a tough, but fair
regulator, the legislature is still leaving it up to them to apply
their own idea of what constitutes unfair discrimination. They
support Senator Mackie's amendment, because it puts, by contract,
what terms and conditions would not constitute unfair
discrimination which brings clarity to the issue.
CHAIRMAN LEMAN asked if he thought the legislature should define
unfair discrimination. MR. REINWAND replied that discrimination is
an important issue and there have been cases in the past where
insurance companies have not always done the right thing regarding
discrimination. He thought it would be in everyone's interest and
good public policy if you're going to say you can't do it, to
define what it is.
MS. LINDELL clarified that any licensed group has within its
statutes that regulate the profession the scope of practice. Under
marriage and family therapists it lists first of all the
requirements in terms of formal education, specific courses that
are required, time of supervision, practicum experience, etc. In
terms of what the practice means, that is also in the statute and
includes the diagnosis and treatment of mental and emotional
disorders that are referenced in a standard diagnostic nomenclature
for marriage and family therapy, whether a cognitive affected
behavior within the context of human relationships, particularly
marital and family systems. They must also apply the understanding
of the dynamics.
CHAIRMAN LEMAN noted that some ministers may qualify, but probably
very few. MS. LINDELL agreed.
SENATOR MACKIE moved to adopt amendment #1. There were no
objections and it was so ordered.
SENATOR MACKIE moved to pass CSSB 122(L&C) from committee with
individual recommendations and $0 fiscal note. There were no
objections and it was so ordered.
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