Legislature(1997 - 1998)
04/22/1997 01:34 PM Senate 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
SB 163 CHEMICAL DEPENDENCY COUNSELORS
CHAIRMAN LEMAN announced SB 163 to be up for consideration.
MS. ANNETTE KREITZER, Staff to Senate Labor and Commerce Committee,
said there were some suggested amendments.
MS. SANDRA DEASON, Alaska Commission on Certification of Chemical
Dependency Counselors, said she was the chair of the coalition for
licensure which was formulating from the substance abuse directors.
SENATOR MACKIE asked her why this bill was necessary. She
explained that one of the primary focuses in working towards
licensure is for consumer protection. She said that almost all
states are working towards licensure. Alaska currently has a
certification process that is voluntary which means if you want to
practice chemical dependency counseling, you can do so without
certification.
There are cases of harm being done to consumers who, then, don't
have recourse. Having licensure would raise the standards. The
Commission is currently affiliated with the National Association
for Chemical Dependency professionals.
SENATOR MACKIE asked if a mechanism for sanctions and enforcement
was currently available. MS. DEASON replied because it's currently
a voluntary certification process, legally they are unable to do
anything about that.
SENATOR MACKIE asked if any new money would be needed for this
program. MS. DEASON replied that there was no fiscal note.
CHAIRMAN LEMAN said there was a fiscal note, but the board pays for
itself through collection of fees.
SENATOR KELLY asked why there wasn't an acronym behind the title of
chemical dependency counselor. MS. DEASON replied that there is
and it's "CDC". SENATOR KELLY suggested putting that in the bill
indicating licensure.
MR. HARRISON CHILDERS, Charter North Star Behavioral Health,
supported SB 163 saying it would be good to protect the public.
SENATOR MACKIE asked him to explain what the bill does. MR.
CHILDERS replied that there would be investigators available to
investigate allegations. It would also assure the public that the
person who is practicing has a certain level of competence.
SENATOR KELLY asked how someone would enter this field under the
new bill. MR. CHILDERS responded that the person coming into the
field would begin at an associate level and would have to do an
internship. SENATOR KELLY asked if the test were standardized
national tests. MR. CHILDERS explained that the only level at this
point is level 2 which is a National Association of Drug and
Alcohol Counselors (NADAC) test. There are no tests at the other
two levels.
MS. CATHERINE REARDON, Director, Occupational Licensing, explained
that the tests referred to for all levels of licensure in this bill
are optional to the board. NADAC suggested that the level 2 test
was more appropriate to the Alaska situation and the committee
could site that particular need.
SENATOR KELLY said the tendency for a licensing board like this is
to make entry more difficult as time goes on because they don't
need any more competition. His concern is that the test not be so
difficult that people can't get into the field. If the standard
now is level 2, he didn't see why they couldn't write that into
legislation.
Number 320
MR. CHILDERS said there was an oral test that was translated into
Yupik that worked in a good direction.
SENATOR KELLY reiterated that his concern was that as the board
matures, it would get tougher and tougher for new people coming
into the system to get licenses.
CHAIRMAN LEMAN said in the fiscal note prepared by the division
there is a suggestion that the biennial licensing fee will cost
about $550 and asked if he was prepared to pay that amount to
support what the division is saying is necessary. MR. CHILDERS
replied that he thought the fee would be lower - closer to $350.
However, he would be willing because it's reasonable in comparison
to other professionals who are licensed.
SENATOR MACKIE asked if there is any national standard for
certification that you have to have at least a bachelor's degree or
can anyone who wants to be a chemical dependency counselor be one.
MR. CHILDERS said there is no requirement, but NADAC wants that as
a goal. SENATOR MACKIE said his understanding is that there are
1,000 in the State and the number continues to grow with no real
guidelines. He said he has the same concern as Senator Kelly about
the qualifications becoming more stringent as time goes on and
asked what happens to people who are currently chemical dependency
counselors who don't qualify under the new regulations the board
would come up with. MR. CHILDERS replied that there would be a
grandfather clause. MS. REARDON added that clause is on page 10,
line 13. It says you're not grandfathered in if you are only
practicing, you must actually hold a certificate from the Alaska
Commission on Certification of Chemical Dependency Counselsors.
MS. JANE FRANKS , Clinical Coordinator, Eastern Aleutian Tribe,
supported SB 163 because she thought licensure would ensure quality
treatment for those suffering from alcoholism and drug addiction.
She noted that there would be no cost to the State and from a Bush
perspective she thought the proposed multi-tier system would ensure
that substance abuse services will continue to be available in
rural communities.
MS. BETH KERSEY, Yukon Kuskokwim Health Corporation (YKHC), said
she has approximately 60 staff serving 57 villages as out patients.
They also have a 16 bed facility. Her main concern is education
and having tests as part of the certification licensing
requirement. She has a number of degrees and none of them had any
more than probably one hour of talking about drugs and alcohol.
Everything she knows is the result of what she has been taught by
the staff who have been taught by others in a format that she knows
works well.
Regarding standardized tests, she said they have worked very hard
to increase the number of counselors who have passed the
certification test. However, there is about a 5% - 7% success
rate. It's not that the staff aren't capable of competence; it's
the way the test is written. Many of their staff are bi-lingual
and English may not have been the primary language. The feedback
she has gotten is that the questions are written in the double
negative and there are examples of how to work with gangs in the
Lower 48 when they are just trying to work in a culturally
appropriate manner in their region.
She said they support licensure when it is based on certification
and experience that requires supervision by someone who is
qualified. She thought a code of ethics along with experience was
the key to quality of care.
MS. KERSEY said the $350 is a lot for someone at an entry level.
For them with 60 staff that would be $21,000 per year and she
didn't know where that money would come from.
SENATOR KELLY asked what it costs now to become a member of the
commission. MS. DEASON replied it is $125 with a $35 non-
refundable fee every two years.
MS. CATHERINE REARDON, Director, Division of Occupational
Licensing, explained that the licensing board activity would be
associated with her division. She pointed out that this is a
mandatory licensure law and there are exemptions. An amendment
might be brought forward to eliminate the second religious
exemption which she supports because she does not want to get into
the business of deciding what is an established church. It also
expands it to any activity that is just sponsored by a religious
institution.
MS. REARDON pointed out on page 2, line 23 there is a prohibition
against using letters, words, or insignia implying that you're
licensed if you're not. This would be a place to consider putting
a specific acronym.
The grounds for disciplinary sanction are on page 8, beginning on
line 25. It is her impression that there are approximately 200
practitioners now who don't have certification. It is optional for
the board to require an exam for all four of the levels, but at
this point only one exists. The board might choose not to mandate
by exam. Her fiscal note factors in three new exams which would
cost $25,000 a piece, a one-time cost. She thought the committee
should decide if exams are appropriate and if they want to leave
that option to the board. One reason the fees will be higher than
existing fees through the commission is that there is no
disciplinary arm now and there will be investigators and money for
prosecution.
CHAIRMAN LEMAN said he intended for her to work with staff in
developing a CS. MS. REARDON flagged the issues on page 4, line 14
on scope of practice; she thought they should use the language on
page 5, line 23 because she thought there might be difficulty in
having enough people in a village to meet the direct supervision
requirement. She thought that "supervision by a licensed
behavioral health professional" should be defined. She also
thought language regarding additional hours should be clarified on
page 6, line 3. In the reciprocity section on page 8, line 6 she
suggested they replace that term with "licensure by credential."
TAPE 97-21, SIDE B
Language in the bill states that we have to accept people who have
other licenses, but they don't have to accept ours. On page 8,
line 21 she thought there was an unintentional provision which says
that we'll accept the person from another state if they hold a
current license and it isn't suspended, revoked, or restricted
which she agrees with, but it then goes on to say except that it
could have been suspended for failure to apply for renewal or
failure to obtain the required continued education credits. She
thought the exception should be eliminated because they don't want
to license people who have 10-year old licenses in another state if
they haven't bothered to renew or get their CE for the past 10
years. She thought that supporters of this bill in the audience
agreed with this.
MS. REARDON also said that the AG's office might have some
suggestions for improving page 9, line 11, the grounds for
discipline based on incapability of performing safely.
She said the fiscal note is based on the license fees covering that
$75,000 initial exam design, a one-time cost. Fees would be
somewhat lower without the exam.
SENATOR KELLY said he understood this bill would not go into effect
until March of next year, so the fiscal '98 costs would be very
small. MS. REARDON replied that her understanding is that the
board would get set up and start meeting and write the regulations
and the mandatory licensure wouldn't kick in for another year or
two. Another aspect of this is that the board would need to
certify training programs. So they need to get applications from
training programs and decide who is going to be certified.
Depending on how they wanted the transition to work, it looked to
her like they would need money for a fair amount of activity.
SENATOR KELLY said he wanted Ms. Reardon to work with the committee
substitute to try and reduce the fee. He asked when there is a
licensure biennual fee, can people pay it over a period of time.
MS. REARDON replied no; she had tried, but the problem she came up
against from the legal angle is that the person is licensed to
practice for two years and if they don't pay their second
installment, they would have to go for revocation and all that
involves. She is hoping credit cards could be used for payment,
although she realized the interest was high.
SENATOR MACKIE asked if they can pay in two installments now. MS.
REARDON replied no; they pay $500 up front. SENATOR KELLY said he
hoped they could lower that fee and CHAIRMAN LEMAN asked why they
would have to start with a new exam. MS. REARDON responded that
the exam exists only for one of the four levels; and they didn't
build in any exam development costs for that one test. The three
other exams don't exist.
MS. DEASON interrupted to say that those exams are in existence,
but the State of Alaska has the option of using two of them.
Currently, Alaska uses the national level 2 for State
certification, but because of the high failure rate in rural Alaska
they dropped down to doing a level 1 national exam. MS. REARDON
said she hadn't understood that. MS. DEASON explained that the
$75,000 was not needed to develop tests. There is a counselor
association which will have a direct affiliation nationally to
administer those tests without any costs.
Number 498
SENATOR HOFFMAN said even if the exams exist, it was testified by
Ms. Kersey that they are not relevant to Alaskan situations. They
are more geared toward gangs in the lower 48. He asked why they
are using them if they are not relevant. MS. DEASON replied it's
because of the cost factor in developing an exam. She informed the
committee that she is the national delegate for NADAC and they are
currently in the process of changing the test for different areas
and Alaska is not the only diverse state. They are currently
looking at how to change some of the testing to fit Alaska
standards from the national affiliation. This is part of the
Counselors Association function which is mainlined into the
National Association.
SENATOR HOFFMAN asked when the change in the exam would take place.
MS. DEASON replied that it is being developed over a long period,
about two years. SENATOR HOFFMAN said the problem in waiting the
two years is that the only way people can get licensed right now is
to pass the exam and only about 10% can pass it. What happens to
the other 90%, he asked. MS. DEASON clarified that they keep
running tallies of how people do on tests. They just recently
down-graded to the level 1 test and don't know what the numbers
are.
Number 454
SENATOR KELLY asked if they are tending more towards oral and
experiential things. MS. DEASON said that is correct and the test
was given for the first time in Yupik in Bethel and it was an
incredible success. Her suggestion would be to take "may or may
not" out and leave it in for the level 2 with NADAC's test. This
would eliminate the fiscal note.
MS. LORI NAMYNIUK , substance abuse counselor, supported SB 163
because it would ensure consumer protection and ensure access to
services in rural communities.
SENATOR KELLY asked if the $75,000 for the tests is taken out of
the fiscal note, and one or two exams are reinstated in a couple of
years, do they have the authority to adjust the licensing fees as
they go along. MS. REARDON replied that she has the authority to
raise and lower fees through regulation. Expenditure authority in
the State budget process would be necessary . If a test is
developed that didn't require any expenditure on her part, she
wouldn't need that.
SENATOR KELLY said they just passed a bill this week on program
receipts and asked if she was included in that. MS. REARDON
replied that they were eliminated in Senate Finance along with many
other similar programs.
SENATOR MACKIE said that seemed like a lot of money to him and he
thought the fees would have to cover the basic needs for this board
to function adequately. He asked if fees could somehow be reduced.
MS. REARDON responded that by statute each program has to cover its
own regulatory costs. So if costs go down, the fee can be lowered.
There's no mechanism for one profession subsidizing another.
SENATOR MACKIE said he didn't intend for that; he asked if it
raised additional money now. MS. REARDON said it was break even at
this point. Basically, if you ignore the exams, the fiscal note is
a full-time range 12 to do the applications and staff the board, a
half-time investigator, range 18; about $10,000 of Attorney General
time to prosecute cases; and some office supplies.
MR. GARY TURNER , Bethel, said he had been working with health
services for two years. He was concerned about making a degree
mandatory for counselors in the villages. He thought they would
lose a lot of fine experienced people to people with degrees who
don't have the experience that is necessary to even work in a
village and who don't speak the language. He has been told by
clients that they preferred a recovering alcoholic to a degreed
person because they can relate to them better. He wanted something
to be done about the level 2 test because it was just too
difficult. He thought it was important for the village people to
remain in the program because they already knew the culture.
SENATOR MACKIE asked him if he thought this bill required everyone
to have degrees. MR. TURNER replied that he thought that's where
it would go eventually.
SENATOR KELLY asked if there was anything in the bill that required
a degree now. MS. DEASON replied no, there is not, and it is
because of rural Alaska.
MR. MIKE CUTTER, YKHC, Bethel, said he felt like they were
reinventing the wheel in requiring testing for things they haven't
had to be tested for previously. It will incur more costs and more
bureaucracy. He thought they should modify what they have already.
MR. RAY WATSON, YKHC, Bethel, said he took the test and passed it,
but he's just good at testing. He strongly supported the bill, but
they have to look at testing requirements. He said there are a lot
of counselors who have a lot more experience than he does and just
miss passing the test by one or two points.
Number 325
MR. PETER TWITCHELL, Substance Abuse Counselor, said he got his
chemical dependency counselor I certificate about a year ago. He
was concerned that if this bill passes they may waste the resource
that they have in the form of all the people who are bilingual and
their first language is Yupik. He also was concerned with the cost
of maintaining a license.
SENATOR KELLY said he understood this bill to be basically a status
quo. Everyone who is now in the program gets grandfathered in with
a license. None of the qualifications are being changed; there are
no onerous written testing requirements. There isn't a whole lot
of change except that they will be licensed and the cost to license
will go up every year. MS. REARDON added that it's possible that
the bill gives the option of requiring exams for all levels and
that it would be up to the board. The other big thing is that
licensure is mandatory where as now it's not.
MS. DEASON commented that the bill actually rolls over the current
certification requirements and down-grades the testing portion of
it so people didn't have to go through the humility of failing
because of lack of academic background. The requirements are less
than what was in place before.
SENATOR MACKIE said he didn't think having a degree was something
that realistically would be required, but he thought there had to
be some form of accountability for people who work in this and
other fields.
MS. JOANNE RILEY, Chairman, ARANDAP, said she did not want the
licensure to exclude existing people to become certified in the
field. Their two issues are quality of care for consumers and
access to care. She said that some villages cost $1,000 round trip
to get into on a charter. She said that her investigations haven't
found anything that indicate excluding existing staff at this time.
They have put a lot of confidence in Scot Prinz, their IHS
representative for substance abuse.
MS. RILEY said they met with the Alaska Native Health Board to go
over the licensure bill and got their endorsement in supporting
their effort to pursue licensure for the field.
MR. DON DAPCEVICH, Executive Director, State Advisory Board on
Alcoholism and Drug Abuse, endorsed the concept of licensure. They
are concerned with standards of care and misconduct. He said that
currently a person could be convicted and go to jail and come out
and resume practicing, even if the crime was associated with this
service. They are also concerned with measuring competency for
rural versus urban Alaska. For instance people with English as a
second language must be competent in their first language and also
have cultural competency. He said the bill needs some work before
they will endorse it specifically.
CHAIRMAN LEMAN said they would set SB 163 aside and work on it.
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